Wound healing Flashcards
What are the different classification of wounds?
- Laceration=tearing of wound, irregular
- Abrasion=loss of epidermis and some dermis
- Incision= Minimal trauma as caused by sharp object
- Avulsion=tearing of tissues from attachments (degloving)
- Puncture= penetrative, can be superficial or deep
What is the subdermal plexus?
- Contains the direct cutaneous artery.
- Can use the plexus to keep skin flaps alive if there is a direct feed to the area of skin (can remove and rotate flaps so long as you keep the subdermal plexus attachment intact)
What are the phases of wound healing?
- Haemostasis/ inflammation
- Proliferation (repair phase)
- Maturation (remodelling phase)
Describe the inflammatory phase
- Vasoconstriction to stop bleeding
- Vasodilation to increase capillary permeability
- Activation of the clotting cascade and chemotaxis of inflammatory cells
- Reduce bacterial contamination and help clotting.
Describe the repair phase
- Fibroplasia
- Fibroblasts migrate to area and try to bridge the damage
- Contact inhibition: fibroblasts don’t stack directly on top of one another
- The fibroblasts secrete proteoglycans, collagen and elastin to help reinforce the wound.
- Wound starts to contract
- Epithelialisation occurs
Describe the remodelling phase
- Matrix is remodelled
- Cross linking of collagen
- Increases tensile strength
- Can take weeks to months
- BUT wound will never regain original strength
List factors affecting wound healing
- Age
- Nutrition
- Medication (steroids)
- Radiation
- Co-morbidities (cushings/ diabetes)
What is the golden period?
- 6-8 hours
- The period of time where a wound is a ‘contaminated’ wound. If it is older than 8 hours then it is an INFECTED wound
What do you use to get the correct pressure during lavage of a wound?
- 18G needle and a 20ml syringe
- Gives 7-8 psi
What are the three different intentions in wound management?
-Primary= surgical closure of the wound
-Secondary=We leave the wound to heal itself
Tertiary= Do something to the wound to help clean it up and then surgically close it a few days later.
What can influence bacterial contamination?
- Vascular supply
- Presence of necrotic tissue
- Type of contamination
- Type of bacteria
Which solutions are best to lavage a wound?
Isotonic (e.g. saline or hartmanns)
Give examples of non surgical debridement
-Dressings:
wet-dry and dry-dry
What is a wet-dry dressing?
- Sterile swab which is moistened with isotonic fluid
- Place damp swab on wound
- Place dry swabs on top
- Helps create a nice granulation bed
When would you use a tie over bolus?
-When wound is in an area difficult to dress
Describe delayed primary closure of a wound
- Used in clean-contaminated to contaminated wounds
- Use methods such as wet-dry dressing then close wound after 3-5 days
What are the advantages and disadvantages of secondary intention healing?
- Advantages: optimum wound drainage, local infection control
- Disadvantages: cosmetic results, time/ expensive
What is proud flesh?
Granulation tissue that has become unhealthy = preventing wound from healing, the epithelium cannot close over the top of it.
-Occurs during secondary intention healing
What are the 2 types of drains?
Active and passive
Describe passive drains
- Penrose drain
- Uses gravity
- Has a wicking action to draw fluid out of the wound
- Needs a large SA
Describe active suction drains
- Closed system that uses negative pressure to draw fluid out
- More expensive than passive drains
- Needs reactivating to keep negative pressure applied
When should you remove a drain?
As soon as possible
Usually 1-5 days
What is topical negative pressure?
A device that applies negative pressure via suction onto an open wound
- Draws off fluid this reducing oedema in surrounding tissues
- Reduces bacteria
- Promotes healthy granulation
- Aids epithelialisation
- Increases wound perfusion
What does wound healing continuum mean?
-A colour chart that helps you identify what stage of healing the wound is at
