Principles of Wound Healing and Treatment Options

1
Principles of Wound Healing and Treatment Options

• By
• Jacquelyn M. Sullivan, MSN, GNP, RN

2
Principles of Wound HealingInflammatory Stage

• Characterized by redness, heat, pain and swelling
• Last approximately 4 to 5 days
• Initiates the healing process by stabilizing the
  wound through platelet activity that stops
  bleeding triggers the immune response

3
Principles of Wound HealingInflammatory Stage

• Within 24 hours of the initial injury,
  neutrophils, monocytes and macrophages are on the
  scene to control bacterial growth and remove dead
  tissue
• Characteristic red color and warmth is caused by
  the capillary blood system increasing circulation
  laying foundation for epithelial growth

4
Principles of Wound HealingProliferation Stage

• Begins within 24 hours of the initial injury and
  may continue for up to 21 days
• It is characterized by three events
• Epithelialization
• Granulation
• Collagen synthesis

5
Principles of Wound HealingGranulation

• Formation of new capillaries that generate and
  feed new tissue
• Granulation tissue is the beefy red tissue that
  bleeds easily

6
Principles of Wound HealingEpitheliazation

• Formation of an epithelial layer that seals and
  protects the wound from bacteria and fluid loss
• It is essential to have a moist environment to
  foster growth of this layer
• It is a very fragile layer that can be easily
  destroyed with aggressive wound irrigation or
  cleansing of the involved area

7
Principles of Wound HealingCollagen Synthesis

• Creates a support matrix for the new tissue that
  provides it with its strength
• Oxygen, iron, vitamin C, zinc, magnesium
  protein are vital for collagen synthesis
• This stage is the actual rebuilding and is
  influenced by the overall patient condition of
  the wound bed

8
Principles of Wound HealingDifferentiation or
Maturation

• Final stage of wound healing
• Begins around day 21 and may continue for up to 2
  years
• Collagen synthesis continues with eventual
  closure of the wound and increase in tensile
  strength
• Tensile strength reaches only about 80 of
  pre-injury strength

9
Principles of Wound HealingNormal Age Changes

• Decreased epidermal cell turnover
• Increased capillary fragility and reduced
  vascularization
• Reduced oxygen flow to the area
• Altered nutrition and fluid intake
• Impaired immune response
• Reduced dermal and subcutaneous mass

10
Pressure Ulcer Management

• Eliminate or minimize intrinsic and extrinsic
  factors of pressure ulcer development
• Provide nutritional support and monitor
  nutritional status
• Create and maintain a clean, moist wound
  environment with adequate circulation and
  oxygenation

11
Clean Moist Wound Environment

• Soap and water
• Removal of dead tissue and eschar on open wounds
• Sharp debridement
• Enzymatic debridement
• Chemical debridement
• Mechanical debridement
• Hydrotherapy
• Autolysis

12
Clean Moist Wound Environment

• Too much moisture
• Desitin/zinc oxide
• Copolymer starch dressings
• Alginates
• Wound VAC therapy

13
Clean Moist Wound Environment

• Too little moisture
• Hydrogel dressing
• Hydrocolloid dressing
• Semi permeable dressing

14
Evaluation of Chronic Wounds

• Nutrition
• Treatment
• If no results after two weeks, change treatment
• Infection
• All wounds are colonized with many bacteria after
  24 hours

15
Additional Treatment Options

• Electrical stimulation
• Whirlpool
• Ultrasound
• VAC wound therapy