urgent 2. Mr. John Smith is admitted to the hospital for surgical incision and d
ID: 277976 • Letter: U
Question
urgent
2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D;) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm x 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5) a. Explain the wound healing process according to the phase of Mr. Smith's wound? The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change. b.Explanation / Answer
a. The right calf with an area of 3 cm*2.5 cm which is red, warm, hard to touch and edematous. These conditions indicate that there is inflammatory response to an open wound. As there is huge influx of immune cells to the site of infection, the wounded site looks red, warm, painful and swelled. The march of immune system to the site of wound is to eliminate the necrotic content or to act against bacterial infection as it is open wound hence there is a chance of bacterial infection. Once immune cells clear the dead cells and pathogenic bacteria from wounded site, matrix gets deposited at the wounded site, angiogenesis happens and epitheliazation occurs. All these events are mediated by growth factors which are released by migrated keratinocytes, endothelial cells and fibroblast cells. Eventually wound site gets contracted which is mediated by myofibroblasts which are differentiated from fibroblasts.
b. Wet to dry dressing is a non-selective mechanical debridement method which removes both necrotic and normal cells. It is a painful treatment which keeps the wound area cool. Its procedure is as follow:
1. Place moist saline gauze at the wound site.
2. Allow it to dry and then it gets adhered to the wound tissue.
3. Once the guaze is dried, remove it (often need to apply force).
4. Repeat the procedure twice a day.
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