WOUND

DEFINITION, CLASSIFICATION AND

MANAGEMENT
TYPES OF WOUND HEALING
HEALING PROCESS
FACTORS AFFECTING HEALING
COMPLICATIONS
WOUNDS
 Wound: It is defined as the break in the continuity
of skin or the mucous membrane or both which
may or may not be accompanied by a loss of tissue.

 Wound healing: It is the inherent property of the

damaged/injured tissue to come to its original
shape.

 Wound repair: It is the complete restoration of the

damaged tissue to its normal shape which is done
manually e.g. skin grafting.
ETIOLOGY OF WOUND

 Mechanical stress: races etc. leading to muscular

rupture in race horses.
 Chemical agents: Acids, alkali etc.
 External violence: Fall, accidents etc.
 Thermal agents: Burns.
 Radiations
 Infective agents: Bacterial, viral etc.
 CLASSIFICATION OF WOUNDS
CLOSED AND OPEN WOUNDS
 Closed wounds:. Commonly known as Contusion, a wound
produced by blunt objects resulting in damage to
subcutaneous tissue without break in the continuity of the
skin. Depending upon the severity the contusion can be:
 Ist degree contusion: Also known as ‘Bruise’ and is
characterized by rupture of capillaries of the skin and
subcutaneous area.
 2nd degree contusion: It is characterized by rupture of
larger vessels with accumulation of blood in subcutaneous
area e.g. Haematoma.
 3rd degree contusion: There is tissue damage to greater
extent and gangrene may set in. The internal organs may
be injured and the symptoms of shock are visible.
OPEN WOUND

 Incised wound Lacerated wound

 Punctured wound Penetrating wounds
 Perforating wounds Gunshot wounds
 Poisoned wounds Envenomed wound
Granulating wound
 Ulcerative wound

 Abrasions Avulsion
 Maggot wound
INCISED WOUND
A wound caused by sharp cutting instruments e.g.
knife, scalpel etc.
 The edges of the wounds are regular

 The wounds bleed freely with minimum loss of

tissue.
 The wounds tend to gape and the extent of
gapping depends upon the elasticity and tension
in the surrounding tissue.
 Healing is always by Ist intension which is
achieved after suturing.
LACERATED WOUND
 An open wound caused by
blunt objects.
 The edges of the wounds
are torn and uneven.
 There is typical tearing of
the tissue.
PUNCTURED WOUND
 A wound caused by
sharp pointed object.
 The wound normally has
a small opening.
 The wound is deep.

 There is more chances of

presence of anaerobic
infection because of no
oxygen in deeper tissues.
PENETRATING WOUNDS
• These are deep wounds
which communicate to
cavities e.g. abdominal
wound, thoracic wound,
wounds of joint etc.

• Mostly caused by long sharp

pointed objects like horn of
cattle leading to horn wounds
of abdomen/thorax etc.
PERFORATING WOUNDS

These are deep wound having

two openings, one at the
entrance and other at the exit
e.g. Perforating wounds of neck,
thigh etc.
 Envenomed wound:
 The wounds resulting from snake/dog/wasp/wild animal
bite.
 There is significant degree of tissue damage depending
upon the bite.
 Commonly known as ‘Bite wounds’. The snake bites are
penetrating type of wounds and are mostly seen at the head,
lips, tongue or extremities.
• Gunshot wounds:
 These are deep wounds caused by firearms.
 The point of entrance is very small but there is extensive
damage to the underlying tissue.
 The damage varies depending upon the kinetic energy produced
by the firearm.
 Granulating wound: A wound which shows
tendency to heal by formation of new healthy
granulation tissue.

 Proud Flesh: Also known as ‘keloid tissue’. It is

excessive granulation tissue of unhealthy nature
characterized as dark, red or purple tissue with
typical serous or sero-sanginous discharge at the site
of the wound. A common condition of equines
ULCERATIVE WOUND

• A wound which does not show tendency

to heal.
• Decubitous ulcers or Pressure sores
 Abrasions: These are the wound in which there is loss only
of the superficial layer (epidermis) of the skin.

