BASIC WOUND CARE 

Basic Wound Care is a competency-oriented, simulation-based clinical skills course designed for undergraduate MBBS students as part of their General Surgery training. The course develops the knowledge, clinical reasoning, communication and practical skills required to safely assess and manage patients presenting with common wounds.

Wound care is a fundamental clinical skill that every medical graduate should be able to approach systematically. Effective wound management involves much more than cleaning and applying a dressing. The learner must first assess the patient, understand the mechanism and circumstances of injury, identify the type and severity of the wound, assess for deeper structural or neurovascular injury, recognize contamination and infection, provide appropriate basic wound care, counsel the patient, document findings accurately and identify situations requiring senior or specialist intervention.

This course uses simulation-based learning, faculty demonstration, DOAP practice, clinical scenarios, case-based discussion and direct observation to help students translate theoretical knowledge into safe clinical performance.

COURSE LEARNING OUTCOMES

By the end of this course, the learner should be able to:

Knowledge

1. Define a wound and describe common types of wounds.
2. Explain the major phases of normal wound healing.
3. Identify local and systemic factors that delay wound healing.
4. Describe the principles of basic wound management.
5. Explain indications for wound cleaning, irrigation and dressing.
6. Recognize clinical features suggestive of wound infection.
7. Identify red-flag findings requiring urgent escalation.
8. Discuss the importance of tetanus assessment and appropriate preventive measures.
9. Explain principles of rational antibiotic use in wound management.
10. Describe important medico-legal considerations in wound documentation.

Clinical Skills

11. Obtain a focused and relevant wound history.
12. Perform a systematic wound examination.
13. Describe wound characteristics accurately.
14. Assess depth and possible involvement of deeper structures.
15. Perform distal neurovascular assessment when clinically relevant.
16. Prepare equipment using appropriate infection-control principles.
17. Perform basic wound cleaning and irrigation safely.
18. Apply an appropriate basic wound dressing.
19. Dispose of contaminated materials safely.
20. Provide appropriate wound-care instructions and follow-up advice.

Professionalism and Communication

21. Introduce oneself and confirm patient identity.
22. Explain the procedure clearly.
23. Obtain appropriate consent.
24. Maintain privacy, dignity and patient comfort.
25. Communicate findings and limitations appropriately.
26. Recognize when assistance or senior review is required.
27. Document clinical findings objectively and accurately.

COURSE CONTENT

MODULE 1 — INTRODUCTION TO WOUNDS

Learners are introduced to the definition and clinical significance of wounds.

Common wound types include:

• Abrasion
• Incised wound
• Laceration
• Contusion
• Puncture wound
• Crush injury
• Penetrating wound
• Perforating wound

Students learn why the mechanism of injury is important in predicting the extent and type of tissue damage.

Key learning point

The size of the skin wound does not necessarily indicate the severity of the underlying injury.

MODULE 2 — NORMAL WOUND HEALING

Students review the major phases of wound healing:

1. Hemostasis

Formation of the initial clot and control of bleeding.

2. Inflammation

Removal of contaminants and damaged tissue through the inflammatory response.

3. Proliferation

Granulation tissue formation, angiogenesis, fibroblast activity, collagen deposition and epithelialization.

4. Remodeling

Reorganization and maturation of collagen with gradual improvement in tensile strength.

Students are taught that these phases overlap and interact, rather than occurring as completely separate events.

MODULE 3 — FACTORS AFFECTING WOUND HEALING

Students distinguish between local and systemic factors.

Local factors

• Infection
• Poor blood supply
• Ischemia
• Necrotic tissue
• Foreign body
• Hematoma/seroma
• Excessive wound tension
• Repeated trauma
• Significant contamination

Systemic factors

• Diabetes mellitus
• Malnutrition
• Anemia
• Smoking
• Immunosuppression
• Advanced age
• Systemic illness
• Certain medications

The learner is encouraged to look beyond the wound itself when healing is delayed.

