Wound Healing

Question 1

Think of 5 Functions of the skin

Answer 1

Regulates body temperature
Protection 
Sensation
Excretion
Immunity
Blood reservoir
Synthesis of Vitamin D

Question 2

What is healthy skin? Think of 5 signs

Answer 2

Pink
Well perfused
Free from blemishes
No cracks 
Warm 
Not dry or flaky
Not sweaty
No oedema

Question 3

What causes skin changes? Think of 5 things

Answer 3

Ageing 
Smoking
Malnutrition
Diabetes
Infection
Medications
Disease eg: eczema, psoriasis

Question 4

What are the effects of ageing on the skin?

Answer 4

Collagen fibres breakdown
Skin loses elasticity
80% of ageing is due to sun damage

Question 5

What are the effects of smoking on the skin?

Answer 5

Smoking reduces skin cell replication through vascular constriction
Decreased oxygen in blood - thickens blood reducing collagen
Skin thickness and health is reduced by up to 40%

Question 6

Think of 5 characteristics of abnormal skin

Answer 6

Skin may have 
Cuts 
Abrasions
Redness
Pallor
Lumps
Bruises
Swelling
Dryness
Profuse sweating
Cellulite
Rashes
Wounds

Question 7

What is an acute wound? give 3 examples of causes and 3 examples of wounds.

Answer 7

An acute wound occurs when healthy tissue is damaged by trauma, such as surgery, heat, electricity, chemicals or abrasion. 
Continuity of the skin surface is lost. 
Eg
Burns 
Donor sites
Abrasions
Incisional\surgical wounds
Trauma

Question 8

What is a chronic wound? Give 3 examples

Answer 8

Chronic wounds are in principle acute wounds where the healing process has stopped or has been interrupted somewhere in the normal sequence. 
Arterial and venous leg ulcers
Pressure ulcers
Neuropathic ulcers
Malignant ulcers

Question 9

4 Stages of Wound Healing

Answer 9

1 Haemostasis Phase
2 Inflammatory Phase
3 Proliferative Phase
4 Maturation

Question 10

Haemostasis: What are its 3 phases, and how quickly does it occur?

Answer 10

The process of the wound being closed by clotting; starts when blood leaks from the body.
First step is vasoconstriction
Next, platelets stick together to seal the break in the wall of the blood vessel. Finally, coagulation occurs and reinforces the platelet plug with threads of fibrin which are like a molecular binding agent. The haemostasis stage of wound healing happens very quickly. The platelets adhere (stick) to the sub-endothelium surface within seconds of the rupture of a blood vessel’s epithelial wall. After that, the first fibrin strands begin to adhere in about 60 seconds.

Question 11

Inflammation phase?

Answer 11

The second stage of wound healing, begins straight after the injury when the injured blood vessels leak transudate (made of water, salt and protein) causing localised swelling. Inflammation both controls bleeding and prevents infection. The fluid engorgement allows healing and repair cells to move to the site of the wound. During the inflammatory phase, damaged cels, pathogens, and bacteria are removed from the wound area.

Question 12

Proliferative Phase

Answer 12

Third phase of wound healing. The proliferative phase of wound healing is when the wound is rebuilt with new tissue made up of collagen and extracellular matrix. In the proliferative phase, the wound contracts as new tissues are built. In addition, a new network of blood vessels must be constructed so that the granulation tissue can be healthy and receive sufficient oxygen and nutrients. Myofibroblasts cause the wound to contract by gripping the wound edges and pulling them together using a mechanism similar to that of smooth muscle cells. In healthy stages of wound healing, granulation tissue is pink or red and uneven in texture. Moreover, healthy granulation tissue does not bleed easily. Dark granulation tissue can be a sign of infection, ischemia, or poor perfusion. In the final phase of the proliferative stage of wound healing, epithelial cells resurface the injury.

