Lesson 5: Wound Healing Systemic Support

Question 1

Perfusion oxygenation

Answer 1

• O2 needed for WBC activity, collagen synthesis, and epithelial resurfacing
• Essential levels = 30-40 mmHg
• Factors affecting perfusion/oxygenation
  — Uncontrolled hypertension
  — Cardiovascular disease
  — Edema
  — Anemia
  — Smoking

Question 2

Smoking/Tobacco Use

Answer 2

• Negatively affect repair via vasoconstriction and impaired tissue oxygenation
• Provide support via education/counselling, NRT, and medications

Question 3

Diabetes + Hyperglycemia

Answer 3

• Normal: 70 – 110 mg/dL
• Goals: 110 – 140 mg/dL + Hga1C <7%
• Impairs WBC function and decreased collagen synthesis

Question 4

Corticosteroids

Answer 4

• Impairs neoangiongensis, inflammation, contraction, and epithelialization
• Topical vitamin A may help to counteract negative affects

Question 5

Denervation

Answer 5

Wounds below level of nerve injury heal slowly

Question 6

Obesity

Answer 6

• subcutaneous tissue perfumes poorly
• increased mechanical stress on incisions

Question 7

Aging

Answer 7

• Reduced growth factor receptor sites and cellular senescence
• Impaired collagen synthesis and epidural turnover
• Compromised inflammatory response

Question 8

Malnutrition

Answer 8

Presentation
- Tissue wasting
- Generalized edema
- Pluckable hair
- Cracked mucous membrane
- Nonhealing wounds

Nutritional Calculations
- Caloric needs: 30 – 35 Cal/kg/day
- Protein needs: 1.25 - 1.5 grams/kg/day
- Fluids: 30 mls/kg/day

Options
- diet modifications with supplements
- enteral nutrition
- TPN