Wound Healing

Question 1

Outline the key events in partial-thickness and full-thickness wound repair

Answer 1

P/T - regeneration (Proliferation-Migration- Reestablishment of normal skin layers/skin thickness) contact inhibition

Full Thickness - scar tissue formation
Acute
a.  Hemostasis/Inflammation
b.  Proliferation (epithelial resurfacing/granulation angioneogenesis w/ ECM/contraction)
c.  Maturation remodeling: 1 year

Chronic (Refractory)

a. Inflammation
b. Proliferation (granulation/contraction/epithelial resurfacing)
c. Maturation (fragile)

Question 2

Identify key nursing issues/concerns during each phase of wound repair

Answer 2

Neoangiogenesis affected by: hypoxia, hyperglycemia, rad/chemo Tx, aging

Factors affecting Chronicity:

a. failure to bleed (no clots=no growth factors)
b. systemic (perfusion, NUT, DM), trauma (unrelieved pressure, no correction to causative factors)
c. difference in wound fluid (eg. proliferative inflammatory stage)

A. Repair cells (Mø, fibroblasts,endothelial cells, keratinocytes)
B. Bioactive molecules controllers/directors of cellular repair (cytokines in Inflammatory Phase, GF -Proliferative phase PDGF/EGF/VEGF/TNF); senescent in elderly/DM
C. Proteins control level of GF/cytokines (MMP, tissue inhibitors of MMP); many are pro-inflammatory
D. ECM (scaffold for migrating cells, fibroblasts are CT)

Question 3

Identify factors that impede wound healing and nursing measures to promote healing during each phase

Answer 3

Perfusion/Oxygenation
(for Fibroblast proliferation/collagen synthesis), Lø, phagocytosis, re-epitheliliation
Ngs: relieve pressure, hydrate, nasal oxygen, no smoking, control edema

Nutrition: adequate protein/Nitrogen stores (collagen synthesis/immune function)
Proteins, CHO & fats, Zn, Fe, ascorbic acid

Corticosteroids & other meds:
20-40mg/day adverse affects
**topical Vit A capsules pricked can be used to counteract (25000-100000 IU)
NSAIDs (high doses)
chemotherapy (negative effect on rapidly dividing cells)

Aging
Tobacco Use
Denervations (increased SCI inflammatory cells)
Obesity (poor perfusion, offloading)
DM (increases Inflammation via proteases, reduced level GF, monitor A1C <7% q3months) 110-140

OPTIMIZE Wound Repair Nsg
Acute wounds Preop (nutrition/taper steroids/eliminate aspirin preoperatively, decrease anxiety to prevent vasoconstriction
Acute wounds (Postop) - pain control, warms (prevents vasoconstriction), hydration, supplemental O2, control edema
Nsg: binder/protect incisions, non adherent drag, antimicrobials w/ occlusive waterproof outer layer

Chronic Wounds: E + ESP
Address etiology
Address systemic
Identify/eliminate Ix
Provide topical therapy