Wound Healing Flashcards
What are the phases of healing?
Haemostasis
inflammation
repair
maturation
Describe the haemostasis phase
initial bleeding flushes wound
vasoconstriction (5-10mins)
Platelt pkuf formation - triggered by dmamge to blood vessel wall
Formaton of fibrin plug and eschar
Describe th inflammation pahse
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
Describe the repair phase
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
DEscribe the maturation phase
Wound edges meet, epithelisation is completed
Redness reduces
Remodelling and reorganisation of connective tissues
Wound strength improves to around 70-80% of normal tissue
What factors promote wound healing?
Moist wound environment Good nutrition Tissue oxygenation Limited movement of wound edges Clean wound and good immune system
What factors delay wound healing?
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
How do you assess wound managemtn?
Assess whole patient initially and stabilise Time since injury Contaimination Necrosis Concrrent disease/medication
What wound closure is used for a clean wound? DEscribe the management
Primary wound closure
Immediate closure with no tension
What wound closure is used for a clean-contaminated/ contaminated wound? Descirbe the management
Delayed primary
Lavage and debridemnt until healthy
Appropraite dressing, closure after 2-3days
What wound closure is used for a contaminated/dirty wound? Descirbe the management
Seconday
Lavage and debridement
Appropraite dressing
Closure after 5-7 days granulation bed has begun to form
What wound closure is used for a extensive contamination and devitalisation wound? Descirbe the management
Second intention Open wound management Lavage and debridemnt Appropraite dressing Allowed to heal
Describe wound preparation
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
Give exmaples of closure techniques
Sutures
Staples
REconcstruction
Surgical drain
Give exmaples of wound problems
Devitalised tissue
Exudating wounds
Infection
How is devitalised tissue treated?
Provide optimum conditions for growth of bacteria
DElays the inflammatory pahse
REduces viability of wound bed
REquired debridement
How are exudating wounds treated?
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
Descirbe an infected wound
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
