Abnormal Wound Healing

• wounds that fail to move through the normal healing process may become chronic wounds
• chronic wounds may show:

  • absent or chronic inflammation
  • hypo or hypergranulation
  • non-advancing wound edges
  • dehiscence
• dehiscence: partial or total separation of previously approximated wound edges due to a failure of proper wound healing
• wounds without inflammation will not heal properly, so clinicians must faciliate the inflammatory process through interventions:

  • debridgement
  • irrigation
  • dressing
  • modalities
• factors that can cause absence of inflammation:

  • steroids
  • malnutrition
  • advanced age
  • immune systems disorders
• absense of inflammation looks like:

  • paleness
  • coolness
  • dry wound bed
• chronic inflammation is commonly caused by 3 things:

  • foreign body in the wound bed
  • repetitive mechanical trauma
  • cytotoxic agents
• chronic inflammation: influx of all the cells that are called to the site in normal inflammation

  • lymphocytes
  • macrophages
  • fibroblastic proliferation
  • body cannot move on to proliferation due to constant overload
• hypogranulation: wound bed does not have enough granulation tissue + cannot close
• hypergranulation: too much granulation tissue (proud flesh)
• the granulation matrix provides a bridge for epitheliazation - too much or too little will stall healing
• treatment of hypogranulation:

  • wound management techniques to support granulation tissue formation:
  • irrigation
  • debridement
  • dressing choises to facilitate tissue growth
  • without granular matrix, epithelial cells cannot migrate to bridge the gap
• epibole: epithelial cells migrate down into the wound + curl to attach at the basement membrane; re-epitheliazation stalls
• hypergranulation occurs due to:

  • maceration - too much moisture
  • too frequent dressing changes
  • adhesives
  • whirlpool
• treatment for hypergranulation:

  • pressure over tissue to decrease blood flow
  • silver nitrate stick to cauterize the excess tissue
  • roll silver nitrate over the tissue then wash with saline to stop chemical reaction
• dehiscence risk factors:

  • steroids
  • diabetes
  • malnutitrion
• characteristic factors that affect healing:

  • etiology
  • time since onset
  • wound location
  • wound dimension
  • temperature
  • hydration
  • foreign bodies or necrosis
  • infection
• linear wounds heal faster than round wounds
• partial thickness wounds heal faster than full thickness wounds
• warm wounds heal the fastest (98.6-100.4 def optimal)
• a main goal in successful wound care is to maintain a warm, moist wound bed environment
• colonization: microbes present in a wound
• infection: microbes at levels of 10^5
• forces that interfere with cellular migration + tissue perfusion:

  • pressure
  • shear
  • friction
  • edema slowing blood flow
  • improper suturing
• systemic factors affecting healing:

  • age
  • nutrition - carbs + proteins help healing
  • comorbidities
  • medication
  • lifestyle choices - alcohol abuse + smoking
• barrier to compliance in wound care:

  • inadequate instructions
  • incomplete instructions
  • lack of understanding
  • limited resources
  • lack of caregiver support
  • emotional reactions to the wounds
• infection prolongs the inflammatory phase, stalls healing, can cause dehiscence, + may increase scarring
• local factors affecting wound healing:

  • circulation
  • inadequate blood flow reduces oxygen + key healing cells to area
  • can lead to infection
  • blood flow can be decreased due to:
  • disease processes, cold, fear, or pain
  • sensation
  • inability to feel pain, hot/cold, pressure, etc.
  • may miss signs of tissue destruction or repeatedly cause trauma to the area
• comorbidities that affect healing:

  • diseases that affect breathing + tissue perfusion
  • immunocompromised patients
  • illnesses limiting mobility
  • diabetes
  • vascular problems