Please note there are many different types of wounds. Specialized attention will be given to each one and documented for continuity. However, the following is an example of one of the more common wounds such as repair of cleft lip to give you an introduction.

• For the FIRST dressing change, clean with normal saline. Hydrogen Peroxide is only used occasionally (H₂0₂ left in a healing wound may cause the tissue to breakdown).
• Re-apply dressing as ordered
• Describe wound condition and care in chart

• Characteristics: Traumatic or surgical wound, possible presence of serosanguineous drainage, pink to bright or dark red healing or chronic wounds with granulating tissue
  
  
• Treatment focus: Protection and gentle but thorough cleansing
  
  
• Dressing/Therapy may include:
  -Transparent film dressing
  -Hydrocolloid or Hydrogel
  -Gauze or Telfa dressing with antibiotic ointment

•Yellow Wound

• Characteristics: Presence of slough or soft necrotic tissue, liquid to semi-liquid slough with exudate ranging from creamy ivory to yellow-green
  
  
• Treatment focus: Wound cleansing to remove non-viable tissue and absorb excess drainage.
  
  

• Dressing/Therapy may include:
  -Irrigation
  -Wet-to-dry dressing
  -Hydrogel
  -Absorption dressing

Black Wound

• Characteristics: Black, gray, or brown adherent necrotic tissue (eschar); possible presence of pus
  
  
• Treatment Focus: Debridement of eschar and nonviable tissue
  
  
• Dressing/Therapy may include:
  -Topical enzyme debridement
  -Surgical debridement
  -Hydrotherapy
  -Chemical debridement (Hydrogen Peroxide)
  -Moist gauze
  -Hydrogel
  -Absorption dressing

• Serous: Clear color which is watery plasma
  
  
• Sanguineous: Red color which is bloody from fresh bleeding
  
  
• Serosanguineous: Pink color which is a mixture of plasma and red blood cells
  
  
• Purulent: White, yellow, green, or brown color with a thick consistency that is white blood cells and living or dead organisms

• Pressure - may decrease the blood supply to capillary network.
  
  
• Dry environment - causes cells to dehydrate.  This leads to cell death, scab formation and formation of a crust which impedes healing.  Wounds heal 3 to 5 times faster and with less pain in a moist environment. 
  
  
• Trauma or swelling - reduces blood supply which reduces oxygenation of the wound that is necessary for healing.
  
  
• Infection -  destroys surrounding tissue and prevents normal healing.
  
  
• Necrosis - is the accumulation of dead and devitalized tissue that must be removed before repair and healing can occur.  There are two main types of necrotic tissue:
      -Slough: Moist, loose, stringy necrotic tissue
      -Eschar: Thick, leathery tissue that may be black

Systemic factors that impede wound healing:

• Age - wounds in older patients heal more slowly
  
  
• Body build - obesity and emaciation may slow wound healing
  
  
• Chronic diseases - coronary artery disease, peripheral vascular disease, cancer, diabetes, AIDS may contribute to slow healing
  
  
• Nutrition - inadequate caloric intake, as well as imbalanced intake of protein, fats, carbohydrates, vitamins and minerals prevents wound healing
  
  
• Vascular insufficiencies - starve the wound of blood carrying oxygen and nutrients

• Stitch abscess:   are usually the result of overlooked sutures or dissolvable sutures that are slow to dissolve that remain in the skin for an extended period of time.
  
  
• Infection:  is the result of bacterial colonization in a wound that causes wound inflammation and drainage of pus or purulent material. The best prevention of infection is to continually reinforce keeping wound clean and washing hands.
  
  
• Over-granulation: is beefy-red tissue extending beyond wound edges. This may be treated by applying silver nitrate, if ordered by the doctor.

• Hypertrophic scar: result of excess collagen tissue. Hypertrophic scars are raised, red and hard. They are confined to the wound edges, and gradually reduce over time
  
  
• Keloid: a greater protrusion of scar tissue that extends beyond the wound edges. They may be tender or painful. Keloids are permanent, however excision may be possible if the keloid first responds to triamcinalone injections (shrinks or grows softer)

• Contracture: some contracture is necessary for healing, but abnormal conditions may result in deformity or alterations.  Excess fibrous formation causes a shortening of muscle or scar tissue. It is most common in burns.

• Fistula: abnormal passage between two organs or organ and body surface.
  
  
• Dehiscence: separation of previously joined wound edges. May be caused by trauma or infection, typically occurs after 3-11 days.

We have tried to standardize wound care procedures as best we can, and have developed a basic wound care chart with provision to add individualized care. We ask you to follow our guidelines because of the limitations of the ship such as space, supplies, type of surgery, etc. Our reasoning comes from years of experience in this area.

    Thanks for remaining flexible with this!

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