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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 3 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 Module 4: Surgical Wound Management 4 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 5 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 Module 4: Surgical Wound Management 6 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 Module 4: Surgical Wound Management 7 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 Module 4: Surgical Wound Management 8