Chronic Wound Healing
What is a keloid scar?
big bubbled up scar outside the affected area
What is a hypertrophic scar?
big bulky scar that stays within incision or wound
What should serum albumin be?
>3.5
What are systemic factors that affect wound healing?
age, inadequate nutrition, co-morbidities (PVD, DM, PAD, CKD, CAD), meds (NSAIDs, steroids, radiation/chem), smoking, ETOH, stress, lack of physical activity
Why is iron important for wound healing?
aids in RBC transport
How do chronic wounds get stuck in the proliferative phase?
chronic wound fluid has features that inhibit cell regeneration, dead space prolongs healing stalling or plateuaing, delayed due to wound size and tissue defect, too much or too little fluid
What are local factors that affect wound healing?
circulation/O2, sensation
What other aspects of patient health must be optimized to treat the wound?
circulatory, pulmonary, nutrition, associated diseases or conditions
What can happen if collagen lysis is impaired?
collagen is allowed to continuously proliferate causing hypertophic and keloid scars
What demographics are at greater risk of dehiscence?
dark skinned people, steroid users, DM, some malnutrition
What is pus?
dead neutrophils
Why is O2 so important to wound healing?
fibroblasts are O2-sensitive, PO2<40mmHg severely affects collagen synthesis and it's the most common cause for infection because body cannot fight bacteria w/o O2
Why is vitamin D important for wound healing?
for enzymes and bone health
Why is vitamin E important for wound healing?
for fat metabolism
Why is vitamin K important for wound healing?
for hemostasis and coagulation
Why is zinc important for wound healing?
helps with B and T cell activity, loss can occur with highly draining wounds
Why is vitamin C important for wound healing?
important for collagen synthesis
What is the most common reason for a wound to get stuck in the inflammatory phase?
inadequate vascular system delivery of O2
What is dehiscence?
insufficent scar formation
Why do chronic wounds get stuck in the epithelialization subphase?
lack of moisture causing a decrease in migration of cells and delay
What factors could cause a wound to get stuck in the inflammatory phase?
lack of stimulus for repair (one cell doesn't trigger next), inadequate perfusion and ischemia, free radicals and O2 reperfusion injury
What are wound characteristics that affect healing?
mechanism of onset, time since onset, wound location, wound dimensions, temperature, wound hydration, necrotic tissue/foreign bodies, infection, localized edema
What could make a wound have an odor?
necrotic tissue, slough, infection bio-film
What are some examples of inappropriate wound management?
patient: adherence, self efficacy, inappropriate or delayed care, cross contamination, too many dressing changes healthcare professional: failure to refer, lack of knowledge of current therapies, antiseptics
Why does stress affect wound healing?
person stuck in fight/flight will cause global vasoconstriction causing wound to have reduced O2 and nutrition
What are some reasons wounds become chronic?
poor vascularization, poor nutrition, repeated trauma, contamination, age, improper interventions, absence of inflammation, hypo/hyper granulation, too much/too little fluid
What phase are epiboles missing?
proliferative phase
What nutrients are necessary for wound healing?
proteins, glucose, vitamins C, B12, A, D, K, E, zinc and iron
How are epiboles prevented?
scrubbing edges with gauze soaked in saline after dressing changes to stimulate them to wait for granulation tissue to come up before trying to cross
What are mechanical stress factors that affect wound healing?
sheer, pressure, friction
What is an epibole?
the rolling in of the edges of a wound which is a typical sign of a chronic wound (think pothole example)
Why is vitamin B12 important for wound healing?
to prevent anemia
Why is vitamin A important for wound healing?
to reduce inflammation