Page 620 - WSAVA2018
P. 620

 25-28 September, 2018 | Singapore
Types of wounds
The cause and type of the wound is a major factor in the treatment technique and long-term plan. They can be initially classified as open or closed.
Open wound
· Incision
· Laceration
· Puncture
· Abrasion
· Burns and scalds
Closed wound
· Contusions
· Crush injury
Incised wound
· Caused by sharp cutting instruments, e.g. knives, glass
· Edges are clean cut and defined
· Generally the wound will gape open
· The wound is usually quite deep
· The wound can be of any size
Lacerated wound
· Generally caused by road accidents, dog-fights, tearing by barbed wire etc
· Wounds are irregular in shape and generally gape open
· Edges are jagged
· Will usually be contaminated – dirt, debris etc
· Very painful
Puncture wound
· Caused by small sharp pointed objects, e.g. fish hook, cats teeth
· Small wound – can easily be overlooked
· Generally causes a deep wound – tracks down
through tissues
· Also known as ‘grazes’
· Caused by such incidents as road traffic accidents
and animal is dragged along the ground
· Wound does not penetrate the whole of the skins thickness – it is superficial, can be of any size
· Very painful
· Wound is generally contaminated.
Wound Care
The initial goals of wound care are to prevent contamination and protect the tissues. On presentation the wound should be covered. Saline soaked swabs are effective to prevent contamination but also protect exposed tissue from drying.
Clip Hair
The hair surrounding the wound should be clipped. Hair should be prevented from entering the wound. Instilling sterile gel into the wound prior to clipping should prevent this. The sterile gel can then be flushed from the wound with sterile saline once the clip is completed.
Flush wound
The wound should be lavaged with fluids under moderate pressure to remove debris and bacteria. Warm isotonic solutions (0.9% NaCl) are preferred. Hypertonic solutions may be used if oedema is present.
Antiseptics and soaps are NOT recommended, as they are irritating to the tissues and delay healing. However, to reduce bacteria a very dilute chlorhexidine or povidine-iodine solution may be used.
Debridement of necrotic or devitalised tissue may be required to enhance healing. It may be performed layer- by-layer or a large excision in one area. The wound should be surgically prepared, placing sterile gel in the wound during preparation so prep solutions do not enter the area. Once debridement is performed, the closure method may be decided.
Closure may be performed (depending on the type of wound) by suturing the wound. It may be necessary
to delay wound suture until further debridement’s are performed. If the wound cannot be closed then healing takes place by second intention.
Drains may be placed in the wound. They are generally
made of flexible non-absorbable tubing. They are placed to:
· Establish drainage of fluids from ‘dead’ space
· Prevent accumulation of fluids or exudates in the wound
· Maintain drainage of fluids during the debridement stage of healing
· Drain exudates from an infected wound. Dressings
There are many types of dressings or gels available to promote wound healing. They are the primary part of the bandage applied to the wound.
The type of dressing or gel used depends upon the current stage of healing and the objective of the wound treatment.
- For infected wounds use dressings that reduce the bac- terial load (e.g ActicoatTM , IodosorbTM). Use in conjunction with systemic antibiotics.
- For wounds with heavy exudate, use dressings that lift the discharge away from the wound and store it in the

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