WOUND

HEALING
Section 2J
Subset 2
CASE 1
A 35 year old male sustained a hacking wound at right
scapular area 30 minutes prior to consultation. No other
associated signs and symptoms like dizziness, weakness
and loss of consciousness. Patient vital signs at the ER, BP
of 120/80mmHg, CR 85/min, RR 20/mic. On PE the wound
size is 5 cm. in length, obliquely located at upper 3rd to
middle at the right scapular area with clean edges and no
active bleeding.
Guide Questions
1) How do you manage this patient at the emergency room?
Discuss the management of acute traumatic wound.

2) What are the factors that affect wound healing?

Management
• A complete patient history is needed to determine the outcome
risks for all wounds
• including risks for and type of potential contamination
• activity at time of injury
• functional changes
• any comorbid illnesses that may prevent or decrease normal healing
• Associated risk factors for infection are increased age,
diabetes, increased laceration width, wound contamination, or
the presence of a foreign body
• In addition, tetanus, medication and allergy history should be
obtained prior to initiation of wound management.
Management
• Physical examination of a wound requires assessment of
location, length, width, depth, type of tissue in the wound
bed, neurovascular and functional status of surrounding
structures, and associated contaminants.
• It is imperative to assess all wounds through a full range of
motion, paying particular attention to the position at the
time of injury.
Factors of Wound Healing
• Systemic
• age
• nutrition
• trauma
• metabolic diseases
• immunosuppression
• connective tissue disorder
• smoking
Factors for Wound Healing
• Local
• mechanical injury
• infection
• edema
• ischemia/necrotic tissue
• topical agents
• ionizing radiation
• low oxygen tension
• foreign bodies
Case 2
A 57 year old male sustained deep abrasions on his left knee
after motorcycle accidents with no other injuries nor experience
other signs and symptoms. No consultation was done, he
cleaned the wound with povidone iodine and cover it with gauze.
He self medicated with amoxicillin 250 mg capsule 2x a day and
mefenamic acid 500 mg tablet 3x a day. Several days prior to
consultation he noticed swelling at his left knee down to his left
leg with erythema and tenderness at the affected area. He also
experienced difficulty in walking and fever at 38 C. prompted him
to consult at the OPD. On PE the wound is 4x4cm in size with
blackish discoloration at the wound periphery with yellowish
discharges at the center of the wound with erythema the left
knee down to the upper left leg. Hematoma formation is also
present at the upper leg.
Guide Questions
2) How do you manage this patient at OPD level?
3) How do you manage the wound of his Patient?
4) Discuss wound classification
Management (OPD)
• Generally, abrasion should be cleaned and any debris removed
• Topical antibiotic should be applied to prevent infection and to
keep the wound moist (Neomycin and Bacitracin)
• Dressing the wound is beneficial because it helps keep the
wound from drying out, providing a moist environment
conducive for healing
• If painful, apply topical analgesic (Lidocaine or Benzocaine)
• For large abrasions, systemic analgesic may be necessary
• Avoid exposing abrased skin to the sun as permanent
hyperpigmentation can develop
• Superficial Abrasions
oRinse and cover
oProphylactic antibiotic ointment
• Deep Abrasions
oRinse with antiseptic or warm normal saline
oScrub gently with gauze if necessary
oDress with semipermeable dressing, changed every few
days
oKeep wound moist, enhance healing process
Management

• Hematomas
present within
wounds should be
carefully evacuated
and any remaining
bleeding sources
controlled with
ligature or cautery.