Wound healing involves a cascade of biological events that results in a closed wound. There are different types of wound healing depending on the depth and severity of the wound. The normal wound healing process consists of three main phases - inflammation, proliferation, and remodeling. Many factors can affect wound healing including the characteristics of the wound and patient as well as how the wound is managed and dressed. Proper wound assessment and choosing the right dressing are important for optimizing the healing process.

1. Wound Healing

2. What is ‘Wound Healing’
• Cascade of immunologic and biologic events resulting in a closed
wound
• Acute wounds proceed through the processes involved in wound
healing in an orderly and timely manner
• Chronic wounds fail to heal in a timely and orderly manner
• Viability of tissues will determine the course and quality of healing

3. Wound Healing Model Types
• Superficial wound healing
• Primary intention wound healing
• Delayed primary intention wound healing
• Partial thickness wound healing
• Full thickness/secondary intention healing

4. Superficial Wound Healing
• Ulcerations in the superficial skin
• Soft tissues heal themselves over time via inflammatory repair
process
• I.e. stage I pressure ulcer, superficial burn, or contusion

5. Primary Intention Wound Healing
• • A.k.a. Surgical wound healing
• Connective tissue deposition and epithelialization
• No granulation tissue formation or wound contraction

6. Delayed Primary Intention
• Wound left open to:
• Promote drainage • Reduce bacterial burden
• Later (often within seven days) surgically closed

7. Partial Thickness Wound Healing
• Wounds with loss of the epidermis or partial thickness skin loss of the
dermis
• Heal by epithelialization/regeneration
• Wound edges
• Dermal appendages
• Normal appearance and function
• I.e. abrasions, skin tears, stage II pressure ulcers, blisters, and partial
thickness burn

8. Full Thickness/Secondary Intention Healing
• Most effective method when:
• The wound extends through all
layers of skin
• High microorganism count
• Debris or non-viable tissue
present

9. Full Thickness/Secondary Intention Healing
• Involves inflammation,
epithelialization, proliferation, and
remodeling
• Scar tissue formation and contraction
• Replacement tissue will have less
elasticity/tensile strength

11. Chronic Wound Healing
• Associated with secondary intention
• A chronic wound is one that has “failed to proceed though an orderly
and timely process to produce anatomic and functional integrity, or
proceeded through the repair process without establishing a
sustained anatomic and functional result”

12. Wound Healing Phases
• Every wound is unique, “with a unique set of physiologic and
social circumstances preventing or retarding wound healing”
• The normal wound repair process consists of three phases that
occur in a predictable sequence : ▫ Inflammation ▫ Proliferation ▫
Remodeling

13. Schematic Diagram of the
Phases of Wound Healing

15. Schematic Diagram of the
Phases of Wound Healing

16. FACTORS AFFECTING WOUND HEALING
• Intrinsic factors (underlying pathology)
• Extrinsic factors (environmental influences)
• Iatrogenic factors (inappropriate management)

17. Wound characteristics
• Exudate
• Odour
• Condition of tissue
within the wound
• Condition of the
surrounding skin
The surrounding skin
 Eczema
 Psoriasis
 Maceration/excoriation
due to exudate or
bowel contents
 Self-inflicted damage

18. Monitoring healing progress
• Wound dimensions
• Photography
 Wound assessment
charts
Frequency of
assessment
 Plan of care
 Useful information
Other methods

19. Dressing choice
• What is available?
• How do we choose?
• Does the patient have a say?
• Do we consider cost?
• Are choices restricted by a protocol?
• How do we evaluate?

20. Dressing choice
The purpose of
dressings:
•To aid debridement
•To remove excess
exudate
•To control bleeding
•To protect a wound
•To support healing
The ideal dressing
A dressing that
creates the optimum
environment
Wound debridement
Wound cleansing
Alternative therapies

21. Dressing choice
• Non-adherent wound contact materials
• Films
• Hydrogels
• Hydrofibre dressings
• Hydrocolloids
• Foams
• Alginates
• Miscellaneous

22. Dressing choice
Film dressings
•Semi-permeable primary or secondary
dressings
•Clear polyurethane coated with adhesive
•Conformable, resistant to shear and tear
•Do not absorb exudate
•Examples: Tegaderm, Op-site.

23. Dressing choice
Hydrocolloids
• Pectin, gelatin, carboxymethylcellulose and
elastomers
• Environment for autolysis to debride sloughy or
necrotic wounds
• Occlusive --> hypoxic environment to
encourage angiogenesis
• Waterproof
• Different presentations e.g. Urgotul

24. Dressing choice
Foam dressings
•Advanced polymer technology
•Non-adherent wound contact layer
•Highly absorptive
•Semi-permeable
•Various types
•Adhesive and non-adhesive

25. Dressing choice
Hydrogels
•Sheets or gels
•Starch and polyacrylamide (94% water)
•Low exudate, shallow wounds
•Re-hydrates necrotic tissue
•Secondary dressing needed
•May cause skin maceration

26. THANK YOU