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Principles of Wound Care

Professor Claire Hale

What is a Wound?
Any break in the continuity of body tissue

Examples:
grazes, burns, surgical incisions, stabs,
leg ulcers, decubitus ulcers ( pressure
sores)
Stages of Wound Healing

 Stage 1 - traumatic inflammation ( 0-3 days)-
redness, heat, swelling
 Stage 2 -destructive phase ( 2-5 days)-
polymorphs and macrophages clear the
wound of debris and stimulate new growth
 Stage 3- the proliferative phase( 3-24 days
increased collagen formation
 Stage 4- maturation phase ( 24 days-1 year)
scar tissue decreases granulating tissue gets
stronger and changes from reddish to pale

Closure of Surgical Wounds
 Primary closure - first intention
( direct suture- if no tissue loss
 Delayed primary closure- usually
when a drain is left in situ.
 Secondary intention - wound closes
by a process of contraction and
epithelialisation e.g ulcers and pressure
sores

Factors Influencing Wound Healing
 Good blood supply: ( oxygen, nutrients)
 Good nutrition:
 Rest: skin cells multiply more rapidly
during sleep
 Lack of stress: increased levels of adrenaline
and steriods delay healing
 Lack of infection:
 Age : children heal more rapidly than older
people
 Site of wound: face and neck heal more
rapidly

Factors Delaying Wound Healing
General factors
 poor diet
 anaemia
 pulmonary disease
 cardiac insufficiency
 arteriosclerosis
 diabetes mellitus
 smoking
 Jaundice
 malignant disease
 high blood urea
 stress
 lack of sleep
 drug therapy e.g.
steroids and
cytotoxic
 radiotherapy
Factors Delaying Wound Healing
Local to patient/wound

 skin edges not lined
up
 dead tissue in wound
 foreign bodies in
wound
 tension on wound




 infection
 irritant material for
suturing
 too tight suturing
Complications of wounds
 Haemorrhage ( surgical wounds)
 Infection
 non union
 rupture ( dehiscence)
 pressure and strain ( coughing vomiting)
 over granulation of scar tissue
 contractures

Caring for Wounds
Assess for:
 type of wound
 location of wound
 size of wound
 shape of wound
 level of exudate
 condition of wound bed
 condition of surrounding skin

Caring for Wounds
Recognising inflammation
 redness over area and surrounding
tissue
 swelling
 heat
 pain/ tenderness
 loss of function

Caring for Wounds
 cleansing wounds
 should it be done?
 what should be used?
 how should it be done/
 types of dressing
 who makes the decision

Cleansing wounds: an area where
ritualistic practice predominates

Key questions:
1. Does the wound really need cleaning?
2. What is the safest method that causes
no ill effects and maintains the wound
temperature?
3. What is acceptable to the patient?
Wounds that are clean and healthy do not
require cleaning and should be left alone

Cleansing wounds: Main reasons
 Excess exudate and signs of infection
 Foreign body contamination ( eg. grit in
a graze)
 Presence of devitalised tissue ( slough
or necrotic tissue)
 To assess the wound
 psychological reasons

Types of Cleansing Fluids
 Antiseptics: generally discouraged
now- can be toxic to tissue healing
 Saline solutions: normal saline
sachets commonly used
 Tap water: Why not!!
tip: cleansing fluids should be at body
temperature
Methods of Cleansing
 Swabbing: not particularly effective,
mainly redistributes organisms
 Bathing: useful for chronic wounds
such as leg ulcers. Take care with
equipment to avoid cross contamination
 Irrigation: shower head, waterjug,
syringes - don’t be overzealous
Choice of Dressing
The concept of moist wound healing

Modern dressing technology is based
on the principle that the wound
/dressing interface should be moist
rather than dry.

In other words scabs are bad!
Common characteristics of wound
dressings
 Capable of maintaining
high humidity at wound
site
 free of particles and
contaminants]
 non toxic / non
allergenic
 capable of protecting
the wound from further
trauma
 Impermeable to
bacteria
 thermally insulating
 capable of allowing
gaseous exchange]
 able to withstand
infrequent changes
 cost effective
 long lasting
Patient Factors Influencing the choice
of dressing:
 Age
 Lifestyle
 Medical History
 Care environment
 Ability to maintain /change own dressing
 Competence and willingness of
potential carers
Types of Dressings
 Low adherent dressings-Tullegras,Tegapore
 Semi permeable films- Opsite, Tegaderm
 Hydrocolloids - Comfeel plus, Granuflex
 Hydrogels- Intrasite, Sterigel
 Alginates- Sorbisan, Kaltostat
 Foam dressings- Cavicare, Lyofoam extra
 Antimicrobial dressings- Actisorb plus,
Inadine
Minimising Cross Infection
 Dressing and cleansing wounds is at
the very minimum a Clean Procedure
and is often an Aseptic Procedures
 Thorough hand-washing and use of
gloves are the most effective methods
of preventing contamination of the
wound
 If wounds are infected then care must
be taken to prevent cross
contamination