 Avulsion: A wound in which there is actual loss of the tissue

e.g. avulsion of tooth/hoof etc.
AVULSION OF HOOF
MAGGOT WOUND (TRAUMATIC
MYIASIS)
 A wound infested with maggots. Also known as traumatic myiasis.
 Primary myiasis: When the flies complete their life cycle in the wound
itself. The flies lay eggs on the wound; larvae burrow deep in the tissues and
enlarge the wound cavity; the tunnels are formed; the maggots feed on the
living tissue. e.g. Lucilia, Calliphora, Phormia etc.
 Secondary myiasis: Only maggot stage is seen in the wound. The maggots

feed on the necrotic tissue and the exudates and don’t burrow deep into the
tissues. e.g. Chrysomia, Musca, Sarcophagi etc.
MANAGEMENT OF MAGGOT
WOUND

Removal of maggots
Manually:
A combination of chloroform and turpentine oil (1:1)
Negasunt powder (contains cumaphos COP 3%, Proxopur
2% and sulfanilamide 5%),
Lorexane/maggocide cream (contains GBHC 0.1%,
proflavin hemi sulfate 0.1% and cetrimide 0.45%)
Phenyl

Once maggots are completely removed treat the

wound as an open wound following the general
principles of wound management.
EFFECT OF NEGASUNT ON MAGGOT INFESTED MEDIAL
CANTHUS OF EYE

Maggot infested medial

canthus of eye in a bullock-
day1
•Note the presence of
maggots in the medial
canthus

Appearance of eye when the animal

was discharged
 EFFECT OF NEGASUNT IN THE MAGGOT
INFESTED PAW OF DOG

Maggot wound of paw-Day-1

Application of
Negasunt+Liquid
paraffin-Day-1

Wound after single

treatment-Day 2
SITES WHERE CONVENTIONAL MAGGOCIDAL
MEDICATIONS ARE IRRITANT AND NEGASUNT CAN BE
APPLIED WITHOUT ANY COMPLICATION

MAGGOT WOUND ON
PENIS OF DOG

MAGGOT WOUND ON
VULVA OF MARE
CLINICAL CLASSIFICATION OF THE
WOUND

 Aseptic wound: A wound created under aseptic conditions like surgical wound.

 Contaminated wound: A wound infected with microbes, dirt, dust etc. The
microbes have entered the wound but don’t start multiplying.

 Infected/septic wound: A wound in which the microbes have started multiplying

and there is production of toxins/pus/exudate. A contaminated wound after a
‘lag period’ of 8-12 hours becomes an infected wound.
 Aseptic wound

Infected/septic wound

Contaminated wound
EXAMINATION OF WOUNDS

 Observations

-When and under what circumstances the wound has been

inflicted?

-What is the possible causative agent? – acid/alkali

-Type of wound –incised/puncture/lacerated

-Location of wound – loss of function

-Degree of disturbance – degree of damage

EXTERNAL EXAMINATION

 If closed wound, palpate the area and do paracentasis to ascertain

haematoma/abscess/emphysema etc.

 When open wound, see the condition of wound edges; freshening

may be required.
PARACENTESIS
INTERNAL EXAMINATION
Normally done in deep wounds to ascertain
degree and depth of wound and to see the
presence of foreign bodies.

 Visual: Separate apart the wound edges and

examine with a light source.
 Probing: Done with the help of
finger/probe/catheter
PROBING AND X-RAY
TREATMENT OF WOUNDS
ASEPTIC WOUND WHICH CAN BE SUTURED
 Tetanus in camel and horses.
 Arrest hemorrhage
 Clipping; shaving; scrubbing
 Irrigate the wound with NSS.
 Apply strong antiseptic (Povidone iodine 5%).
 Sprinkle antibiotic
 Suture the wound up to skin.
 Sealing with antiseptic
 antiseptic dressings of the wound on alternate day or every
3-4 day till the sutures are removed.
 Provide necessary rest.
 Use systemic antibiotics for 3-5 days. Use of fly repellent
TREATMENT OF WOUNDS
ASEPTIC WOUND WHICH CAN’T BE SUTURED
A. Follow steps A, B, C and E as described earlier.
B. Irrigate the wound with any antiseptic
C. Do antiseptic dressing with antiseptic ointments (BIPP or
ZIPP) or antiseptic/antibiotic powders.
D. Apply the protective bandage, wherever possible.
E. Do antiseptic dressings of the wound on alternate day or
every 3-4 day till the sutures are removed.
F. Provide necessary rest.
G. Use systemic antibiotics for 3-5 days.
H. Use of fly repellent creams
TREATMENT OF WOUNDS
Management of contaminated and septic wounds
‘Principles of 4 D’s

