Wound Care
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Date: Sun, 24 May 2009 Time: 9:14 AM
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By definition, a wound is a physical injury that results in an opening
or break of the skin.
*Types:*
There are several types of wounds, including surgical, traumatic, and chronic wounds. Traumatic wounds may be caused by mechanical, traumatic or thermal injury, including contusions, abrasions, punctures, fractures, burns, and frostbite. The surgical wound is usually clean and easiest to heal. By definition, chronic wounds may be more difficult to heal, and include pressure sores and diabetic ulcers.
Generally, wounds can be further classified into 2 categories: partial and full thickness. Partial thickness wounds present with damage to the epidermal and dermal tissues, including flame burns, scalds, and blisters, usually being painful to the touch. Full thickness wounds
present with damage to epidermal, dermal, or subcutaneous tissues, including flame burns, boiling liquids and chemical burns, usually without pain being evident.
The most common type of wound is a traumatic wound. Traumatic wounds are categorized into several types: (1) abrasion - exists when the surface of the skin or a mucous membrane is scraped away, (2) contusion - an injury where the surface of the skin is not broken, but underlying or
internal tissues are damaged, usually resulting from a sharp blow to the body and frequently producing a discoloration or bruising of the skin surface, (3) incision - a traumatic wound made with a sharp instrument
that produces a clean cut, such as a scalpel, (4) tunneled wound - presents with a passageway under the surface of the skin that is generally open at the skin level, with most of the tunneling not seen, (5) laceration - the skin is irregularly torn and a penetration wound
results from events like a stab or gunshot, (6) bites - abrasions and/or contusions caused by the entrance and crushing of teeth, usually in animals, humans, or insects, (7) cuts - classified as traumatic wounds where there is only a minor break in the integrity of the skin, and (8)
thermal wounds - include heat injuries such as burns, sunburns, and electric injuries.
Surgical wounds result from the trauma induced by surgery. Surgical wounds include: (1) post-surgical incisions, including dental extraction, (2) suture site wounds, (3) donor site wounds such as in blood donation, (4) IV site wounds, (5) skin graft wounds, (6) periostomy skin wounds, and (7) peritracheotomy wounds.
The most difficult wounds to treat are the chronic, non-healing wounds. These include: diabetic wounds, arterial ulcers, venous ulcers, and pressure ulcers.
*Repair of the Wound:*
The process of repair and regeneration following injury represents one of the most fundamental defense mechanisms of an organism against the environment. Wound healing in individuals generally occurs over a reasonable length of time. However, there are reasons that wounds may
not heal appropriately, such as in impaired immunity, diseases such as diabetes and CVD, immobility, poor nutrition, and the like. Intervention is necessary in these individuals. Even with minor injuries such as
cuts, wounds in impaired individuals may readily develop into very traumatic injuries requiring medication, hospitalization, and even surgery. In general, if a wound does not heal within a month, medical intervention is necessary.
Immediately after injury, the wound fills with blood and a clot forms. The clot contains a threadlike protein called fibrin, which binds the edges of the wound together and stops any bleeding. If tissues are damaged, a cascade of cellular events is initiated to prepare the injured area for the deposition of collagen, which ultimately will
replace damaged mesenchymal tissues. Wound healing occurs in several stages.
1. _Inflammation:_ A wound initiates a natural inflammatory response with heat, redness, pain, swelling, and impaired function of the involved body tissues. Vasoconstriction occurs within seconds and lasts only a few minutes. This response is followed by vasodilation with an increase in vascular permeability. Next, pronounced leakage of serum proteins occurs in the wound for approximately 10-20 minutes. The final stage of inflammation spans a period of several hours and is characterized by vascular stasis, local hemorrhage, and infiltration of tissues with leukocytes. Vasoactive substances are released from cells in the local environment, most notably histamine. Histamine-induced
vasodilation is brief, and seldom lasts more than one hour. Other unknown factors may be involved, including kinins and serotonin.
During the inflammatory phase the patient will develop
leukocytosis, a mildly elevated temperature, and general malaise. Wound management during this phase of healing should include monitoring the wound for erythema or swelling and redness outside the edges of the wound, possibly indicating infection.
2. _Proliferative Phase:_ The second stage of wound healing begins three to four days after wounding, and lasts approximately 21 days. During this stage, the wound starts to get smaller and new tissue begins to grow.
3. _Remodeling Phase:_ This final stage of healing begins around day 21 and can continue for as long as one to two years post-injury. Collagen that has been deposited in the wound is remodeled, making the healed wound stronger and more like the adjacent tissue. New
collagen continues to be deposited, and this compresses the blood vessels in the healing wound, so that the scar eventually becomes a thin, flat, white line. The scar is a vascular collagen tissue that does not sweat, grow hair, or tan in the sunlight. Maximum scar strength is achieved in about three months.
Some factors that may negatively influence wound healing include:
* Age? aging may alter many phases of wound healing including: vascular changes, reduced liver function and synthesis of clotting factors, slowed inflammatory response, reduced immune function, changes in collagen.
* Obesity- adipose tissue lacks adequate blood supply to resist bacterial infection or deliver nutrients and cellular elements for healing.
* Malnutrition? may impair all phases of wound healing due to vitamin and mineral deficiencies.(1 <#fn106662>)
* Decreased oxygenation of wound site
* Smoking
* Diabetes
* Radiation
* Wound stress
* Pharmaceutical medications
Additional Links Back to Top <#top>
* Statistics about Wound Care
* Signs and Symptoms of Wound Care
Footnotes Back to Top <#top>
^1 Young ME. Malnutriton and wound healing. Heart Lung. 1988;17:60-67.
View Abstract view-abs.asp?fnid=106662&absid=102364>
About Wound Care
? Introduction
? Statistics
? Signs & Symptoms
*Treatment Options*
Click to View additional treatment options for Wound Care
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