Mechanisms of Wound Healing

• Wound bed: necrosis and granulation tse

Healthy granulation tse is pink
Dark red, easily bleeds on contact,
may indicate wound infection
Excess granulation may be associated
w/infection or non-healing wound
Necrotic tss (black areas)
• Surrounding skin: color, moisture, suppleness
Periwound – the tse surrounding the
wound
Cellulitis – nfxn of the skin and
underlying soft tse
Maceration – softening and breaking
of skin from prolonged exposure to
moisture
• Wound edge – not diagnostic but may help
identify its etiology from hx.

WOUND ASSESSMENT LAB. TEST

• TcPO2 – transcutaneous oximetry
Albumin – CHON, produced by liver
diminished in severe burn wounds,
malnutrition, liver dse
• Prealbumin – CHON, produced by the liver, a
better indicator for changes in nutritional
status. Diminished in widespread tse damage,
malnutrition, CHON wasting
• Hgb AIc – composed of hgb A w/a glucose
molecule, an indicator of long-term glucose
control
• CBC • Odor and exudates
• Size, depth and location of the wound • Infection
Measure @ 1st presentation, and • Quality of life
regularly thereafter
Mgnt. Of clients w/wounds: Medical and Surgical
mgnt.
• Management depends on the type of wound
• Wound from surgical procedure:
1. Ongoing assessment of the surgical site:
Approximation of wound edges
Integrity of sutures or staples
Redness, discoloration, warmth,
swelling, unusual tenderness
Rxn to tape of trauma to tight
bandage
2. Caring for surgical drains
Penrose, Jackson-Pratt

3. Changing the dressing

By surgical team member, then by a
nurse
Reasons for applying dressing to
wound:
a. To provide proper environment
for proper wound healing
b. To absorb drainage
c. To immobilize the wound
d. To protect wound and new
epithelial tse from injury
e. To protect wound from bacterial
contamination
f. To promote hemostasis like in
pressure dressing
g. To provide mental and physical
comfort
Observe sterile or clean technique
when doing dressing change
 Wound cleansing: usually w/normal
saline
Povidone-Iodine (betadine) and
hydrogen peroxide should not go
deep into the tse w/o thru rinsing,
only used for initial cleansing
Hypoallergenic tape if necessary,
porous prevents maceration
Disinfect sol’n per MD
During dressing change, the nurse has
the opportunity to educate the px.
4. Px education =: wound care instructions. Until
sutures are removed:
a. Keep wound dry and clean
b. Immediately report any signs of nfxn
c. For soreness and pain, apply dry cool
pack, or take prescribed medication
d. Elevate affected part as swelling is
common postop
: After sutures are removed
a. Cont. monitoring, still tender and
continues to heal
WOUND DEBRIDMENT
GOALS OF DEBRIDEMENT:
1. Removal of devitalized tse or burn eschar in
preparation for grafting and wound healing
2. Removal of tse contaminated by bacteria and
foreign bodies
TYPES OF DEBRIDEMENT:
1. Natural debridement
2. Mechanical debridement
3. Chemical debridement
4. Surgical debridement
WOUND GRAFTING
• A surgical procedure of removing skin from
one area of the body and transplanting it to a
different area of the body
• May be done when there is lost of protective
covering of skin from deep burns, skin nfxn,
large open wounds, or bedsores or other ulcer
that have not healed well
• Can reduce risk of nfxn, prevent further loss
of CHON and electrolytes
• Aesthetics
• Autografting – the preferred autologous
method for definitive burn wound closure
after excision
• Autografts are px. Own skin therefore are not
rejected by our immune sys.
• CEA (Cultured Epidermal Autograft)
A tse grown from one’s own skin cells
for use in placing on the person’s own
body
Maintenance or growth of cells in the
incubator after removal from the
body
Care of the Graft Site:
1. Protection is the key goal
Occlusive dressing initially to
immobilize the graft
OT may construct splint to immobilize
grafted area
Homograft, xenograft or synthetic
dressings are used to protect grafts
2. 1st dressing change usually performed 2-5
days
3. Monitor sign of bleeding and nfxn
4. Px is turned and positioned carefully to avoid
disturbing the graft or putting pressure to
graft
5. Exercise of the grafted area may begin 5-7
days
6. If extremity has been grafted elevate to
minimize edema
Disorders of Wound Healing
1. Delayed wound healing
2. Wound nfxn
3. Wound disruption
4. Others
• Delayed wound healing or non-healing
chronic wound
There is interruptions, aberrancies or
prolongation of the healing process
From tse trauma from surgery,
previous radiation therapy,
inadequate nutrition, or infection
• Mgnt: delayed wound healing
Determine cause
Minimize pressure on he wound site
to promote circulation to the tss
Aseptic, non traumatic dressing
promotes healing
Monitoring of lab results to initiate
interventions that promotes
homeostasis and wound healing
Repositioning px frequently to
prevent further skin breakdown
Medical and surgical mgnt
Special therapeutic bed
• Wound nfxn
For surgical incision, the doctor will
remove suture and put a drain
 Deep wound may require incision and ❖ Common form is WET-TO-
drainage antimicrobial therapy DRY dressings – an open
mesh gauze is moistened
• Wound disruption w/NSS packed on or into the
Dehiscence and evisceration wound surface and allowed to
Serious complications esp. for dry
abdominal incision ❖ Topical antimicrobials ex.
Place px in a Low Fowler’s and Betadine; Dakin’s sol’n (Na+
instruct to lie quietly hypochlorine); hydrogen
Cover w/a sterile dressing moistened peroxide; chlorhexidine
w/normal saline ❖ Wound irrigation
Notify surgeon immediately ❖ Whirlpool
Note: mechanical debridement should not be used in
Complication of wound Healing a clean granulating wound
a) Hypertrophic scars – an inappropriately large, 3. Autolytic debridement
red, raised and hard ❖ Semiocclusive or occlusive
b) Keloid formation – greater protrusion of scar dressings used to promote
tse that extends beyond the wound edges and softening of eschar by
may form tumor like a mass; permanent autolysis
c) Contracture – shortening of muscle or scar tse 4. Enzymatic debridement
result from excessive fibrous tse formation, ❖ Use of drugs that are topically
esp. near the joint applied to the necrotic tse in
d) Evisceration – separation of wound edges, the wound and then covered
intestine protrudes thru the wound w/saline – moistened gauze
e) Adhesion – bands of scar tse b/n or around ex. Collagenase
organs Hyperbaric O2 Therapy – delivery of O2 @increased
atmospheric pressure
Mgnt:
a) Drug therapy
Antipyretic drugs
Anti-inflammatory
❖ Salicylates
❖ Corticosteroids – interfere
w/tse granulation, induce
immunosuppressive effects
❖ NSAIDS
Vitamins
❖ Vit. A – accelerates
epithelialization
❖ Vit. B complex – act as
coenzymes
❖ Vit. C – synthesis of collagen
and new capillaries
❖ Vit. D – facilitates Ca
absorption
b) Nutritional therapy
c) RICE – rest, ice, compression, elevation
d) Immobilization – decrease metabolic needs
e) Debridement
1. Surgical debridement
2. Mechanical debridement
❖ Use when minimal debris is
present