Factors that impair wound healing Flashcards
what are the intrinsic factors that impair wound healing
Intrinsic
Age
Impaired perfusion and oxygenation
Impaired Sensation/neuropathy
Co-morbid disease states (Diabetes, inflammatory diseases, anemia, HTN, COPD, SCI, CVA)
Impaired Mobility
what are the extrinsic factors that impair wound healing?
Extrinsic
Pressure
Shear/friction
Moisture
Incontinence
Wound exudate
Perspiration
Nutrition
Medications
Infection
Poor Wound Care
Behavioral Risk Taking
when looking at the intrinsic factor of aging on wound healing what is decreased?
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)
when talking about chronic diseases mainly diabetes what factors are noticed that impede wound healing?
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
what are the risk factors for amputation for a patient with diabetes?
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
what therapies can we use to improve patients with diabetes?
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
What is chariot foot and how can you distinguish between Charcot foot and a diabetic foot ulcer?
bones are erroted so you can push on the bones
what are the appropriate factors for diabetic footwear?
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
what are the chronic disease factors that impair wound healing?
Renal, cardiopulmonary
Immune suppression
Diabetes, cancer, HIV, chronic corticosteroids
? What stage of wound healing would this effect? -proliferative
Autoimmune
Perfusion and oxygenation
hypovolemia
What stage of wound healing would this effect?
proliferative
What are the conditions seen with neurologically impaired skin?
Peripheral neuropathy
Chronic diabetes
Alcoholism
SCI
CNS neuropathy
Temperature regulation
Reflex sweating
Loss of vasomotor tone
Mechanical factors
what conditions have impaired sensations that can impede wound healing
Guillian Barre
ALS
Orthopedic
Many others
Semmes-Weinstein Monofilament
how can impaired mobility have an affect on wound healing?
Unable to change position
Unwilling to admit risk
Orthopedic population/pain
Dementia
Incontinence
what other extrinsic factors might change the improvement of wound healing?
Nutrition
Medications
Irradiation and chemotherapy
Chemo induced PN
Stress
Depression
Bioburden/infection
what medications can effect wound healing?
Antidepressants
Sleeping pills
Drug related immunosuppression
Anabolic steroids
Anticoagulants
Chemotherapy
what are the Iatrogenic factors that determine wound healing?
Local ischemia
Inappropriate wound care
Trauma
what are the generic factors that can change wound healing?
Inadequate perfusion and oxygenation
Lack of moist wound environment
Senescent cells
Free radicals
Dead space
Chronic wound fluid
what are the wound characteristics that change wound healing?
Location, location, location
Size
Shape
Etiology
Chronicity
Co-morbidities
Temperature
Hydration
Necrotic tissue
what are the traditional myths of wound healing?
Let a scab form
Let it dry out
Wounds should be open to air and sunlight
DSD
what is the main concept when it comes to dressings and wound healing?
if its too wet , dry it
if its too dry, wet it
what are the functions of wound healing?
Protection
Moisture management
Temperature regulation
Debridement
what topical antimicrobials would you put on a wound?
Silver
Iodine
Charcoal- odor control
what enzymes are used in wound healing?
Collagenase-Santyl
Older- Papain-Accuzyme and Panafil
Maggot excrement
what are the basic categories of dressings?
Gauze
Films
Foams
Hydrogels
Hydrocolloids
Alginates
Silicone
Biologics
what decision making comes into play when addressing wound healing?
Granular and non-draining
Granular and draining
Necrotic and non-draining
Necrotic and draining
what other factors might effect wound healing?
Infection
Wound and periwound characterisitics
Frequency of dressing changes
Cost
Wound location
