Wound Repair. Epidemiology. History. Location of Injuries Face/Scalp Extremities. Legal Risk Missed FB and Fx Infection
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1 Wound Repair Edwin W. Schaefer, DNP, R.N. - FNP Emergency Nurse Practitioner Epidemiology Location of Injuries Face/Scalp Extremities Legal Risk Missed FB and Fx Infection History Mechanism of Injury Associated Trauma Foreign Body Potential Description Length, Depth, Type, Location When Occurred Tetanus Vaccination Medical History 1
2 Physical Exam Wound Type Avulsion Abrasion Flap Stellar Linear Depth Full vs Partial Distal Circulation, Movement, and Sensation (CMS) Range of Motion Strength Specific Joints Physical Exam - Referral/Consultation Consider Facial Laceration perpendicular to stress lines Potentially disfiguring laceration Animal Bites Patient/Family Request Recommended Extensor Tendon Laceration (Consult) Joint Violation (Consult) Flexor Tendon Laceration (Refer) Eyelid, Lacrimal, Parotid Duct Laceration (Refer) Through Facial Laceration (Consult) Lines of Tension 2
3 Wound Preparation MOST IMPORTANT PART Equipment Setup Restraint Bloodless Field Preparation - Sutures Non - Absorbable Absorbable Needle Procedure - Anesthesia Lidocaine With/Without Epi Allergies Bupivacaine Topical Nitrous Oxide 3
4 Procedure - Anesthesia Local Techniques Enough Buffering Speed Topical Length Test Infiltration Procedure - Cleansing IRRIGATE Explore Foreign Body Deep Structure Injury Debride Documentation Procedure - Exploring Full Range of Motion with 5/5 strength Use correct test Tendon Injury Joint Injury Fascia Injury 4
5 Procedure - Technique Primary, Delayed Primary and Secondary Intention Approximate Edges No overlap Perpendicular to Wound Wound Tension Use Wound Landmarks Procedure - Technique Interrupted Easy Individual Tension Non Linear Lacerations Procedure - Technique Wound Eversion Enter Perpendicular to the Skin Eversion Inversion 5
6 Procedure - Technique The needle must enter/leave the tissue at the same level on both sides of the wound Procedure - Technique Tissue Adhesive Indications Technique Results Speed Pain Cosmetic Scar Minimization Wound infection Inversion of Margins Tissue Necrosis Improper Wound Alignment Impaired Phagocytic Migration and epithelialization Wounds perpendicular to lines of tension Wound with high tension Sutures in too long Tattooing Uneven Wound Margins 6
7 Post Repair Scar Minimization Hyperpigmentation Avoid sun Vitamin E Cream Weak Steroid Dehiscence Aloe Gel Weak Salicylate Mederma Onion extract Weak antibacterial Weak antiinflammatory Wait 2 weeks Pharmaceutical sponsored study found improvement on post surgical superfical abrasions at 4, 6 and 10 weeks Discharge Instructions Foreign Body Potential Antibiotic Prophylaxsis Suture Removal Facial Wounds Revision Clean, Dry and Covered Antibiotic Oint and Bandaid - Change daily or wet/dirty Watch for Signs of Infection - Explain Alternate Therapies Wound Checks Suture Removal Dehiscence Infection Cut opposite of knot Pull toward incision Avoid introducing exposed suture into wound 7
8 Pearls - Young Patients Trust Negotiating Special Stitches Pearls Prepare patient for possible complications Have enough help before you start ALWAYS explore Good documentation Preparation MOST Important 8
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