Wound healing

Question 1

Four stages of wound healing

Answer 1

1. Exudative
2. Resorptive
3. Proliferation
4. Maturation

Question 2

Time period acc to stages of wound healing

Answer 2

exudative (day 1), resorptive (day1-3), proliferation (day 3-7) - first 2 weeks
maturation - weeks to 1 year

Question 3

What happens in the exudative phase of wound healing

Answer 3

First- Hemostasis, scab formation, immediate local vasoconstriction followed by vasodilation and increased vessel permeability

Question 4

What happens in the resorptive phase of wound healing

Answer 4

Second- chemotaxis, vasodialtion, epithelium at wound margins begins to proliferate

Question 5

What happens in the proliferative phase of wound healing

Answer 5

third- granulation tissue formation, epidermal cells migrate and replicate

Question 6

What happens in the maturation phase of wound healign

Answer 6

Fourth= scar formatiion, removal and organisaito of collagen

Question 7

Risk factors for delayed wound healing

Answer 7

DID NOT HEAL
Drugs - steroids, cytoxics, other immunosuppresives
Infections/ischemia
Diabetes
Nutritional def - iron def anaemia
Oxygen - hypoxia
toxins - etoh, smoking
hypo/hyperthermia
excessive tension on the wound edges
Acidosis/another wound
local anasthetics

Question 8

What is primary intention

Answer 8

1. Primary Intention
   Definition: Healing by primary intention occurs when the wound edges are clean and can be directly approximated, typically using sutures, staples, or

Characteristics:
Minimal tissue loss
Clean, surgical incisions or well-aligned lacerations
Rapid healing with minimal scarring
Low risk of infection
Examples: Surgical incisions, paper cuts, or small, clean lacerations.

Healing Process:
Hemostasis: Immediate cessation of bleeding through clot formation.
Inflammation: Short-lived inflammatory response to prevent infection.
Proliferation: Formation of new tissue, including collagen deposition and epithelial growth.
Maturation: Strengthening and remodeling of the tissue over time.

Question 9

what is secondary intention

Answer 9

Definition: Healing by secondary intention occurs when the wound edges cannot be brought together, leading to healing from the bottom up.

Characteristics:
Significant tissue loss
Wounds with irregular edges or large surface areas
Longer healing time
Higher risk of infection
More pronounced scarring

Examples: Chronic ulcers, large traumatic wounds, or wounds with significant tissue loss.

Healing Process:
Granulation Tissue Formation: New connective tissue and blood vessels form to fill the wound.
Epithelialization: Epithelial cells migrate across the wound bed.
Contraction: Myofibroblasts pull the edges of the wound together.
Maturation: Collagen remodeling strengthens the new tissue

Question 10

What is tertiary intention

Answer 10

Definition: Tertiary intention, also known as delayed primary closure, involves leaving a wound open initially to allow for drainage and observation, then closing it surgically after a period of time.

Characteristics:
Wounds at risk of infection or contamination
Requires initial management to reduce infection risk
Closure is delayed until the wound is clean and free of infection
Combines aspects of both primary and secondary intention

Examples: Contaminated surgical wounds, bite wounds, or wounds with compromised surrounding tissue.

Healing Process:
Initial Open Phase: Wound is left open to allow for drainage and to reduce infection risk.
Observation Period: Wound is monitored for signs of infection or complications.
Closure: Once the wound is clean and infection-free, it is closed surgically.

Question 11

Reasons for conducting a wound assessment

Answer 11

1. Establishes a baseline for monitoring healing
2. Guides appropriate treatment planning - evaluating factors like wound type, size, depth, presence of inf/necoriss
3. Identifies potential complications earlier

Question 12

Healthy wound bed tissue types

Answer 12

Granulation tissue
Epithelial tissue

Question 13

Non healthy/non viable wound bed tissue types

Answer 13

Slough
Eschar
Necrotic tissue

Question 14

Granulation tissue- tissue type, appearnace, significance and management

Answer 14

Healthy - Appears bright red, moist and granular with bumpy texture
Indicates active healing- forms new CT and capillaries
Preserve this tissue to promote continued healing

Question 15

https://live.staticflickr.com/8816/28958870125_9a7d45bde3_b.jpg

Answer 15

granulaiton tissue

Question 16

epithelial tissue - tissue type, appearnace, significance and management

Answer 16

Healthy-
Appears pale pink or pealy white, smooth and shiny
Represents the final stage of healing where new skin cells migrate
Protect to prevent disruption

Question 17

Slough - tissue type, appearnace, significance and management

Answer 17

Non healthy/non viable
Apears yellow, tan, gray- stringy, mucinous
- nectrotic tissue form inflammation- may have bacteria, can impede healing
Requires debridement to faciliatte healing

Question 18

Eschar - tissue type, appearnace, significance and management

Answer 18

Nonhealthy/ non viable
Appears dry, blck, hard and leathery
Necrotic tissue that can obstruct healing and may indicate infection
- stable eschar can be left in place, unstbale eschar requires debridement

Question 19

Necrotic tissue - tissue type, appearnace, significance and management

Answer 19

Non healthy/ non viable
Black or brown, dry or wet, adherent
Dead tissue that must be removed for healing to progress
Debridement is necessary to eliminate necrotic tissue

Question 20

https://www.accessmedicinenetwork.com/cdn-cgi/image/metadata=copyright,format=auto,quality=95,fit=scale-down/https://images.zapnito.com/uploads/e10954bae9855dd58b6877d76b045329/6078f3d7-374e-42b0-bdd6-a45a930a6af5.jpeg

Answer 20

epithelial tissue

Question 21

https://uk.advancismedical.com/cdn/shop/files/Wounds_Sloughy.jpg?v=1673878032

Answer 21

Slough

Question 22

https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQQ0Oe8uxppQZOdc-pvaqRbN2NGvL9qazamug&s

Answer 22

eschar

Question 23

Characteristics/ descirptors to consider when assessing the skin around the wound

Answer 23

Colour
Temperature
Texture and thickness
Mositure
Integrity and damamge
Signs of infection and inflammation

Question 24

Color changes associated with areas around wounds and their significance

Answer 24

Redness (erythema): Suggests inflammation or infection. A spreading red edge may indicate cellulitis.

