The skin is an organ responsible for many of the body’s reactions to the environment, such as protection, temperature control and sensory information. It provides non-verbal information on one’s condition. It also has a profound effect on the psychological well-being of the individual. But like every other organ, it needs to be well cared for to provide optimum functionality. Wound care in nursing practice requires the knowledge of various techniques used in the assessment, treatment and care of the patient with one or multiple wounds. Techniques include debridement, cleaning, bandaging, as well as liaising with the multi-disciplinary team for better and quicker treatment.
Optimum wound care requires:
- Good relevant patient history taking
- Detailed documentation
- Identification of the patients requiring a multidisciplinary approach
- Early complication detection and referral to the appropriate specialists
- Patient education
- Awareness on the psychosocial impact that the skin has on the individual
Wound Healing Process
A wound is the discontinuity of the skin, mucous membrane or tissue caused by physical, chemical or biological insult. Wound healing requires:
- The replacement of injured tissue with new tissues
- An increased consumption of energy
HAEMOSTASIS – The body aims to stop the bleeding through vasoconstriction, platelet formation, etc. In other words, haemostasis is the body’s natural physiological response for the prevention and stopping of bleeding.
REMODELLISATION – Takes up to around 2 years of healing. This is why a visibly healed wound can just open by itself, even if untouched. Some ‘simple’ dry skin can trigger a wound to re-open.
Moist Wound Healing in Wound Care
In moist occlusive and semi-occlusive environments, epithelialisation happens at twice the rate when compared to dry environments. Moist wound healing can be achieved through the use of advanced wound care dressings. However, a wet environment can be detrimental to wound care, as this may lead to maceration as well as tissue breakdown. The key to wound healing is to keep the wound bed balanced between dry and wet – find moisture balance!
NOTE: Iodine-impregnated dressings and silver dressings can be used if wound exudate is present. Alginates, which are made of seaweed extract, can absorb exudate. Aquacel AG has the ability to absorb up to 3 times more than alginates.
NOTE: Moist wound healing shouldn’t be used for necrotic digits (fingers and toes) due to ischaemia and/or neuropathy. Necrotic digits should be kept thoroughly dry. If kept wet, infection may travel up through the whole leg, leading to the amputation of not just one toe but a whole foot.
Acute VS Chronic Wounds – chronic wounds happen when things go wrong. This usually happens within the inflammatory phase of wound healing (hours to days following wound infliction).
Problem Wounds – These are wounds that don’t heal due to other local issues, such as infections, individuals on steroidal drugs, immunocompromised individuals, etc.
Local Factors Affecting Wound Healing
Wound healing can be delayed by various factors local to the wound itself. Such factors include:
- local infection
- necrotic tissue or foreign body presence
- poor blood supply / low oxygen perfusion
- venous stasis – loss of proper vein function of the legs that would normally carry blood back towards the heart
- lymph stasis – lymph circulation disorder that leads to oedema
- tissue tension – a state of equilibrium between tissues and cells that prevents over-action of any part
- haematoma and dead space
- large defect or poor opposition
- recurrent trauma
- x-ray irradiated area
- wound location – eg. wound over joint
Complications of Wound Healing
- Infection – red, swollen, painful wound with discharge, pus or bad smell
- Avoidable scar
- Excess healing-keloid and hypertrophic scar
- Skin pigmentation
- Marjolin ulcer-occurs due to scar tissue
- Contractures
- Incisional hernia and wound dehiscence
Wound Descriptive Terms for Wound Care
- Necrotic Eschar
- Necrotic Slough
- Infective
- Granulation
- Hyper-granulation
- Poor quality granulation
- Epithelialisation
- Maceration
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