A.

Wound
a. Definition
- An abnormal break in the tissues of the skin or in the underlying surfaces.
b. Classifications
Open wound
- allows blood and other fluid to be lost from the body and germs to enter
Closed wound
- bleeding is purely internal. This is easily recognized by bruising which
indicates damage to blood vessels just beneath the skin
c. Types of Wound
Incision
- a clean cut from a sharp edge, such as broken glass, that causes an incision.
Laceration
- a crushing or ripping forces result in rough tears or lacerations.
Abrasion (graze)
- a superficial wound in which the top layers of the skin are scraped off;
leaving a raw, tender area.
Contusion (bruise)
- a blunt blow or punch can rupture capillaries beneath the skin.
Punctured wound
- a wound with small entry site, but a deep track of internal damage
Gunshot wound
- the entry wound may be small and neat; any exit wound may be large
and ragged.
Avulsion
- a forceful tearing away or separation of tissues from the casualtys body.
d. Factors affecting Wound Healing
Age
-Wounds in older patients may heal more slowly than those in
younger patients, mainly because of comorbidities that occur as a
person ages. Older patients may have inadequate nutritional intake,
altered hormonal responses, poor hydration, and compromised
immune, circulatory, and respiratory systems, any of which can
increase the risk of skin breakdown and delay wound healing.
Body type
- Body type may also affect wound healing. An obese patient, for
example, may experience a compromise in wound healing due to
poor blood supply to adipose tissue. In addition, some obese patients
have protein malnutrition, which further impedes the healing.
Conversely, when a patient is emaciated, the lack of oxygen and
nutritional stores may interfere with wound healing.
Nutritional status
- Ongoing nutritional assessment is necessary because the visual
appearance of the patient or the wound is not a reliable indicator of
whether the patient is receiving the proper amount of nutrients.
Albumin and prealbumin levels, total lymphocyte count, and
transferrin levels are markers for malnutrition and must be assessed
and monitored regularly, as protein is needed for cell growth.
Alcohol consumption
-Clinical evidence and animal experiments have shown that exposure
to alcohol impairs wound healing and increases the incidence of
infection. Alcohol exposure diminishes host resistance, and ethanol
intoxication at the time of injury is a risk factor for increased
susceptibility to infection in the wound.
Smoking
- the negative effects of smoking on wound-healing outcomes have
been known for a long time. Patients who smoke show a delay in
wound healing and an increase in a variety of complications such as
infection, wound rupture, anastomotic leakage, wound and flap
necrosis, epidermolysis, and a decrease in the tensile strength of
wounds.
Medications
-Anti-inflammatory drugs such as steroids and non-steroidal anti-
inflammatory drugs may reduce the inflammatory response necessary
to prepare the wound bed for granulation.
e. Wound care interventions
1. Keep the area clean and tidy with good lighting.
2. Dressing materials: use disposable set for dressing ( usually include
sterile towels, forceps, cotton balls and gauge),mask and gloves ( if
needed ), disposable bag for soiled dressing, bandages, adhesive tape
and scissors.
3. Keep the patient warm and comfortable. Ensure adequate privacy
during the procedure.
4. Wash hands thoroughly with soap and water.
5. Open the package of sterile dressing. Lay the instruments on the
sterile towel provided.
6. Remove the soiled dressing with a pair of forceps. If the dressing is
stuck to the wound, soak the dressing with normal saline. Dispose
forceps and soiled dressing in a plastic bag.
7. Reserve the other two pairs of forceps for handling the clean dressing
and the wound.
8. Use forceps to dip the cotton ball into antiseptic solution and wipe
the wound from inside to outside. Repeat the procedure using a new
cotton ball each time until the wound is clean.
9. Dry the wound with sterile gauze.
10. Cover the wound with clean dressing and apply adhesive strapping to
secure it.

B. Phases of Wound Healing
Homeostasis
damaged vessels constrict to slow the blood flow
platelets aggregate to stop
bleeding
leukocytes migrate into tissue to initiate inflammatory process

Inflammation
neutrophils

Proliferation
fibroblast, collagen

Remodelling

Injured tissues repaired by:
1. regeneration
replacement of destroyed tissue cells by dlls that are identical or similar in
function

2. connective tissue repair
replaced with connective tissue elements of collagen, blood capillaries,
lymphatics and other - bound substances

Inflammatory Phase
immediate 2-5 days
hemostasis (vasoconstriction, platelet aggregation, thromboplastin makes a
clot)
inflammation (vasodilation, phagocytosis)
the wound is rinsed by blood and filled with blood collagen and fibrin
constituents

Proliferation Phase
resorption of blood collagen and reepithelialization (is a movement of the
surrounding epithelial cells to close the wound)
begins within 2-3 days of injury; last as long as 3 weeks after injury
MAIN PROCESS: building new tissue to fill the wound space
FIBROBLAST - a connective tissue that synthesises an secrete collagen and
other elements needed for healing
angiogenesis - formation of new blood vessels
granulation tissue development - scare formation (matrix of collage, capillaries,
and cells)
wound contraction
debridement (removal of damaged tissues from the wound

Maturation/Remodelling Phase
growth of new epithelial cells
begins about 3 weeks from injury
marked by remodelling of the scr
collagen is deposited; tissue is repaired
scar is remodelled
scar tissue regains about 2/3 of its strs