Wound Healing

What are the three layers of the skin and their main functions?

1. Epidermis (barrier)

2. Dermis (blood vessels, nerves, collagen)

3. Subcutaneous (fat, connective tissue)

What are the four main functions of the skin?

Maintains body temperature

Detects pain

Produces vitamin D

Acts as a waterproof barrier

What defines a wound?

A break in skin continuity due to trauma (cut, blow, surgery)'

What are the two main types of wounds?

1. Acute (trauma/surgical, heals predictably)

2. Chronic (fails to heal within 4 weeks, e.g., diabetic ulcers)

What happens during the hemostasis phase of wound healing?

• Vasoconstriction

• Clotting factor activation

• Fibrin clot formation

First phase of wound healing

What occurs during the inflammation phase of wound healing?

• Vasodilation

• Macrophages clean debris

• Fibrin clot loosely holds wound edges

(Days 1- 4)

What processes occur during the proliferation phase of wound healing?

• Epithelial cells bridge the wound

• Angiogenesis forms new blood vessels

• Fibroblasts produce collagen

(Days 4-21)

What happens during the remodeling phase of wound healing?

• Collagen reorganizes

• Tensile strength improves

(Weeks to months)

What are four strategies for pain management in wounds?

1. Assess pain before/during/after dressing changes

2. Use analgesics

3. Use atraumatic dressings [Specialized wound care products designed to minimise pain and trauma during application, removal, or dressing changes. Easy release without damaging newly formed tissue or causing discomfort. Commonly used for chronic wounds (e.g., ulcers, burns) or fragile skin]

4. Gentle removal

What does the HEIDI framework assess in wounds?

HEIDI:

• History

• Examination

• Investigation

• Diagnosis

• Intervention

What are the four tissue types in the TIMES assessment tool?

TIMES:

• Necrotic (black)

• Slough (yellow)

• Granulation (red)

• Epithelial (pink)

—

T - Tissue: non-viable or deficient

I - Infection or inflammation

M - Moisture imbalance

E - Edge of wound, epidermal advancement

S - Social and patient-related factors: Considers lifestyle, compliance, and socioeconomic barriers (e.g., access to care) that impact healing.

How is infection classified in the TIMES assessment tool?

• Local (topical antibiotics)

  vs.

• Systemic (oral/IV antibiotics)

What is a moisture imbalance in wound healing?

Heavy exudate [a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation] slows healing

What are the edge characteristics in the TIMES assessment tool?

• Undermining (chronic)

  vs.

• Tract (narrow tunnels)

What surrounding skin issues are assessed in TIMES?

• Maceration (too wet)

  or

• Dryness

What are the five types of wound exudate?

• Serous (clear, watery)

• Fibrinous (cloudy)

• Purulent (yellow/green)

• Hemopurulent (pink)

• Hemorrhagic (red)

What causes pressure ulcers?

• Pressure (skin compressed over bony areas)

• Shear (gravity pulls body, skin fixed)

What are two risk factors for pressure ulcers?

• Elderly

• Immobility

What are the four stages of pressure ulcers?

1: Discolored intact skin

2: Partial-thickness loss

3: Full-thickness loss

4: Necrosis with bone/tendon exposed

What are the four types of moisture-associated skin damage (MASD)?

• Incontinence-associated dermatitis [Skin damage associated with exposure to urine or faeces or body fluids]

• Intertrigo [Skin-to-skin friction, most often in warm, moist areas of the body, such as the groin, between folds of skin on the abdomen, under the breasts]

• Peristomal

• Periwound

What is a non-adherent dressing best for, and what is its key feature?

Granulating wounds, silicone-coated'

What is a hydrocolloid dressing best for, and what is its limitation?

Moist healing, not for diabetic ulcers'

What is a hydrogel dressing best for, and what is its key feature?

Necrotic wounds, rehydrates dead tissue'

What is an alginate dressing best for, and what is its key feature?

Bleeding wounds, forms gel with exudate'

What is larvae therapy best for, and what is its key feature?

Debridement, maggots eat dead tissue'

What are two key takeaways for wound healing?

Balanced moisture and infection control are essential

Chronic wounds may need advanced therapies like NPWT

Notes