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CLASS 3 WOUND HEALING.pptx
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- 2. What is ‘WoundHealing’ • 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 ModelTypes • 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 WoundHealing • • 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 WoundHealing • 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 IntentionHealing • 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 IntentionHealing • 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 ofthe Phases of Wound Healing
- 15. Schematic Diagram ofthe Phases of Wound Healing
- 16. FACTORS AFFECTING WOUNDHEALING • 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 • Whatis 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 purposeof 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-adherentwound contact materials • Films • Hydrogels • Hydrofibre dressings • Hydrocolloids • Foams • Alginates • Miscellaneous
- 22. Dressing choice Film dressings •Semi-permeableprimary 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 •Advancedpolymer technology •Non-adherent wound contact layer •Highly absorptive •Semi-permeable •Various types •Adhesive and non-adhesive
- 25. Dressing choice Hydrogels •Sheets orgels •Starch and polyacrylamide (94% water) •Low exudate, shallow wounds •Re-hydrates necrotic tissue •Secondary dressing needed •May cause skin maceration
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