Factors that impair wound healing

Question 1

what are the intrinsic factors that impair wound healing

Answer 1

Intrinsic
Age
Impaired perfusion and oxygenation
Impaired Sensation/neuropathy
Co-morbid disease states (Diabetes, inflammatory diseases, anemia, HTN, COPD, SCI, CVA)
Impaired Mobility

Question 2

what are the extrinsic factors that impair wound healing?

Answer 2

Extrinsic
Pressure
Shear/friction
Moisture
Incontinence
Wound exudate
Perspiration
Nutrition
Medications
Infection
Poor Wound Care
Behavioral Risk Taking

Question 3

when looking at the intrinsic factor of aging on wound healing what is decreased?

Answer 3

Dermal thickness (especially legs and arms)
Fatty layers (bony prominences less protected)
Collagen and elastin fibers
Size of Rete ridges (allows easier separation of epidermis and dermis)
Sensation and metabolism
Sweat glands (dry skin)
Circulation (healing, poor heat regulation)
Epidermal regeneration (slower healing)

Question 4

when talking about chronic diseases mainly diabetes what factors are noticed that impede wound healing?

Answer 4

Greatest risk for diabetic foot ulcer (DFU) is neuropathy
Greatest risk for amputation is a DFU
Diabetic amputations > 80,000/year according to the CDC
25-68% incidence of contralateral amputation within 3-5 years
50% three year mortality rate
Each amputation costs $25,00-$40,000

Question 5

what are the risk factors for amputation for a patient with diabetes?

Answer 5

Duration of diabetes
High A1C or fasting glucose levels
Loss of protective sensation
Arterial insufficiency
History of previous ulcer
Retinopathy-independent predictor of risk
Lack of patient education

Question 6

what therapies can we use to improve patients with diabetes?

Answer 6

Blood glucose control
Wound bed preparation
Debridement
Management of the bioburden
Exudate management
Dressings-according to the characteristics of the wound
Adjunctive technologies
Bioengineered tissues
Electrical modalities
HBO therapy
Total contact casting (offloading), healing shoes, walking splints

Question 7

What is chariot foot and how can you distinguish between Charcot foot and a diabetic foot ulcer?

Answer 7

bones are erroted so you can push on the bones

Question 8

what are the appropriate factors for diabetic footwear?

Answer 8

Assess shoes in relation to feet
Toe box adequate
Shoe length appropriate
Leather uppers
Adequate width through forefoot
Contact of shoe last with arch of foot
Low heels

Question 9

what are the chronic disease factors that impair wound healing?

Answer 9

Renal, cardiopulmonary
Immune suppression
Diabetes, cancer, HIV, chronic corticosteroids
? What stage of wound healing would this effect? -proliferative
Autoimmune
Perfusion and oxygenation
hypovolemia

Question 10

What stage of wound healing would this effect?

Answer 10

proliferative

Question 11

What are the conditions seen with neurologically impaired skin?

Answer 11

Peripheral neuropathy
Chronic diabetes
Alcoholism

SCI
CNS neuropathy
Temperature regulation
Reflex sweating
Loss of vasomotor tone
Mechanical factors

Question 12

what conditions have impaired sensations that can impede wound healing

Answer 12

Guillian Barre
ALS
Orthopedic
Many others
Semmes-Weinstein Monofilament

Question 13

how can impaired mobility have an affect on wound healing?

Answer 13

Unable to change position
Unwilling to admit risk
Orthopedic population/pain
Dementia
Incontinence

Question 14

what other extrinsic factors might change the improvement of wound healing?

Answer 14

Nutrition
Medications
Irradiation and chemotherapy
Chemo induced PN
Stress
Depression
Bioburden/infection

Question 15

what medications can effect wound healing?

Answer 15

Antidepressants
Sleeping pills
Drug related immunosuppression
Anabolic steroids
Anticoagulants
Chemotherapy

Question 16

what are the Iatrogenic factors that determine wound healing?

Answer 16

Local ischemia
Inappropriate wound care
Trauma

Question 17

what are the generic factors that can change wound healing?

Answer 17

Inadequate perfusion and oxygenation
Lack of moist wound environment
Senescent cells
Free radicals
Dead space
Chronic wound fluid

Question 18

what are the wound characteristics that change wound healing?

Answer 18

Location, location, location
Size
Shape
Etiology
Chronicity
Co-morbidities
Temperature
Hydration
Necrotic tissue

Question 19

what are the traditional myths of wound healing?

Answer 19

Let a scab form
Let it dry out
Wounds should be open to air and sunlight
DSD

Question 20

what is the main concept when it comes to dressings and wound healing?

Answer 20

if its too wet , dry it
if its too dry, wet it

Question 21

what are the functions of wound healing?

Answer 21

Protection
Moisture management
Temperature regulation
Debridement

Question 22

what topical antimicrobials would you put on a wound?

Answer 22

Silver
Iodine

Charcoal- odor control

Question 23

what enzymes are used in wound healing?

Answer 23

Collagenase-Santyl

Older- Papain-Accuzyme and Panafil
Maggot excrement

Question 24

what are the basic categories of dressings?

Answer 24

Gauze
Films
Foams
Hydrogels
Hydrocolloids
Alginates
Silicone
Biologics

Question 25

what decision making comes into play when addressing wound healing?

Answer 25

Granular and non-draining
Granular and draining
Necrotic and non-draining
Necrotic and draining

Question 26

what other factors might effect wound healing?

Answer 26

Infection
Wound and periwound characterisitics
Frequency of dressing changes
Cost
Wound location