Wound management Flashcards
what are the stages of wound healing and explain what happens in each. How long does each take.
- Inflammatory - remove injurious agents and prepare wound for healing.
- haemostasis –> acute inflammation the blood vessel dilates to bring more cells to the area (hot, swells and red), then healing cells take away the debris 1-4 days - Proliferative - granular tissue is formed. Fibroblasts come into and secrete growth factor which brings nutrients to the area and allows new epithelial cells to begin to close the wound bed, new collagen and ECM (4 days to 42)
- Remodelling -crosslinking of collagen increases the tensile strength of wounds, type 3 collagen is replaced with type 1, scar flattens (after 6/52 –> 2 years)
How do adhesions form
Collagen is the most abundant protein in the human body though significantly contributes to the integrity of connective tissue structures. Excessive proliferation of collagen can limit exursion and ultimately the function of healing tissues in the upper extremity
What 9 things do you need to comment on in a wound assessment
- signs of infection
- physical location
- size
- appearance
- the stage of healing
- wound edema
- presence of haematoma
- vascular perfusion
- status of deeper tissues
In what stage of wound healing is immobilising splinting indicated
inflammatory phase
What stage of wound healing can you usually commence dynamic splinting
proliferative phase
in what stage of wound healing would you consider serial static splinting
remodelling phase
what is the the SAFE position of the wrist hand MCP and IP joints
Wrist 0-15, MCP joints 45, IP joints 0, thumb slightly abducted
Indications for imobilising splinting
- symptom relief after injury or overuse
- protect and position oedmatous structures
- aid in maximising functional use of the hand
- maintain tissue length to prevent soft tissue contracture
- protect healing structures and surgical procedures
- maintain and protect reduction of a fracture
- protect/ improve joint alignment
- blcok/ transer power to enhance exercises
- reduce tone and contracture of a spastic muscle
why do we dress wounds
prevent dessication (drying and cell death of top of wound - slowing healing) maintain moisture
how long after a wound is sutured can it be washed
24 hr hours with mild soap and running water
why is debridement neccessary
necrotic tissue promots bacterial growth and by mechanical impedance interferes with epitheralial cell migration. This prevents infection in the acute wound and in the management of a contaminated or chronic wound
What is a dressing trying to recreate?
reproduce the barrier function of the epithelium and a moist wound healing environment
why is strikethrough in dressings not good
the accumulation of wound fluid to the point of flooding causes maceration and bacterial overgrowth. if strike through does occur a channel is created that will allow microorganisms to enter the wound from the external environment
what effect does oedema have on a scar
the edematous wound environment contributes to sustaining and perpetuating a chronic inflammatory state associated with excessive scarring . Gross odema in the periwound area decreases vascularisation by altering hydrostatic capillary pressure, decreased oxygen and nutrient supply subsequently decrease the proliferation of granulation tissue
why is avoiding haematoma in a wound important
haemato formation compromises the repair process. It decreases perfusion and may cause graft seperation or wound dehiscence and increases workload of phagocytic cells. The increased inflammatory response increases fibrosis and scar. It also serves as a culture medium for bacteria and increases risk for infection