Pale or dusky: May indicate poor perfusion (e.g., arterial insufficiency).

Brown staining: Often seen in chronic venous insufficiency due to haemosiderin deposition.

Bluish or purple: Suggests venous congestion or cyanosis.

Black or necrotic: Indicates tissue death, often due to severe ischemia or uncontrolled infection.

Question 25

temperature changes associated with areas around wounds and their significance

Answer 25

Warm skin: Inflammatory or infectious process. Cool skin: Suggests poor arterial supply, possibly indicating peripheral arterial disease (PAD).

Question 26

texture and thickness changes associated with areas around wounds and their significance

Answer 26

Thin, shiny, fragile skin: Often seen in arterial insufficiency. Thick, fibrotic, or indurated skin: Common in chronic venous disease or lymphedema. Dry, flaky skin: Can suggest poor hydration or neuropathy (as in diabetic patients).

Question 27

moisture changes associated with areas around wounds and their significance

Answer 27

Excessively moist (maceration): Suggests poor wound management or excessive exudate. Dry, cracked skin: May impair healing and reflect systemic dehydration or ischemia.

Question 28

integrity and damage changes associated with areas around wounds and their significance

Answer 28

Breaks or ulcers nearby: May suggest fragile or diseased skin, possibly due to pressure, trauma, or systemic disease like diabetes. Satellite lesions or excoriations: May point to fungal infections or inflammatory conditions.

Question 29

infection and inflammation changes associated with areas around wounds and their significance

Answer 29

Pus, odor, warmth, swelling, and pain: Indicate local infection. Crepitus or rapidly spreading redness: Raises concern for necrotizing infection.

Question 30

Basic principles of wound dressings

Answer 30

Moist Wound Healing A moist environment supports cell migration, angiogenesis, and epithelialization. Prevents desiccation and tissue death. Exudate Management Dressings should absorb excess fluid to prevent maceration but retain enough moisture to support healing. Infection Control Some dressings have antimicrobial properties (e.g., silver, iodine). Prevents bacterial colonization and promotes a clean wound bed. Protection Shields the wound from mechanical trauma, contamination, and further injury. Pain Reduction Modern dressings aim to reduce pain during application and removal (atraumatic). Promotion of Autolytic Debridement Certain dressings (e.g., hydrogels) help the body naturally remove necrotic tissue.

Question 31

Classifications of dressings according to their fucntion or purpose

Answer 31

Primary dressing- direct contact with the wound - maintains moist environment - eg: hydrocolloid, alginate Secondary dressing- secures primary dressinf or adds absorbency- gauze, foam pad

Question 32

Classifications of dressings according to their material/ form

Answer 32

Hydrocolloids -Occlusive; forms a gel with exudate. Low-to-moderate exudate wounds, pressure ulcers Hydrogels High water content; cooling Dry wounds, painful wounds, burns Foam dressings Absorbent, cushioning Moderate-to-heavy exudate wounds Alginate dressings Highly absorbent; made from seaweed Heavy exudate, bleeding wounds Film dressings Transparent, adhesive; semi-permeable Superficial wounds, skin protection Gauze Non-occlusive, inexpensive Low-cost coverage; often secondary Silver/iodine dressings Antimicrobial Infected or high-risk wounds Charcoal dressings Odor-absorbing Malodorous wounds Collagen dressings Promote granulation tissue Chronic or non-healing wounds

Question 33

Pressure injury classification

Answer 33

https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/259259/Pressure-Injury-Classification-System.PDF

Question 34

Pathophysiology of Chronic Wounds

Answer 34

A chronic wound is one that fails to progress through the normal phases of healing (hemostasis → inflammation → proliferation → remodeling) in an orderly or timely manner, typically taking >4–6 weeks to heal. 🔄 Key Pathophysiological Features: Prolonged Inflammation: Elevated levels of pro-inflammatory cytokines (e.g., TNF-α, IL-1) and proteases (e.g., MMPs) degrade essential extracellular matrix and growth factors. Impaired Angiogenesis: Poor oxygen and nutrient delivery hinders tissue repair. Cellular Dysfunction: Fibroblasts and keratinocytes have reduced migration and proliferation. Biofilm Formation: Bacteria form a biofilm, which is resistant to antibiotics and immune clearance. Hypoxia and Ischemia: Due to underlying vascular disease, especially in diabetic or arterial ulcers. Underlying Disease Burden: Diabetes, venous insufficiency, and immobility often impair healing mechanisms.

Question 35

Classification of chronic wounds and their causes characteristics

Answer 35

Venous ulcers <- chronic venous insufficiency - Arterial ulcers <- peripheral arterial disease - Diabetic foor ulecers <- neuropathy, ischemia, trauma- Pressure injuries <- prolonged pressure over bony areas- Malignant/fungating wounds <- tumor infiltration -

Question 36

Management of chronic wounds

Answer 36

Use TIME framework Tissue- non viable - debride Infection/inflamation- ABx, antimicrobial dressings Mosture balance - appropriate dressing choice to absorb or hydrate Edge of wound - adress stalled adges with advaced therapies