 Disinfection:

 Debridement:

 Drainage

 Dressing
 MANAGEMENT OF PUNCTURED
WOUNDS
 Never sutured because of possible bacteria/foreign body.
 External opening must be enlarged to facilitate proper drainage.
 Irrigation is always done with 0.5-2.00% H2O2 to provide nascent
oxygen to prevent anaerobic environment.
 Antiseptic dressing is always done with strong antiseptic (Tr. Iodine) or
antibiotics.
 Always use systemic antibiotics.
 TYPES OF CLINICAL WOUND
HEALING
1. Ist intention (Primary Healing)
2. 2nd intention (Secondary healing)
3. Mixed intention
4. Delayed primary healing
IST INTENTION (PRIMARY
HEALING)
 Mostly seen in wounds which are:
 Aseptic and fresh
 Free from hemorrhage
 Have minimum dead cells
 Have good blood supply to the wound edges
 The wound edges are in apposition with each other i.e. the wounds
are immobilized by suturing

 In such healing the

 narrow space is first filled with blood clot
 angioblasts and fibroblasts invade the clot
 healing is completed in 5-14 days
 negligible scar formation
 full function is restored.
2ND INTENTION (SECONDARY
HEALING):
 Also known as healing by organization. Mostly seen in
wounds where:
 There is actual loss of tissue
 The wound edges are widely separated
 The healing starts from the base of the wound and the gap is
replaced by newly forming granulation tissue
 complete healing is seen in 6 weeks or more and there is more
scar formation
 full function may not be restored.
MIXED INTENTION HEALING
 When there is healing by both i.e. Ist and 2nd intention.
 Such type of healing is seen in wounds which have been
sutured but sometimes, at places the sutures are
disrupted leading to gaping of wound edges (called
wound dehiscence).
 Mostly seen in patients suffering from jaundice.
DELAYED PRIMARY HEALING
 It is a type of healing which is achieved in such wounds which
can’t be sutured initially

 The wounds are allowed to heal by granulation till

epithelialization stage.
 At this stage the skin edges are separated from new
granulation tissue and sutured.

 The suturing is normally done 5-7 days after the injury. Such
type of healing, when achieved is advantageous in 2 ways:
 The large wounds heal with minimum scar formation
 The wound healing is rapid
PROCESS OF WOUND HEALING
( STAGES)
 It is restoration of the function and structure of the
damaged tissues
 It involves the four stages

inflammatory
Debridement
proliferative
maturation
INFLAMMATORY STAGE
 Homeostasis
 vasoconstriction
 clot formation (activation of kinin and platelets
aggregation)
 vasodilation (influence by histamine from platelets and
mast cells)
 Duration of events 1-4 days
 Capillary permeability increases
 White blood cells escapes into the cells and net work of
fibrin is formed
 Monocytes appears as increase no and becomes
dominent of up to 5th day
 Phygocytes

 New capillaries bud from the endothelial cells

DEBRIDEMENT STAGE
 Removal of dead and contaminated tissues and cells
 Dead tissue acts as good medium for the growth of micro
organism
 Cellular or biological

neutrophill and monocytes

 Enzymatic debridement

streptokinase, streptodornase, trypsin

 Chemical debridement
copper sulphate
silver nitrate
 Surgical or mechanical debridement

when all above fail then surgical deb.

PROLIFERATIVE STAGE
 Fibroplasia
fiberoblast moves into the site of wound
collagen production
Granulation
it starts 3-5 days after the fibroplasia
 Epithelialization

the gap is filled with new tissues

chalone enzyme
 it fill up the gap and supply blood
velvety moist appearance (pink color)
 Wound contraction

wound contracts due to myofibroblast

depending upon the wound size it may take months, weeks or
days
 Process the proliferation follows by the process of intact
inhibition (mitosis stopped)
MATURATION STAGE
 Wound increases in strength
 Fiberoblast increases in no

 Collagen fiber are arranged along the pressure line to

strength
 This stage lost for weeks to months
FACTORS AFFECTING WOUND
HEALING

Systemic factors:
1. Role of nutrients
2. Role of systemic diseases
3. Role of drugs/medicines used
4. Miscellaneous factors
 ROLE OF NUTRIENTS

Proteins:
 Deficiency - decreased fibroplasia
 Production of immature fibroblasts with lower
tensile strength.
Vitamins:

Deficiency of vitamins A and C

Decreased collagen synthesis,
improper epithelialization,
scanty blood vessels
and hence delayed healing.
ROLE OF SYSTEMIC DISEASES
Diabetes:
Diabetes - insulin deficiency - less energy-
decreased cell metabolism - healing delayed.

