Wound management

Question 1

What are steps in the wound healing process?

Answer 1

1. Inflammatory phase: healing by first intention clot formation and neutraphil response)

2. Proliferative phase: new capillary growth, macrophages and fibroblast contribute to inflammatory clean up/tissue repair

3. Remodeling phase: wound contraction, fibrous replacement of tissue, fill in from bottom up in larger wounds

Question 2

Role of antiseptics & antibiotics in wound healing

Answer 2

Generally not necessary and may impede wound healing through toxic effects on normal tissue

Reserve antibiotic therapy for wounds that appear infected

EXCEPTIONS: Cadexomer iodine reduces bacterial load while providing moist environment, silver is toxic to bacteria but does not improve rate of wound healing

Question 3

What role does glycemic control play in wound healing?

Answer 3

• Extremely important, especially in high-risk surgical closures
• Poor glycemic control associated with worse outcomes
• Even a single elevated glucose value post-op is adversely associated with morbidity and mortality

Question 4

What are other factors in proper wound healing?

Answer 4

-Oxygenation: usual reasons for inadequate oxygenation are local vasoconstriction due to sympathetic overactivty (blood loss, pain, and hypotherma)

-Nutrition: suspect malnutrition in pts with chronic illnesses, inadequate social support, multisystem trauma, & GI or neuro problems

Question 5

Role of wound debridement

Answer 5

-promotes wound healing by limiting protease production and conserving local resources needed for healing

Question 6

Types of wound debridement

Answer 6

1. Low-pressure irrigation: with normal saline, should be routine, flushes bacteria and removes loose material

2. Surgical debridement: removes large areas of necrotic or infected tissue

3. Enzymatic debridement: has mixed results, collagenase may promote endothelial cell and keratinocyte migration for angiogenesis and epitheliziation

4. Biologic debridement: maggot therapy effective agains necrotic tissue (liquidization) but has sigma and ineffective against pressure ulcers

Question 7

What is becaplermin?

Answer 7

• Platelet derived growth factor that promotes cell proliferation & angiogenesis
• Only agent approved for treatment of chronic diabetic foot ulcers
• Has blackbox warning for malignancy for use of more than

Question 8

Epidermal growth factor and wound healing

Answer 8

does not significantly improve epithelization

Question 9

How should you dress a wound?

Answer 9

-keep moist and covered (heals 40% faster with less scaring if kept occluded)

Question 10

What should you include in the treatment plan for a wound in the debridement stage of healing?

Answer 10

Hydrogels

Question 11

What should you include in the treatment plan for wounds in the granulation stage of healing?

Answer 11

Foam and low-adherance dressings

Question 12

What should you include in the treatment plan for wounds in the epithelization stage of healing?

Answer 12

Hydrocoloid and low adherance dressings