Wound Healing

Question 1

What are the phases of healing?

Answer 1

Haemostasis
inflammation
repair
maturation

Question 2

Describe the haemostasis phase

Answer 2

initial bleeding flushes wound
vasoconstriction (5-10mins)
Platelt pkuf formation - triggered by dmamge to blood vessel wall
Formaton of fibrin plug and eschar

Question 3

Describe th inflammation pahse

Answer 3

triggered within 6rs of injury
vasodilation and inflammatory response
Neutophils (0-3 days), monocytes and macrophages (2-7days) enter wound to phagocytose bacteria and derbis
T lymphocyte release

Question 4

Describe the repair phase

Answer 4

Eschar sloughs, epithelisation - new epidermal cells fromed at wound edges
Granulation tissue - connective tissue develops from fibrin plug, new capillaries develop and collagen forms
Wound contraction - area of wound reduces, surrounding skin stretches

Question 5

DEscribe the maturation phase

Answer 5

Wound edges meet, epithelisation is completed
Redness reduces
Remodelling and reorganisation of connective tissues
Wound strength improves to around 70-80% of normal tissue

Question 6

What factors promote wound healing?

Answer 6

Moist wound environment 
Good nutrition 
Tissue oxygenation 
Limited movement of wound edges
Clean wound and good immune system

Question 7

What factors delay wound healing?

Answer 7

Excessively dry or exudating wound
Poor circulation - shock, concurrent conditions, age, recumebcny
Lack of essential amino acids
Lack of oxygen delivery and waster removal from tissues
Excessive wound edge tension, patient interfercen, damage of dressing changes
Infection

Question 8

How do you assess wound managemtn?

Answer 8

Assess whole patient initially and stabilise
Time since injury 
Contaimination 
Necrosis 
Concrrent disease/medication

Question 9

What wound closure is used for a clean wound? DEscribe the management

Answer 9

Primary wound closure

Immediate closure with no tension

Question 10

What wound closure is used for a clean-contaminated/ contaminated wound? Descirbe the management

Answer 10

Delayed primary
Lavage and debridemnt until healthy
Appropraite dressing, closure after 2-3days

Question 11

What wound closure is used for a contaminated/dirty wound? Descirbe the management

Answer 11

Seconday
Lavage and debridement
Appropraite dressing
Closure after 5-7 days granulation bed has begun to form

Question 12

What wound closure is used for a extensive contamination and devitalisation wound? Descirbe the management

Answer 12

Second intention 
Open wound management 
Lavage and debridemnt 
Appropraite dressing 
Allowed to heal

Question 13

Describe wound preparation

Answer 13

Swab for culture and sesitivty
Keep covered with sterile, non-linting dressing prior to preparation
Esnure analgesia is adequate
GA usually required
Insert water soluble jelly into wound
Clip around wound - total injury should be visible, clip passed unviable tissue and provide a 2cm margin
Debridement

Question 14

Give exmaples of closure techniques

Answer 14

Sutures
Staples
REconcstruction
Surgical drain

Question 15

Give exmaples of wound problems

Answer 15

Devitalised tissue
Exudating wounds
Infection

Question 16

How is devitalised tissue treated?

Answer 16

Provide optimum conditions for growth of bacteria
DElays the inflammatory pahse
REduces viability of wound bed
REquired debridement

Question 17

How are exudating wounds treated?

Answer 17

Exudate is a notmal part of the imgallmmatory process
Excess, prolonged, infected or fresh bleeding is abnormal
May indicate increased bacterial burden, oedema, excess movement, patient interfercen etc.
Check underlying cause, ensure correct wound dressing is selected, ensure bandgaechanes are appropariate frequency, protect periwound tissue with barrier cream

Question 18

Descirbe an infected wound

Answer 18

Develoepment - contamination, colonisation, critical colonsastion, infection
Signs - erythema, pain , oedema, localised heat
Biofilm - protectice coatinf produced y bactiera. CAuses folding in of skin edges
Causes damage or deteriation of the wound healing
Check wounf is properly debrided and cleaned, exudate level is managed, antimicrobial dressings