Wound healing Flashcards
Epidermis- one of two major layers
thin outer layer
- regenerates every 4 to 6 weeks,
- acts as a barrier
- temp. control
- sensations
Dermis
- Blood vessels (removes waste via capillaries
- Hair follicles
- Lymphatic vessels (removes waste via lymphatic gates)
- sweat glands
- Nerves
- proteins
- fibroblast, collage, and elastic fibers.
strength of skin
- Collagen gives strength to the skin
- Collagen bundles anchor to subcutaneous tissue
- Collagen is normally organized and aligned in a smooth collagen matrix
connection decreases as we age.
Wound healing
inflammation healing response to vascularized tissue.
-ultimate goal of response is to eliminate the pathological or physical insult, replace the damaged tissue, promote regeneration and restore function.
-body doesn’t know how to focus on just one thing.
inflammation is the first stage of wound healing.
Primary intention healing
sutured together- best healing type for a wound- will heal the fastest and the cleanest with the least amount of scaring.
steri-strips or surgical adhesive.
wound bed is closed and covered with skin.
Secondary intention healing
Heals from the bottom up. Was not closed surgically- pressure sores, blisters on our heals, edges are not brought together. Left to fill in.
Tertiary intention healing
There was a delay in closure- fisherman cuts hand, cat bites, human bites (have a lot bacteria), don’t want to close right away. need to be pumped with antibiotics and leave open to make sure they do not close the site with bacteria inside. Come back later and close it up after safe to do so.
combination of primary and secondary healing
Tensile strength
Strength of tissue
- load applied per unit of cross section area
- measured in newtons of force
- how much force the tissue can take before breaking/rupture
- fibrin contributes to its strength.
Tensile strength continued
- Skin achieves peak tensile strength by 60 days post injury in a healthy individual (8 weeks)
- This scar tissue has decreased vascularity
- Scar tissue strength is 70 to 80% of normal.
-At 4 weeks we can do scar massage (sometimes even sooner, wont be any fluid coming from it.
tensile strength timeline
4 weeks- 40% to 50%
6 weeks- 60%
8 weeks- 70% to 80%
at 4 weeks can come out of splint for some activities/motions to do active motion for 50% tensile strength
At 6 weeks- person can usually come out of splint. For a shoulder they have to wait until it is 60% tensile strength- MOST ADLs but no power griping (nothing heavier than toothbrush or spoon)
At 8 weeks- MAGIC NUMBER- we can start doing stuff such as strengthening a little bit, can do most of their ADLs with resistance, putty and stuff can be worked with.
For shoulder- strengthening doesn’t start until about 10 to 12 weeks.
Stages/phases of wound healing
Hemostasis -(sometimes considered a separate phase). Vasoconstriction followed by vasodilation- we start bleeding and body focuses to stop bleeding.
1) Inflammatory phase
2) Proliferative, fibroblastic stage, latent or reparative phase
3) Maturation, remodeling phase.
inflammatory stage
Usually lasts 3 to 5 days. Typically don’t use hot packs- it is already hot, red, and inflamed. We may elevate and massage the injury site.
-IN this stage, leukocytes migrate into the wound, followed by monocytes which convert to macrophages to clean up the area. Clotting occurs to stop bleeding.
0-6 days
Fibroblastic stage
Reparative stage- collagen is being laid down- collagen matrix is being formed and the wound is closing. A lot of scar tissue formation.
-This stage is characterized by wound contraction, scar synthesis, blood vessel proliferation and epithelialization. Collagen is being laid down at a rapid rate.
- This is where our most effective work is done.
- From day 7 to day 21
Maturation stage
After 3 years
- In this stage the collage matric is remodeled and the tissue changes over time. when things are being smoothed out.
- 21 days- 2 years
Epithelialization
When the skin seals shut. Closure of the skin. When all of the collage has been laid out.
Fibroblasts synthesizes and secretes collagen.
-Collagen closes or seals the opening in the skin.
Partial thickness wound
Tissue injury that extends partially through the dermis.
- Heals by epithelialization
- IF painful it is secondary to exposure of nerve endings.
Ex: Skin tears, Abrasions, Tape burns, non-bloody blisters
Full thickness wound
- Tissue destruction extending through the dermis to involving subcutaneous tissue.
- Healing process: Granulation, contraction, and epithelialization.
- Appearance can be snowy white, gray, or brown,
- Firm leathery texture
All scars want to be shorter which can cause problems with movement and like to stick to things under and around them.
Ex: Donor sites for grafting, venous ulcers-blood flow issues, surgical wounds
Tidy
what doctor did under sterile conditions
red wound
uninfected, granulation tissue, revascularization. wound is beefy red, without infection
-Granulation tissue is dark pink or red.
Tx focus is on protection and wound closure.
Whiteness is not okay- too much moisture in dressing that is wrapped around the hand. Or may have some vascular issues. Wound will head from the bottom up.
Yellow wound
Drainage, slough, delayed epithelization
Usually some drainage and will have a dressing on it. Slough is a yucky yellow stuff that has to come off.
- odor in wound is a sign of infection.
- requires debridement.
- fever and streaking redness are signs of infection.
Black wound
Eschar, necrotic tissue.
tissue is either dead or eschar- a build up of protein. Typically done by doctor.
Healing cannot progress.
- requires meticulous and timely debridement to decrease the risk of infection and promote healing by facilitating normal cellular response.
- requires surgery
Cellulitis
Inflammation of cellular or connective tissue.
Pearl: inflammation may be diminished or absent in immunosuppressed patients.
May present differently in others.
Cellulitis advancing
Cellulitis that is visibly spreading in the area of the wound.
- Inflammation of subcutaneous tissue with local redness, warmth and pain. Tender red streaks may be seen.
- circle to see if spreading.
Spider bites are very common for causing cellulitis
*antibiotics are necessary- its an infection.
massages can spread cellulitis.
Wound care
- clean wound immediately with mild diluted soap and water, saline or purified water. Do not use peroxide or iodine. These are too harsh and can damage tissue.
- Do apply pressure to stop bleeding ASAP. Maintain pressure for 5 minutes (allow for coagulation)
- Keep wounds covered and moist. Wounds were found to heal twice as fast with a little moisture vs being dry.
Comorbidities- affect the healing process.
