CABANBAN, MARIELLE

TACDER, RABIN ROY

WOUND
HEALING
WARD CLASS

OCTOBER 16, 2020
2:00 - 4:00 PM
ZOOM MEETING
 WHAT:
A wound is a break in the continuity of the skin, the
break caused by violence or trauma to the tissue,
with or without loss of underlying connective tissue.
 WHAT IS WOUND
HEALING?
It is a complex and dynamic process of replacing
devitalized and missing cellular structures and tissue
layers.
It is important in restoring normal function to the
tissue.
 WHAT IS WOUND
HEALING?
There are two main types of healing, primary
intention and secondary intention.

In both types, there are four stages which occur;

haemostasis, inflammation, proliferation, and
remodelling.
Factors that affect

WOUND
HEALING
 AGE OF
PATIENT

1
Skin gets thinner and the body shows a

decreased inflammatory response meaning that,

as you get older, your skin is predisposed to

injury and will heal slower when injury occurs.

 INFECTION

2
All skin breaks can allow bacteria, virus, or

fungus to enter the wound site. Normally, these

pathogens are overtaken and eliminated by

white blood cells and other components of the

immune system.
 NUTRITION

3
Proper nutrition is vital to optimal healing. A

wound is unable to heal properly if you lack the

necessary nutrients for cell repair and growth.

 TYPE OF
WOUNDS

4
The characteristics of a wound can affect the

speed of wound healing. Linear wounds

typically heal faster than rectangular wounds,

and circular wounds are the slowest to heal.

 REPEATED
TRAUMA

5
If you have multiple wounds or have undergone

a severe trauma (e.g. surgery) your body’s

defense mechanisms will be limited and slow

wound repair.
 SKIN
MOISTURE

6
Skin needs an adequate amount of fluid and

moisture to be viable. If you’re prone to dry skin

(especially common in the elderly) you may be

at risk for skin lesions, infection, and thickening,

which will all impair wound healing.

 CHRONIC
CONDITIONS

7
Chronic diseases have a direct impact on the

body’s natural ability to heal. Examples are

cardiovascular diseases, diabetes, and

immunodeficiency conditions.
MEDICATION

8
Prescription medications can have a negative

effect on healing. Examples are nonsteroidal

anti-inflammatory drugs and OTC aspirin and

ibuprofen.
 PATIENT
BEHAVIORS

9
Unfortunately, some patients contribute to

delayed wound healing through lifestyle choices

like smoking or excessive drinking.

WOUND
assessment
 Tissue Loss
The degree of tissue loss may be referred to in broad
terms as:

SUMMER

ENDS 15.03.19 ENDS 15.03.19

Superficial Wound Partial Wound Full - Thickness

 Wound bed clinical
appearance:
GRANULATING
It presents as pinkish/red coloured moist tissue
and comprises of newly formed collagen, elastin
and capillary networks.
The tissue is well vascularised and bleeds easily.
GRANULATION
 Wound bed clinical
appearance:
EPITHELIALIZING
It is a process by which the wound surface is
covered by new epithelium. The tissue is pink,
almost white, and only occurs on top of healthy
granulation tissue
EPITHELIALIZATION
 Wound bed clinical
appearance:
SLOUGHY
The presence of devitalised yellowish tissue is
observed and is formed by an accumulation of
dead cells. Must not be confused with the
presence of pus.
SLOUGHY
 Wound bed clinical
appearance:
NECROTIC
It describes a wound containing dead tissue. The
wound may appear hard, dry and black. Dead
connective tissue may appear grey. The presence
of dead tissue in a wound prevents healing.
NECROTIC WOUND
 Wound bed clinical
appearance:
HYPER GRANULATION
This is observed when granulation tissue grows
above the wound margin. This occurs when the
proliferative phase of healing is prolonged
usually as a result of bacterial imbalance or
irritant forces.
OVERGRANULATION
 Wound measurement:

All wounds require a two-dimensional assessment of

the wound opening and a three-dimensional
assessment of any cavity or tracking
Two-dimentional
Assessment
- It can be done with a paper tape to measure the
length and width in millimetres.
- The circumference of the wound can be traced if the
wound edges are not even
Third-dimentional
Assessment
- the wound depth is measured using a dampened
cotton tip applicator.
 Wound edges:
The edges of the wound are assessed for:

COLOUR
- pink edges indicate growth of new tissue
- dusky edges indicate hypoxia
- erythema indicates physiological inflammatory
response or cellulitis
 Wound edges:
EVIDENCE OF
CONTRACTION
- wound edges
coming together
indicate the healing
process is occurring.
 Wound edges:

RAISED ROLLED
may indicate hyper can inhibit healing.
granulation tissue
 Wound edges:
CHANGES IN SENSATION
- increased pain or the absence of
sensation should be further investigated.
 Exudate:
It is produced by all acute and chronic
wounds (to a greater or lesser extent)
as part of the natural healing process.
 Exudate:
It plays an essential part in the healing process in that
it:
Contains nutrients, energy and growth factors for
metabolising cells
Cleanses the wound
Maintains a moist environment
Promotes epithelialisation
 Exudate:

- Excess exudate leads to maceration and degradation

of skin

- Too little can result in the wound bed drying out.