Question 13

Maturation Phase

Answer 13

Also called the remodelling stage of wound healing, the maturation phase is when collagen is remodelled from type 3 to type 1 and the wound fully closes. The cells that had been used to repair the wound but which are no longer needed are removed by apoptosis, or programmed cell death. When collagen is laid down during the proliferative phase, it is disorganised and the wound is thick. During the maturation phase, collagen is aligned along tension lines and water is reabsorbed so the collagen fibers can lie closer together and cross-link. Cross-linking of collagen reduces scare thickness and also makes the skin area of the wound stronger. Generally, remodelling begins about 21 days after an injury and can continue for a year or more. Even with cross-linking, healed wound areas continue to be weaker than uninjured skin, generally only having 80% of the tensile strength of unwounded skin.

Question 14

3 Wound closure types

Answer 14

Primary Wound Closure
Secondary Closure
Delayed Primary Closure

Question 15

Think of 5 Factors influencing the healing process

Answer 15

• Advanced age
• Diseases (diabetes, PVD, cardiovascular diseases)
• Poor nutrition
• Medications (steroids, cytostatica)
• Smoking
• Inactivity
• Poor mental health
• Systemic infections (Infections that are in the blood stream)
• Infected or highly colonised wound
• Devitalised/necrotic tissue/ haematoma -
• Foreign bodies, (Sutures, dressing debris)
• Moisture balance
• Reduced wound temperature
• Pressure, friction, shearing forces
• Inappropriate wound management
• Location of wound

Question 16

Characteristics of Dry Wound Healing

Answer 16

Not as good as moist healing
Dries the wound
Scab Formation
Frequent changes
Mechanical injury to the granulating tissue 
Longer healing time

Question 17

Characteristics of Moist Wound Healing

Answer 17

Prevents the formation of scab
Provides optimal conditions for the body’s own wound healing system
Speeds up the healing process

Question 18

What to check with wounds and how to deal with them

Answer 18

Dimensions (including sinuses and undermining)
Tissue type/s
Exudate type and amount
Odour
Surrounding skin
Signs of infection
Pain
Cleansing solution
Wound Product in use with instructions for application if specific to wound
Frequency of dressing change
For acute wounds you document each time you complete the wound dressing
For all wounds you should ensure there is documentation completed when the wound bed changes and at least weekly.

Question 19

What is periwound skin?

Answer 19

Skin around the wound

Question 20

Primary Wound Closure

Answer 20

Primary wound closure is the fastest type of closure - is also known as healing by primary intention. Wounds that heal by primary closure have a small, clean defect that minimizes the the risk of infection and requires new blood vessels and keratinocytes to migrate only a small distance. Surgical incisions, paper cuts, and small cutaneous wounds usually heal by primary closure. These wounds generally aren’t serious.

Question 21

Secondary Wound Closure

Answer 21

Secondary wound closure, also known as healing by secondary intention, describes the healing of a wound in which the wound edges cannot be approximated. Secondary closure requires a granulation tissue matrix to be built to fill the wound defect. This type of closure requires more time and energy than primary wound closure and creates more scar tissue. The majority of wounds close by secondary wound closure.

Question 22

TIME Wound bed preparation

Answer 22

Tissue - removal of necrotic and\or devitalised tissue and slough
Infection - recognition of wounds at high risk for infection, malodour, delayed healing, excessive exudate, pain, undermining borders. Prevention and treatment of wound infection
Moisture Imbalance - ensure adequate moisture balance of wound bed, eliminate excess exudate
Edge Advancement - create a microenvironment that promotes healing at the cellular level.

Question 23

Delayed Primary Closure

Answer 23

Occasionally, wounds are closed by delayed primary closure, also known as healing by tertiary intention. Delayed primary closure is a combination of healing by primary and secondary intention and is usually instigated by the wound care specialist to reduce the risk of infection. In delayed primary closure, the wound is first cleaned and observed for a few days to ensure no infection is apparent before it is surgically closed. Examples of wounds that are closed this way include traumatic injuries such as dog bites or lacerations involving foreign bodies.

Question 24

Granulation tissue

Answer 24

Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size.