Wound Healing and

Treatment
Ryan Shigley
Nurs 400
BYU - Idaho

Phases of Wound Healing

*The healing process will vary according to the
stage of the pressure ulcer*
Stages I and II heal by tissue regeneration
Stages III, IV and full thickness heal through

scar formation and contraction

Inflammatory Phase
0-3 days
Hemostasis
Inflammation
Phagocytosis

Proliferation Phase
3-21 days
New blood vessels develop
Collagen synthesis
Granulation formation
Epitheliazation
Contraction

Maturation Phase
21 days- 2 years
Reorganization of collagen
Increase tensile strength

Treatment
Optimize Wound Environment
Dressing Selection

Wound Environment

Manage Comorbidities
Increase cardiovascular and pulmonary

function
Support tissue oxygenation
Maintain blood glucose control

Nutrition and Hydration

Encourage protein and calorie dense foods

and fluids
Monitor intake, weight and skin turgor

Pain Control
Address the source
Pharmacological EBP prefers scheduled long-

acting with available short-acting for

breakthrough
Appropriate dressing selection, and removal

Protect
Appropriate dressing change intervals to

prevent pooling
Barrier creams to protect periwound from
moisture and adhesives

Prevent Infection
Wound infection can result in failure to heal,

poor quality tissue, increased friability and

increased drainage

Debridement
Autolytic
Naturally occurring

Wet-to-dry (not

in moist
environment

recommended)
Whirlpool
Pulse lavage

Chemical
Collagense (ex.

Santyl)
Papin with urea
(ex. Accuzyme)
Denaturing agent
(ex. Dankins)

Mechanical

Sharp

Conservative

removal with sterile

scalpel and forceps

Surgical

Moisture Control
High moisture vapor transmission dressings

for minimal exudate wounds

Highly absorbent dressings for heavy exudate
wounds

Factors for Dressing Selection

Etiology
Pressure- undermining requires packing
Neuropathic- undermining requires packing
Arterial generally require moisture
Venous generally require compression

Wound History
Duration and course of wound healing
Previous treatments and outcomes

Comorbidities
Diabetes- impairs wound healing and increase

risk of infection
Congestive Heart Failure- could contraindicate
compression
Obesity- increased risk for dehiscence,
infection, circulation impairments

Size
Wound packing required for larger wounds
Exposed tendons or ligaments require

moisture and protection

Base
Healthy granulation keep moist
Slough debridement
Slight- encourage autolysis with moisture
Moderate- mechanical or chemical
Large- sharp in adjunct with chemical or

mechanical
Epithelium moist protective dressing

Exudates
Amount and type will determine primary and

secondary dressing types

None-moderate gauze or composite
Moderate-heavy foam or composite
Frequent soiling hydrocolloid or film
Fragile skin stretch gauze or net

Adequate containment will:

Protect periwound skin
Control odor
Avoid overuse of wound care products

Perimeter
Barriers for fragile or compromised skin
Exudate control for macerated skin
Topical treatments for fungal infections

Common Dressing Products

Topical Antimicrobials
SilvaSorb- broad spectrum
Bacitracin- broad spectrum
Silver impregnated dressings

Alginates
Highly absorbent
Maintains moist environment
Painless removal

Barriers
SurePrep- clear liquid
Vasoline- petroleum
Hydraguard- paste
Stomahesive wafer- solid

Collagen
Stimulate wound repair and epithelial

regrowth
Mild absorptive quality

Composite Products
3-layered products
Non-adherent to protect wound bed
Absorbent layer
Moisture permeable layer with adhesive

boarder

Compression Wraps
Utilized to reduce edema
Contraindicated in CHF

Foams
Highly absorbent hydrophilic polyurethane
Decreases maceration of periwound tissue

Gauze
Available in strips, squares, or rolls
Adheres to wound tissue

Hydrocolloids
Mildly absorbent
Maintains moist wound surface
Not recommended for use with ischemic

wounds

Hydrofiber
Twice as absorbent as alginate
Requires secondary dressing

Hydrogels
Increase moisture content
Produce soothing effects

Negative Pressure Wound

Therapy
Promote contraction
Remove excess exudate
Reduce edema
Increase blood flow

Petroleum Impregnated
Dressings
For minimal exudate
Provides moist environment for epithelial

regrowth
Protects wound base and periwound

Transparent Films
Absent or minimal exudate
Utilized often as secondary dressing