 Surrounding skin:
The surrounding skin should be examined carefully as
part of the process of assessment and appropriate
action taken to protect it from injury.
 Presence of infection:
LOCAL INDICATORS OF INFECTION:
Redness (erythema or cellulitis)
Exudate- a change to purulent fluid or an
increase in amount of exudate
Malodor
Localized pain
Localized heat
Edema
 Pain:
- Pain can be an important indicator of abnormality.

- The pain associated with chronic wounds and

wounds that require frequent dressing changes can be
underestimated.
WOUND
management
 Acute Wound Healing
The goal of wound cleansing is to:

Remove visible debris and devitalised tissue

Remove dressing residue
Remove excessive or dry crusting exudates
Reduce contamination
 PRINCIPLES OF WOUND
CLEANSING
Use Aseptic Technique procedure
- a non-touch technique is used to protect key parts
and key sites. If a key part or key site is to be touched
directly then sterile gloves must be worn.
 PRINCIPLES OF WOUND
CLEANSING
Cleansing should be performed in a way that
minimises trauma to the wound as new epithelial
cells and vessels are fragile.
Wounds are best cleansed with sterile isotonic saline
or water, warmed to body temperature.
PRINCIPLES OF WOUND
CLEANSING
Irrigation is the preferred
method for cleansing open
wounds.

Gauze swabs and cotton

wool should be used with
caution.
 CHOICE OF DRESSING
Much research has demonstrated that moisture
control is a critical aspect of wound care.
The appropriate dressing can have a significant
effect on the rate and quality of healing.
The appropriate dressing will help to minimize
bacterial contamination and pain associated with
wound care.
 Recommended dressings include:
Hydrocolloid
- can be used on burns, wounds
that are emitting liquid,
necrotic wounds, pressure
ulcers, and venous ulcers.
- These are non-breathable
dressings that are self-adhesive
and require no taping.
Recommended dressings include:

Hydrogel
- can be used for a range of
wounds that are leaking little
or no fluid, and are painful or
necrotic wounds, or are
pressure ulcers or donor sites.
Recommended dressings include:

Alginate
- are made to offer effective
protection for wounds that
have high amounts of drainage,
and burns, venous ulcers,
packing wounds, and higher
state pressure ulcers.
 Recommended dressings include:

Collagen
- can be used for chronic
wounds or stalled wounds,
pressure sores, transplant sites,
surgical wounds, ulcers, burns,
or injuries with a large surface
area.
 Recommended dressings include:

Foam
- can work incredibly well, as well
as for injuries that exhibit odours.
Foam dressings absorb exudates
from the wound’s surface,
creating an environment that
promotes faster healing.
Recommended dressings include:

Transparent
- are useful for when medical
professionals or carers want to
monitor wound healing, as these
dressings cover the wound with a
clear film.
Recommended dressings include:

Cloth
- are the most commonly used
dressings, often used to protect
open wounds or areas of broken
skin. They are suitable for minor
injuries such as grazes, cuts or
areas of delicate skin.
 CHRONIC WOUND
MANAGEMENT
Determine the aetiology for inhibition of wound
healing. Address or control the factors identified for
example: presence of infection, poor nutritional status,
appropriate dressing selection, moist wound
environment.
WOUND HEALING
COMPLICATIONS
 INFECTION
The most common wound care complication
COMMON CAUSE:
Staphylococcus
Streptococcus
Pseudomonas.
 INFECTION
They are categorized in three ways:
Superficial incisional SSI
Deep incisional SSI
Organ or space SSI
TREATMENT:
- can be treated using only antibiotics.
- More severe SSIs may require additional surgery or
procedures
 OSTEOMYELITIS

- It is an infection of the bone, a rare but serious

condition.
- In patients with diabetes-related foot ulcers,
infection is among the most common reasons for
hospitalization.
 OSTEOMYELITIS
The most common types of bacteria:
Staphylococcus
Pseudomonas
Enterobacteriaceae.
OSTEOMYELITIS
 BACTEREMIA
- the presence of bacteria
in the bloodstream.

- may result from ordinary activities (such as vigorous

toothbrushing), dental or medical procedures.
 SEPSIS
- potentially life-threatening condition caused by the
body's response to an infection.

- the body's response to these chemicals is out of

balance, triggering changes that can damage multiple
organ systems.
 DEHISCENCE
Wound dehiscence is the separation of the edges
of a surgical wound.
It may be just the surface layer or the whole
wound.
It may become a serious problem.
 CAUSES
Some general causes include:
Infection at the wound
Pressure on sutures
Sutures are too tight
New injury to the area
Weak tissue or muscle at the wound area
Incorrect suturing at time of surgery
 TREATMENT
Antibiotics if an infection is present or possible
Changing wound dressing often to prevent
infection
Open would to air—will speed up healing, prevent
infection, and allow growth of new tissue from
below
Negative pressure wound therapy—a dressing that
is to a pump that can speed healing
 PERIWOUND DERMATITIS
Periwound is the tissue surrounding a wound.
When not properly cared for, dermatitis may
occur, turning the periwound area red, swollen,
and sore, sometimes with small blisters.
TREATMENT:
Proper wound dressing.
Use barrier creams and/or ointments to prevent
and protect the skin from moisture, primarily from
incontinence.