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Advanced Musculoskeletal
Physiotherapy Selfdirected Learning
Modules:
Physiotherapy
Arthroplasty Review Clinic
(PAR) 2014
Module 4: Surgical Wound Management
Prepared by Alfred Health on behalf of the Victorian Department of Health 2014
1
Module 4: Surgical Wound
Management
Contents
Module 4: Surgical Wound Management ................................................... 2
4.0 Surgical Wounds ........................................................................................ 3
Theme 1 History taking in surgical wounds...................................... 3
Theme 2 Focused Clinical Wound Assessment ................................ 6
4.0 Surgical Wounds
Theme 1 History taking in surgical wounds
LEARNING OBJECTIVES:
1. To understand the key principles of history taking in surgical wounds post arthroplasty
2. To identify high risk groups for delayed wound healing.
3. To demonstrate an understanding of high risk wounds.
KNOWLEDGE
HISTORY

What are the stages of wound healing?

What key areas of the following are important in the management surgical wounds:
o past medical and surgical history?
o social history?
o current medications?
o allergy history?

List the high risk patient groups that are predisposed to wound healing impairment.

List medications that may affect wound healing and explain your reasons.

Discuss the special considerations that must be given for patients with suspected infected
wound with regards to history, assessment, investigations, management and pharmacological
agents post arthroplasty
RECOMMENDED RESOURCES
Purcel, D (2010) Minor Injuries A Clinical Guide. Churchill Livingstone, UK.
Chapter 6, Minor Wounds and Burns, p173-199.
Talley, NJ & O’Connor, S (2009) Clinical Examination: A systematic Guide to Physical Diagnosis. 6th
Edition. Churchill Livingstone, Sydney.
Chapter 1, The General Principles of history taking, p1-12; Chapter 2, Advanced history taking, p13-21.
Troutt, A (2005) Wounds and Lacerations Emergency care and closure. 3rd Edition. Elsevier Mosby.
Chapter 4, Surface Injury and Wound Healing: Mechanism of Injury, p19-22
Wardrope, J & Edhouse, J (2002) The Management of Wounds and Burns. 2nd Edition. Oxford University
Press.
.
Module 4: Surgical Wound Management
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/pdf/10.1177_0022034509359125.pdfGaine,
W. J., Ramamohan, N. A., Hussein, N. A., Hullin, M. G., & McCreath, S. W. (2000). Wound infection in hip
and knee arthroplasty. Journal of Bone & Joint Surgery, British Volume, 82(4), 561-565.
Guo, S., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of dental research, 89(3), 219229.http://www.bjj.boneandjoint.org.uk/content/82-B/4/561.full.pdf+html
Saleh, K., Olson, M., Resig, S., Bershadsky, B., Kuskowski, M., Gioe, T., ... & McElfresh, E. (2002). Predictors
of wound infection in hip and knee joint replacement: results from a 20 year surveillance program.
Journal of orthopaedic research, 20(3), 506-515.
Poss, R. O. B. E. R. T., Thornhill, T. S., Ewald, F. C., Thomas, W. H., Batte, N. J., & Sledge, C. B. (1984).
Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clinical
orthopaedics and related research, 182, 117-126.
Pulido, L., Ghanem, E., Joshi, A., Purtill, J. J., & Parvizi, J. (2008). Periprosthetic joint infection: the
incidence, timing, and predisposing factors. Clinical orthopaedics and related research, 466(7), 1710-1715.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505241/pdf/11999_2008_Article_209.pdf
Vince, K., Chivas, D., & Droll, K. P. (2007). Wound complications after total knee arthroplasty. The Journal
of arthroplasty, 22(4), 39-44.
Namba, R. S., Paxton, L., Fithian, D. C., & Stone, M. L. (2005). Obesity and perioperative morbidity in total
hip and total knee arthroplasty patients. The Journal of arthroplasty, 20, 46-50.
Greene, K. A., Wilde, A. H., & Stulberg, B. N. (1991). Preoperative nutritional status of total joint patients:
relationship to postoperative wound complications. The Journal of arthroplasty, 6(4), 321-325.
Møller, A. M., Pedersen, T., Villebro, N., & Munksgaard, A. (2003). Effect of smoking on early
complications after elective orthopaedic surgery. Journal of Bone & Joint Surgery, British Volume, 85(2),
178-181. http://www.bjj.boneandjoint.org.uk/content/85-B/2/178.full.pdf#page=1&zoom=auto,0,779
Meding, J. B., Reddleman, K., Keating, M. E., Klay, A., Ritter, M. A., Faris, P. M., & Berend, M. E. (2003).
Total knee replacement in patients with diabetes mellitus. Clinical orthopaedics and related research, 416,
208-216.
Uptodate
Anderson et al (2012) Epidemiology of surgical site infection in adults
http://www.uptodate.com/contents/epidemiology-of-surgical-site-infection-inadults?source=search_result&search=wound+infection&selectedTitle=1%7E150
Garlington et al (2012) Evaluation of infection in the older adult
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http://www.uptodate.com/contents/evaluation-of-infection-in-the-olderadult?source=search_result&search=joint+infections&selectedTitle=40%7E150
Anderson et al (2013) Antimicrobial prophylaxis for prevention of surgical site infection in adults
http://www.uptodate.com/contents/antimicrobial-prophylaxis-for-prevention-of-surgical-siteinfection-in-adults?source=search_result&search=wound+infections&selectedTitle=2%7E150
Anderson et al (2014) Basic principles of wound management
http://www.uptodate.com/contents/basic-principles-of-woundmanagement?source=search_result&search=wound+infections&selectedTitle=4%7E150
Armstrong et al (2012) Wound healing and risk factors for non healing
http://www.uptodate.com/contents/wound-healing-and-risk-factors-for-nonhealing?source=search_result&search=surgical+wound+care&selectedTitle=2%7E150
Armstong et al (2013) Clinical assessment of wounds
http://www.uptodate.com/contents/clinical-assessment-of-wounds?source=see_link
Alguire et al (2013) clinical manifestations of lower extremity chronic venous disease
http://www.uptodate.com/contents/clinical-manifestations-of-lower-extremity-chronic-venousdisease?source=see_link
Module 4: Surgical Wound Management
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Theme 2 Focused Clinical Wound Assessment
LEARNING OBJECTIVES
1. To understand the important features of conducting a wound assessment in patients
post arthroplasty
KNOWLEDGE

How does age of the wound effect the management and outcome?

