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