Wound Healing

1
Wound Healing

• Types of wounds
• Undertake basic wound care

2
Types of wounds

• Acute wounds
• Surgical wounds
• Trauma
• Burns
• Chronic wounds
• Pressure wounds
• Radiotherapy
• Care of access sites e.g. IV, CVCs

3
Wound classifications

• Abrasions
• Lacerations
• Penetrating
• Contusions
• Burns
• Not to mention surgical wounds

• Ulcerative wounds
• Leg ulcers
• Ulcers associated with systemic conditions,
  radiotherapy, malignancy.

4
Modes of wound closure

• Primary closure
• Secondary closure
• Debridement and granulation (secondary intention)
• Split skin grafting
• Flaps, pedicles, full tissue grafts

5
Optimal healing environment

• Matches the stage of the healing process
• Inflammatory phase involving absorption of
  exudate
• Granulation phase requires stimulation of
  granulation tissue
• Maturation phase potentiation of
  epithelialisation

6
The optimal healing environment is .

• Moist
• Not macerated
• Free of toxic chemicals
• At the optimum temperature pH
• Free of clinical infection
• Undisturbed by unnecessary dressing changes

7
.. and

• Protected by a dressing that conforms to the
  wound
• .. is comfortable
• .. and easy to apply

8
Antibiotics

• Bacterial contamination of chronic wounds is not
  usually significant
• Infection prolongs the inflammatory phase and
  causes discomfort
• Necessary to identify and treat acute infection
• Note Chronic wounds will be colonized but not
  necessarily infected

9
Wound cleansing

• Why cleanse?
• To deter infection by removal of exudate
• Should not interfere with local or systemic
  defences, or healing
• Not necessary to cleanse every time
• Normal saline is isotonic and conducive to healing

10
Effects of bacteria

• When non-intact tissue is exposed to air,
  bacteria adhere to it and colonize
• Bacteria cause local inflammation
• They
• damage epithelium
• retard contraction
• reduce wound tensile strength

11
Efficacy of antiseptics

• Bacteriocidal effect is related to concentration
  and duration of exposure
• Choice of antiseptic should be weighed against
  activity and possible cytotoxicity
• Complete eradication is not necessary for healing
• Slow healing wounds with identified pathogens
  require antibiotics

12
Deterrents to healing

• Necrotic tissue
• Requires debridement for healing to occur
• Provides a suitable environment for anaerobic
  org.s
• Foreign bodies
• Must be removed by irrigation e.g. grit, soil,
  etc
• Toxic chemicals choice of antiseptic

13
Moist wound healing

• Prevents tissue dehydration and cell death
• Accelerates angiogenesis
• Increases breakdown of dead tissue
• Potentiates interaction of growth factors
• Decreases pain
• Does not increase risk of clinical infection

14
Extrinsic factors affecting healing

• Mechanical stress
• Debris
• Temperature
• Desiccation / maceration
• Infection
• Chemical stress
• Other factors

15
Pressure ulcers

• Hospital patients 10 15
• Nursing home 20
• gt 60-65 age group 30
• NOF 60
• Key to prevention is assessment of risk Norton
  scale

16
Causes of pressure ulcers

• External physical compression (e.g. POP)
• Shearing force
• Friction
• Compounded by underlying factors such as
• Age, immobility, debility, nutritional state,
  conscious state

17
Pressure ulcers
18
Tracking/undermining
19
Venous ulcer
20
Learning Activity

• Refer to the Victorian Government Health
  Information, Pressure Ulcer (PUPPS) website and
  complete exercises 1, 2 and 3 see next page
• http//www.health.vic.gov.au/pressureulcers/educat
  ion.htm

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References

• Body1 Inc. 2008 Wounds1.com accessed 19/5/08
  http//www.wounds1.com/pr_ulc/index.cfm
• Carville, K. 2005 Wound Care, 5th edition.
  Silver Chain Nursing Association, Osborne Park,
  WA (617.14 CAR)
• Stockslager, J. (Ed.) 2003 Wound Care made
  Incredibly Easy!, Lippincott Williams Wilkins,
  Philadelphia (617.14 WOU)
• Templeton, S. (Ed.) 2005 Wound Care Nursing A
  Guide to Practice, Ausmed Publications, Melbourne
  (617.106 WOU)
• Victorian Government Health Information, Pressure
  accessed Ulcers accessed 19/5/08
  http//www.health.vic.gov.au/pressureulcers/educat
  ion.htm