How would you measure the size of a wound?

How would you describe and document the characteristics of the wound?

What would concern you on the peri-wound areas?

How would you assess the level of pain?

What features of a wound assessment warrant referral?

What are the differences between staples and sutures?
RECOMMENDED RESOURCES
Purcel, D 2010, Minor Injuries A Clinical Guide (Chapter 6 Minor Wounds and Burns pp
173-199), Churchill Livingstone, UK
Wardrope, J & Edhouse, J 2002, The Management of Wounds and Burns (Chapter 1:
Wound Assessment pp 5-12), 2nd Edition, Oxford University Press
Lazerus, GS, Cooper DM, Knighton DR, Margolis, DJ, Pecoraro RE, Rodeheaver, G, &
Robson MC 1994, Definitions and guidelines for assessment of wounds and evaluation of
healing, Archives of Dermatology, 130, 4, pp 489-493, Viewed at
http://www.ncbi.nlm.nih.gov/pubmed/8166487
Anderson et al (2013) Antimicrobial prophylaxis for prevention of surgical site infection
in adults
http://www.uptodate.com/contents/antimicrobial-prophylaxis-for-prevention-ofsurgical-site-infection-inadults?source=search_result&search=wound+infections&selectedTitle=2%7E150
Anderson et al (2014) Basic principles of wound management
http://www.uptodate.com/contents/basic-principles-of-woundmanagement?source=search_result&search=wound+infections&selectedTitle=4%7E150
Armstong et al (2013) Clinical assessment of wounds
http://www.uptodate.com/contents/clinical-assessment-of-wounds?source=see_link
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Kronfol (2013) Closure of wounds with staples
http://www.uptodate.com/contents/closure-of-minor-skin-wounds-with-staples
Gaine, W. J., Ramamohan, N. A., Hussein, N. A., Hullin, M. G., & McCreath, S. W. (2000).
Wound infection in hip and knee arthroplasty. Journal of Bone & Joint Surgery, British
Volume, 82(4), 561-565.
http://www.bjj.boneandjoint.org.uk/content/82-B/4/561.full.pdf+html
Fitzgerald Jr, R. H., Nolan, D. R., Ilstrup, D. M., Van Scoy, R. E., Washington 2nd, J. A., &
Coventry, M. B. (1977). Deep wound sepsis following total hip arthroplasty. The Journal of
bone and joint surgery. American volume, 59(7), 847-855.
Ridgeway, S., Wilson, J., Charlet, A., Kafatos, G., Pearson, A., & Coello, R. (2005). Infection
of the surgical site after arthroplasty of the hip. Journal of Bone & Joint Surgery, British
Volume, 87(6), 844-850.
http://www.bjj.boneandjoint.org.uk/content/87-B/6/844.full.pdf+html
Blom, A. W., Brown, J., Taylor, A. H., Pattison, G., Whitehouse, S., & Bannister, G. C. (2004).
Infection after total knee arthroplasty. Journal of Bone & Joint Surgery, British Volume,
86(5), 688-691.
http://www.bjj.boneandjoint.org.uk/content/86-B/5/688.full.pdf
Vuolo, J. C. (2006). Assessment and management of surgical wounds in clinical practice.
Nursing standard, 20(52), 46-56.
ftp://195.206.160.172/NSTD/V20.website/N52/4494.pdf#page=1&zoom=auto,62,818
Smith, T. O., Sexton, D., Mann, C., & Donell, S. (2010). Sutures versus staples for skin
closure in orthopaedic surgery: meta-analysis. BMJ: British Medical Journal, 340.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840224/pdf/bmj.c1199.pdf#page=1&
zoom=auto,0,794
Shantz, J. A. S., Vernon, J., Morshed, S., Leiter, J., & Stranges, G. (2013). Sutures versus
staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial.
Patient safety in surgery, 7(1), 6.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598732/pdf/1754-9493-76.pdf#page=1&zoom=auto,0,794
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Galat, D. D., McGovern, S. C., Larson, D. R., Harrington, J. R., Hanssen, A. D., & Clarke, H. D.
(2009). Surgical treatment of early wound complications following primary total knee
arthroplasty. The Journal of Bone & Joint Surgery, 91(1), 48-54.
Wound care RCH
http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Wound_care/
Australian wound management association
http://www.awma.com.au/pages/competencies.php
View your organisations resources on wound management . For example Alfred Health
2013, Wound management, Viewed at
http://intranet.alfredhealth.org.au/Content.aspx?topicID=1719. Contact The Alfred if
your organisation doesn’t have any resources on wound management.
Policies
Alfred Health No Date, Wound Care Assessment and Management (Poster), Viewed at
http://intranet.alfredhealth.org.au/assets/contentFiles/1/Wound%20Care%20Assessm
ent%20and%20Management%20Poster.pdf
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