Wound healing

Question	Answer
refresher-anatomy	integumentary system 3 layers -epidermis, dermis, hypodermis (subcutaneous layer)
types of wounds	surgical -caused by excision, incision traumatic- mechanial, thermal, chemical, destruction chronic - pressure ulcers implications to practice- determines wound closure
three types of wound closure	primary - first intention secondary - intention, granulation tertiatry - intention, delayed primary closure
primary intention	health edges incised wound minimal infection - strict aseptic technique minimal trauma to wound no tissue loss no dead space minimal drainage
secondary intention	occurs when wound edges cannot be joined together wound left open to heal from inside to outside typically for infection large scar, skin contractions, prolonged healing
tertiary intention	delated primary closure typically seen - inflamed, contaminated, traumatic, haemodynamically unstable closure delyaed
3 phases of wound healhting	inflammatory (reactive), proliferative (regenerative), remodelling (maturation)
inflammatory phase	inflammatory response, migration of exudate, increased blood supply, vascular response, cellular response to fight infection, formation of scab, lasts 1-4 days
proliferative phase	allows new epithelial to cover wound occurs within hours of injury cells migrate and proliferate to close defect collagen synthesis, wound contraction occurs formation of granulation tissue surgical implications - may need skin graft
remodeling phase	late process - begins 2-4 weeks after injury can last up to 1 year scar tissue formed during fibroplasia break down and regeneration of collagen scare ages, fibre bundles closelyy packed best tensile strength 80% approx
factors influencing wound healing	patient factors - nutrition, oxygenation, age, disease state Perioperative factors - maintanence of body temp, consequences of hypothermia
causes of delayed wound healing	patient factors age, stress, immunological status, smoking perioperative factors SSI, aseptic technique, antibiotic prophylaxis criteria for SSI superficial, deep, organ/space
Intraoperative tissue handling	length, direction, dissection technique (blunt/sharp) amount of tissue handling, retraction technique, achievement of haemstasis, precise tissue approximation, elimination of dead space, secure wound closure
wound classification	CDC classification system class 1 - clean wounds class 2 - clean contaminated wounds class 3 - contaminated wounds class 4 - infected wounds
clean - class 1 wounds	uninfected wound no inflammation
clean contaminated wounds - class 2	operative wounds, nil unusual contamination, controlled conditions
contaminated wounds - class 3	open, fresh, accidental wounds, major breaks in sterile techniques, nonpurulent inflammation is encountered
dirty/infected wounds - class 4	includes old traumatic wounds, retained tissue, involve existing clinical infection or perforated viscera
complications of wound healthing	dehiscence, eviceratoin, haemorrhage, infection, fistula
factors preventing dehiscence	long paramedian incision adequacy of closure intraabdominal pressure deficient wound healing infection
factors preventing infeciton	degree of contamination adequacy of local blood supply virulence of organism presence of dead space
wound management alternatives	debridement, hyperbaric oxygenation, negative pressure wound therapy, vacuum assisted closure, skin substitutes, growth factors
debridement	removal of patients dead tissue, reveal health tissue surgery, mechanical means forceful irrigtion
hyperbaric oxygenation or HBO	definition - use of oxygen at a higher level than atmospheric pressure technique - 100% oxygen, under pressure in chamber, increase oxygen dissolved in plasma (increase oxygen tension)
negative pressure or VAC	definition - continous suction in a sealed environment to aid wound healing principle use for: acute, traumatic wounds, subacute wounds, dehisced incisions, pressure ulcers, flaps contraindications: fistulas, necrotic tissue, osteomyelitis, malignancy
hydrotherapy	water used to perform debridement pulsative lavage hazardous - aerosol/droplets - good use of PPE
Skin substitutes	group of substances, that aid in temporary permanent closure of wound for coverage used on thermal injuries
growth factors	naturally occuring substance capable of stimulating cellular growth, proliferation, cellular differentiation types - platelet derived growth factors, epidermal growth factors
haemostatics	chemical, external, thermal
chemical	absorbed gelatin, collagen, oxytocin, thrombin
external	antiembolic stockings, torniquets, bp cuff, pressure dressings, packing, suction
thermal	cold/hot methods, diathermy, electrosurgery, laser
tissue replacement materials	biologic wound cover, biologic materials

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	Created by Elizabeth Then over 6 years ago