MODULE 4 — FOCUSED WOUND HISTORY

Students practice obtaining a structured wound history.

Important areas include:

Mechanism

• What happened?
• What object caused the injury?
• Was it blunt, sharp or penetrating?

Timing

• When did the injury occur?

Contamination

• Soil
• Water
• Foreign material
• Animal or human contamination

Symptoms

• Pain
• Bleeding
• Numbness
• Weakness
• Loss of movement

Patient factors

• Diabetes
• Vascular disease
• Immunosuppression
• Medications
• Allergies
• Previous wound problems

Preventive history

• Tetanus immunization status

Special circumstances

• Bites
• Assault
• Occupational injuries
• Road traffic injuries

Students also learn the importance of privacy, consent and sensitive communication.

MODULE 5 — SYSTEMATIC WOUND EXAMINATION

A structured approach is introduced:

LOOK → FEEL → ASSESS

LOOK

Assess:

• Site
• Number
• Size
• Shape
• Wound edges
• Wound bed
• Tissue exposure
• Discharge
• Surrounding skin
• Signs of infection

FEEL

Assess where appropriate:

• Tenderness
• Warmth
• Induration
• Fluctuation
• Crepitus

ASSESS

Determine:

• Depth
• Possible tendon injury
• Nerve involvement
• Vascular injury
• Bone or joint involvement
• Distal neurovascular status

Students are specifically taught not to blindly probe wounds.

MODULE 6 — BASIC WOUND CLEANING AND IRRIGATION

Students observe and practice safe wound cleaning using a simulation task trainer.

The session includes:

1. Patient identification
2. Explanation and consent
3. Hand hygiene
4. Appropriate PPE
5. Equipment preparation
6. Removal of old dressing where applicable
7. Wound inspection
8. Appropriate cleaning/irrigation
9. Removal of superficial contamination where appropriate
10. Reassessment
11. Safe disposal of waste
12. Hand hygiene

The emphasis is on gentle, appropriate wound care while minimizing additional tissue trauma.

MODULE 7 — BASIC WOUND DRESSING

Students learn the principles of selecting and applying an appropriate dressing.

The practical sequence includes:

Explain → Consent → Hand hygiene/PPE → Remove old dressing → Inspect → Clean/Irrigate → Apply dressing → Secure → Check → Dispose → Counsel → Document

Students are taught to avoid excessive pressure and to consider circulation and patient comfort where relevant.

MODULE 8 — WOUND INFECTION AND RED FLAGS

Students learn to distinguish expected wound findings from concerning features.

Features suggesting infection

• Increasing pain
• Increasing redness
• Warmth
• Swelling
• Purulent discharge
• Malodour
• Wound breakdown
• Fever
• Systemic illness

Important red flags

• Severe pain disproportionate to the apparent wound
• Rapidly increasing swelling
• Rapidly progressive tissue changes
• Discoloration
• Bullae
• Crepitus
• Systemic toxicity
• Neurovascular compromise
• Suspected deep structural injury

The key principle is:

Recognize early → Escalate appropriately → Do not delay definitive care.

MODULE 9 — PREVENTION, COUNSELLING AND FOLLOW-UP

Students practice counselling patients regarding:

• Wound hygiene
• Dressing care
• Tetanus-related advice
• Medication adherence
• Nutrition and general health
• Follow-up
• Warning signs

Students learn that antibiotics should not be used routinely for every wound and that their use should be based on appropriate clinical indications and assessment.

MODULE 10 — MEDICO-LEGAL ASPECTS AND DOCUMENTATION

Students learn to document wounds using:

• Objective observations
• Accurate measurements where appropriate
• Site and anatomical location
• Wound characteristics
• Relevant history
• Neurovascular findings where applicable
• Treatment provided
• Patient advice
• Follow-up plan
• Referral/escalation

In potentially medico-legal cases, learners are taught to document objectively and avoid unsupported assumptions.