Anaemia: Oxygen carrying capacity of the blood

decreased- hypoxia - collagen synthesis

Jaundice: Wound dehiscence is a common problem

Hemophilia: Deficiency of antihaemophilic factor (Factor VIII)

- difficult clotting - healing delayed.

Uraemia: High blood urea levels- protein degradation -

decreased number of fibroblasts - delayed
healing
 ROLE OF DRUGS/MEDICINES USED

Corticosteroids:
Excessive corticosteroid therapy –
decrease number of fibroblast,
decreased number of newly forming capillaries,
fragile capillaries –
wound healing delayed.

NSAIDs:
In excess- decreased granulation, decreased tensile
strength of newly forming tissue and hence the healing
will be delayed.
 MISCELLANEOUS SYSTEMIC FACTORS
 Age:
Wound healing is delayed in old patients because of decreased holding power ,
decreased tensile strength of the newly forming tissue and decreased
fibroplasia

 Fat:
The wound healing is normally delayed in fatty patients because of decreased
holding power as well as decreased tensile strength of the newly forming
tissue and decreased fibroplasia

 Ambient temperature:
The wound healing is best when the ambient temperature is approximately 30oC.
At temperature 10-20oC the tensile strength of newly forming tissue is
decreased by 20% whereas at higher temperature (>50oC) thermal injuries
may occur and destroy the newly forming tissue.
 LOCAL FACTORS
Vascularity: Normal blood - normal healing because of proper
nutrients, oxygen and phagocytes Avoid tension during
suturing
Trauma: Gentle handling - avoids excessive trauma. Rough
handling - decreased tensile strength, prolonged healing
period and more scar formation
Haematoma: Good seat for the proliferation of infection - destroy
the newly forming cells - healing delayed.
Improper apposition of wound edges: Any gaping – no primary
healing
Infection/maggots: Presence of microorganisms or maggots -
continuously destroy the newly forming tissue - healing
delayed.
 LOCAL FACTORS
Foreign bodies:

Nerve injury:

Immobilization

Presence of neoplastic/dead tissue/proud flesh:

Presence of dead space: Anaerobic environment -

proliferation of microbes - extensive destruction of
newly forming cells - healing delayed.
 COMPLICATIONS OF WOUND
Haemorrhage
Haemorrhage following injury may lead to anaemia (when slight),
haematoma (when closed) or shock and death (when severe)
Always ensure proper haemostasis using different methods of haemostasis
(digital pressure, ligature etc.)
Wound dehiscence: Disruption of the suture line - ventral abdominal
and joint wounds.
Predisposing factors: Break in antiseptic procedure
 obesity; senility
 anaemia and jaundice
COMPLICATIONS OF WOUND

Traumatic neuralgia: Severe pain along the course

of nerve due to injury
Primary (pain ever since wound infliction)
Secondary (pain development after few days of wound infliction
due to infection).
Use anodyne preparations (systemic analgesics/NSAIDS for 3-5
days with topical Iodoform).
The complication is more seen in horses.
 COMPLICATIONS OF WOUND

Tetanus: More seen in camels and equines

Provide active immunization in these animals at least 15-21 days
before surgery using tetanus toxoid (5-10 ml I/M)
In emergency surgery go for passive immunization using ATS
(Anti tetanus serum) @ 1500-3000 IU S/C.
Shock:
Due to excessive loss of fluid (haemorrhage),
massive infection or overdosing of general anaesthesia
Prevent - preoperative corticosteroids and intravenous fluids
(before, during and after surgery).
 COMPLICATIONS OF WOUND

Haematoma and seroma: Accumulation of blood/serum due to

injury to blood vessels or improper haemostasis

Proud Flesh: Excessive granulation tissue of unhealthy nature

 COMPLICATIONS OF WOUND

Venous thrombosis: Injury to the medium sized vein

Dangerous when breaks – emboli- cause obstruction of important vessels like
coronary artery - death of the patient

Erysipelas: Mostly seen in horses, dogs and pigs due to streptococcal

infection of the wounds