LEC 1: Wound Care Basics Flashcards
What is the function of the skin?
- The skin protects against disease-causing organisms
- Senses pain, temperature, and touch
- Synthesizes vitamin D
What are the two layers of the skin?
- Epidermis
- Dermis
Epidermis
The superficial, thinner layer of skin (epithelial tissue), composed of keratinized stratified squamous epithelium.
- The epidermis skin layer is avascular
- Is the 1st layer of skin
Dermis
A layer of dense irregular connective tissue containing collagen and elastic fibers that lay deep in the epidermis.
- Is the 2nd layer of skin.
How does the epidermis help with wound healing?
The epidermis functions to resurface the wound and restore the barrier against invading organisms
How does the dermis help with wound healing?
The dermis functions to restore the structural integrity (collagen) and the physical properties of the skin
What are the two types of wound classifications?
- Acute wound
- Chronic wound
What do wound classification systems describe?
- The status of the skin integrity
- Cause of the wound
- Severity/ extent of the wound
- Descriptive qualities of the wound, such as colour, smell, edema, etc.
Acute Wound
A wound that heals in a timely manner
- Healing is quicker - Simple wound
Chronic Wound
Wound that fails to heal in a timely manner
- Complex wound
- The more layers that are involved, the longer it will take to heal
What causes an acute wound?
- Trauma
- Surgical incision
What are the implications for healing regarding acute wounds?
- Wounds are easily cleaned and repaired
- Wound edges are clean and intact
What causes a chronic wound?
- Vascular compromise
- Chronic inflammation
- Repetitive insults to the tissue
How long can you expect an acute wound to heal?
Expect to heal within two months or less
How long can you expect a chronic would to heal?
A chronic wound will take greater then two months to heal
- Can last for ever
What are the implications for healing regarding chronic wounds?
Continued exposure to insult impedes wound healing
What are the three processes of wound healing?
- Primary intention healing
- Secondary intention healing
- Tertiary intention healing
Primary Intention Healing
- Wound with minimal or no tissue loss
- Skin edges are approximated/ closed
- Risk of infection is low
- Minimal scar formation
- Healing occurs quickly
What causes primary intention wounds?
Surgical incisions, wound that is sutured or stapled
What are the implications for primary intention wound healing?
Healing occurs by epithelialization
- Heals quickly with minimal scar formation
Epithelialization
Healing by the growth of epithelium over a denuded surface. The formation of granulation tissue into an open wound allows the re-epithelialization phase to take place, as epithelial cells migrate across the new tissue to form a barrier between the wound and the environment.
Secondary Intention Healing
- Wound with loss of tissue
- Wound is left open until it becomes filled by scar tissue; must heal from bottom up
- Takes longer to heal
- Chance of infection is greater
What causes secondary intention wounds?
- Pressure ulcers
- Surgical wounds that have tissue loss
What are the implications for secondary intention wound healing?
Wound heals by:
- Granulation tissue formation
- Wound contraction
- Epithelialization
Tertiary Intention Healing
Wound is left open for several days then closed surgical
What causes tertiary intention wounds?
Wounds that are contaminated and require observation for signs of inflammation
What are the implications for tertiary intention wound healing?
Closure of wound is delayed until risk of infection is resolved
What are the four phases in the pathophysiology of wound healing?
- Homeostasis
- Inflammatory
- Proliferative (Granulation)
- Maturation (Remodelling)
Homeostasis Phase
- Occurs within minutes of initial injury
- The body sends platelets to the site of the injury to aggregate and vasoconstrict blood vessels
- At the same time it starts the clotting cascade to stabilize the clot
*Body will stop bleeding in that area
Inflammatory Phase
- The body’s protective response to injury
- Last 2 to 4 days and can restart at any point
- Histamine released causing vasodilation and WBCs migration
- Leukocytes and macrophages ingest bacteria, dead cells, and debris
Proliferative Phase
- Lasts 3 to 24 days
- New blood vessels form
- Newly formed collagen starts to contract, decreasing wound bed size and speeds healing
- Epidermal cells migrate over the granulation tissue (epithelialization)
Maturation/ Remodelling Phase
- Can last up to 2 years
- The surface of the wound may look healed but the internal structures are still gaining strength/ healing
- Collagen production continues, thickening the epithelium and contacting to form a scar
- Scar tensile strength increases to 80% of the original tissue, but has limited elasticity
What are factors that affect wound healing?
- Lifespan considerations
- Nutrition
- Lifestyle
- Medications
- Contamination, colonization, and infection
