Wound Management & Healing Flashcards
learn the phases of wound healing and how to manage them
Inflammatory Phase
Begins immediately and lasts 3-5 days; platelets aggregate to form a fibrin clot, controls bleeding, and stabilizes wound edges; neutrophils and macrophages arrive to direct wound healing and remove bacteria and cellular debris
Proliferative Phase
Begins 3-5 days after injury and lasts 2-4 weeks; characterized by invasion of fibroblasts, formation of granulation tissue, deposition of collagen, epithelialization, and wound contraction by myofibroblasts
Granulation Tissue
Creates a surface for re-epithelialization, consists of fibroblasts, myofibroblasts, endothelial cells, inflammatory cells, and new blood vessels; appears pink with a cobblestone appearance
Angiogenesis
Formation of new blood vessels
Epithelialization
Process where epithelial cells cover the wound with new skin; starts 4-5 days after injury, begins at wound edges and moves inward
Maturation Phase
Final phase of healing, begins ~3 weeks after initial injury and can continue for weeks and months; involves remodeling and realignment of collagen fibers along tension lines
Factors Influencing Wound Healing
Include patient health, wound classification, and concurrent wound treatment; patient factors such as age, endocrinopathies, chronic infections, orthopedic & neurologic conditions, nutritional status, and obesity can affect healing
Clean Wound
Atraumatic and surgically created under aseptic conditions
Clean Contaminated Wound
Created by controlled, surgical entry into contaminated areas with minimal contamination that is easily removed
Contaminated Wound
Recent traumatic wound with bacterial contamination or major contamination by bacteria from GI or urogenital tract
Dirty Wound
Older wound with obvious infection, such as an abscess, bite wound, puncture wound, or necrotic tissue
Steps in Proper Wound Management
- Prevent further contamination
- Remove foreign debris and contamination
- Debride nonviable tissue
- Manage wound drainage
- Protect the wound through the inflammatory and proliferative phases
- Select appropriate wound closure
Cleaning Wounds
Involves wearing gloves, covering and filling the wound with sterile lubricant, using chlorhexidine or Betadine for cleaning, and flushing the wound with LRS or 0.9% NaCl
Wound Debridement
Process of removing contaminated, devitalized, or necrotic tissue from a wound; can be done surgically or mechanically
Staged Surgical Debridement
Involves repeated surgical debridement procedures to remove compromised tissue and questionable tissue left for possible removal later; commonly used for large wounds with substantial trauma
En Bloc Excision
Debridement achieved by surgically excising completely around the wound and closing with primary closure; commonly used on small wounds
Mechanical Debridement
Nonselectively debrides heavily contaminated wounds using an adherent bandage layer, such as a wet-to-dry bandage; used only in the inflammatory phase
Biological Example
Maggots used to ingest necrotic tissue, beneficial for chronic wounds with poor tissue health
Dead Space
Space created by tissue separation after surgery or trauma, fills with blood or serosanguinous fluid, excessive fluid accumulation impedes healing
Minimizing Dead Space
Important in wound management to prevent fluid accumulation and infection, drains may be used for extensive dead space
Wound Drains
Devices used to manage fluid drainage in wounds, categorized as passive, active, or negative pressure wound therapy
Passive Drains
Allow fluid to flow along the drain surface via capillary action, placed in a dependent location for gravity drainage
Active Drains
Create a vacuum within the wound for fluid removal, used for extensive wounds, removed when fluid production decreases
Negative Pressure Wound Therapy
Controlled vacuum application for wounds unsuitable for normal drains, benefits include increased vascularization and reduced wound size
Primary Closure
Direct surgical closure of fresh, clean wounds with sutures/staples, promotes rapid healing without granulation tissue
Delayed Primary Closure
Closure method for older contaminated wounds, initially treated open for drainage before surgical closure
Secondary Closure
Closure method for infected or failed primary closures, wound allowed to form granulation tissue before closure
Second Intention Wound Healing
Healing method for older or infected wounds without surgical intervention, slower than primary closure with potential disadvantages
Abrasion
Partial thickness dermal wounds that heal easily due to minimal dermal damage
Laceration
Deeper wounds caused by tearing or cutting of skin and deeper tissues, minimal trauma to surrounding tissue
Degloving Injury
Tearing off a large section of skin from underlying tissues, common in vehicular trauma, requires aggressive wound care
Penetrating Wounds
Wounds caused by bites, bullets, etc., challenging to assess extent of injury, may lead to dead space accumulation
Burn Classification
First-degree burns involve the outermost skin layer, second-degree burns affect epidermis and dermis, third-degree burns penetrate deep dermal layers
Decubital Ulcers
Pressure sores from prolonged skin compression, common in recumbent patients, preventive care includes soft bedding
Exuberant Granulation Tissue
Excessive granulation tissue hindering wound healing, managed by various methods including surgical excision
