Wounds and their management 2 Flashcards
What is a chronic wound?
A wound that fails to progress through an orderly and timely sequence of repair
e. g. chronic wound or ulcer
- associated with delayed healing and reoccurrence
Describe a chronic wound
Considered stuck in between inflammatory and proliferation stages of healing
A range of causes
- extrinsic
- intrinsic
Usually very weepy - exudate management and odour control are important in chronic wound care
What are MMPs?
Matrix Metalloproteinases
What do chronic wounds contain?
Increased levels of inflammatory cells and elevated levels of proteases that degenerate the extracellular matrix
What are MMPs important for?
Breaking down proteins so that new tissue forms
What happens if the levels of MMPs are too high for too long in the wrong place?
Can delay healing
What are pressure ulcers also known as?
Bed sores
Pressure sores
Who usually suffers from pressure sores?
Mainly affect people with mobility issues and aging/weakened skin
- bed ridden
- elderly
What are the ranges of pressure sores?
Patches of discoloured skin to open wounds that expose the underlying bone or muscle
What is decubitus?
Simultaneous compression, friction and shear forces causing breakdown of local microcirculation
What causes ulcer formation?
Without a blood supply, the affected tissue becomes starved of oxygen and nutrients and begins to break down, leading to ulcer formation
Where are common pressure points for ulcer formation?
Heel
Buttocks
Sacrum
What is a venous ulcer?
Painful wound that occurs due to improper functioning of a weakened venous valve
Where do venous ulcers occur?
Lower leg
- leg ulcers
Why do venous ulcers occur?
Returning blood flow against gravity compromised
What is the major cause of chronic wounds?
Venous ulcers - occurring in 70% of chronic wound casesWhat is the common treatment for venous ulcers?
What is the common treatment for venous ulcers?
Topical treatment
Dressing
Compression bandage
Which disorder impedes the normal steps of the wound healing process?
Diabetes mellitus
What is a major complication of diabetes mellitus?
Diabetic foot ulcer
For diabetics, what can seemingly superficial cuts turn into?
Chronic wounds, infection and gangrene
What are the two major concerns with wounds and microbes?
Commensal pathogens
Pathogens on penetrating objects
Why do pathogens in a wound proliferate?
Nutrient rich environment
- some microflora unavoidable in wounds (unless surgical)
What are planktonic bacteria?
Free floating single bacteria
What can planktonic bacteria that have successfully colonised a wound do?
Rapidly evolve into a biofilm
What is a biofilm?
A shiny and slimy material covering the wound bed
Which species of bacteria in a wound produces a green/yellow colour with a putrid smell?
Pseudomonas
What problems can the presence of bacteria in the biofilm cause?
Cause or problem inflammation
Strain the body’s ability to fight infection
What percentage of chronic wounds have a biofilm?
Up to 90%
What percentage of acute wounds have a biofilm?
6%
What is debridement?
Removal of biofilm and dead tissue
- counteracts impeding factors
How is debridement carried out?
- surgical
- mechanical
- chemical
- autolytic
- larvae
How do larvae (maggots) gently remove necrotic tissue?
Proteolytic enzymes in saliva gently remove necrotic tissue, ingest and kill bacteria and inhibit inflammation
What is larvae debridement an effective treatment for?
Leg ulcers and other chronic wounds
How can you tell if a wound is infected?
A wound infection arises when microorganism colonies invade surrounding tissues, provoking an immune response
- risk of systemic infections or sepsis
