Wound Management

Level 6: Wound Management

DV6VN303 Medical Nursing 2024

1. Initiate necessary therapeutics and interventions based on analyses and changes noted in hospitalized patients, recognizing the importance of timely responses to evolving wound conditions.

Physiology of Wound Healing

Wound healing involves a series of orchestrated biological processes that recover tissue integrity and function:

Phase 1: Inflammatory Phase

• Timing: This phase begins immediately post-injury and can extend from 0-3 days to 6 days depending on the severity and nature of the wound.

• Mechanism: The immediate response involves hemostasis, where platelets aggregate and fibrin strands form a clot that serves as a temporary barrier. Neutrophils enter the site to eliminate debris and pathogens, while macrophages follow, playing a crucial role in coordinating the healing response by releasing cytokines and growth factors to stimulate further healing processes.

Phase 2: Proliferative (Repair) Phase

• Duration: Extends roughly from 4 days to 3 weeks. It includes several key processes:

  • Granulation: The formation of new connective tissue and blood vessels to fill the wound. This tissue appears moist and red and is essential for healing.

  • Contraction: Myofibroblasts draw the edges of the wound together, reducing its size.

  • Epithelialization: Keratinocytes migrate across the wound bed, leading to skin regeneration. This process is closely linked to the presence of moisture and the elimination of necrotic tissue.

• Importance: This phase is crucial for re-establishing the integrity and function of the affected tissue, setting the stage for remodeling.

Phase 3: Remodeling (Maturation) Phase

• Timeline: Begins around 7-10 days post-injury and may continue for months or years. This phase is not linear and may require adjustments based on healing progress.

• Outcome: The wound undergoes collagen remodeling where type III collagen is replaced with type I, increasing tensile strength. The final scar may only reach about 80% of the original skin strength, and ongoing assessments are required to monitor this process.

Wound Healing Overview

• Hemostasis: Blood clotting immediately after injury forms a physical barrier that restricts bleeding and pathogen entry.

• Inflammatory Phase: Characterized by marked vascular changes, such as increased permeability leading to edema, and infiltration of immune cells that help initiate healing.

• Proliferative Phase: Involves significant angiogenesis, the formation of granulation tissue, and careful regulation of the balance between collagen deposition and degradation.

• Remodeling Phase: A dynamic phase where collagen fibers reorganize and cross-link, enhancing the tensile strength of the wound, with physiological adjustments based on mechanical stressors applied to the area.

Differences in Wound Healing Between Cats and Dogs

Despite shared basic phases of wound healing, cats and dogs exhibit critical physiological differences:

• Vascular Supply: Dogs have a higher density of the vascular network; thus, they have an enhanced capacity for healing due to improved blood flow and nutrient delivery.

• Inflammatory Response: While cats initially exhibit a similar inflammatory response, cats often have a delayed switching to the proliferative phase, leading to prolonged healing times. This is partly due to their distinct immune responses involving different cytokine profiles.

• Granulation Tissue Formation: In cats, the formation of granulation tissue tends to occur slower, which can impact subsequent phases. In contrast, dogs may develop these tissues more evenly across wound surfaces.

• Wound Strength: Studies show that cats develop strength in their healing tissue at a slower rate, increasing risks for complications such as chronic wounds or ulceration if not carefully managed.

Conditions That Delay Wound Healing

Conditions that can impede the effectiveness of the healing process include:

1. Oxygen Deprivation: Reduced oxygen levels can severely impair collagen synthesis and angiogenesis, which are crucial for effective wound repair.

2. Diabetes: Leads to neuropathy and poor circulation, inhibiting the body’s natural healing capabilities and increasing susceptibility to infection.

3. Hyperadrenocorticism: Elevated corticosteroid levels can suppress both inflammation and fibroblast activity, both of which are necessary for timely healing.

4. Liver Disease: Compromised liver function affects protein metabolism which is essential for collagen production; resulting malnutrition can impede recovery.

5. Cytotoxic Medications: Certain chemotherapeutic agents or steroids can inhibit immune responses which are vital during the proliferative phase.

6. Temperature Variations: Healing is optimally effective at normothermic conditions; hypothermia or hyperthermia can disrupt metabolic pathways necessary for cellular functions involved in healing.

7. Infection: The presence of pathogens can prolong inflammation and lead to chronic non-healing wounds, necessitating diligent infection control measures.

8. Malnutrition: Lack of essential nutrients and proteins can critically impair immune function and the synthesis of healing components.

Mechanical Forces and Decubitus Ulcers

• Mechanical Forces: Excessive pressure, friction, or shear forces applied to the skin can compress capillaries, diminishing blood flow and delaying healing processes, particularly in patients with limited mobility.

• Decubitus Ulcers: Also referred to as pressure ulcers or bedsores, these occur due to prolonged pressure on the skin that compromises tissue integrity, leading to necrosis. Early intervention through repositioning, proper cushioning, and skin care is vital for management and prevention.

Wound Management Strategies

Effective wound management encompasses multiple layers of intervention which include:

• Decontamination: Thorough cleaning of the wound to prevent infection. This can involve saline irrigation and the use of antiseptic solutions.

• Debridement: The removal of non-viable tissue, which can be conducted through various methods such as selective (sharp or enzymatic) or non-selective debridement techniques based on the wound's characteristics.

• Promoting Vascularity: Techniques to enhance blood flow to the wound site can include the use of topical growth factors or optimally designed dressings.

Wound Closure Techniques

• Physiological Closure: Recognizes the ability of healthy tissue to heal naturally under optimal conditions where infection is managed and support structures are intact.

• Surgical Closure: Involves either immediate closure (primary closure) or delayed closure after granulation tissue has formed (secondary closure) to ensure the wound can heal effectively with minimal complications.

Open Wound Management and Dressing Types

• Open Wound Management: Required when surgical closure is not feasible due to factors like infection or severity; this method seeks to optimize the healing environment while minimizing complications.

• Wound Dressings: The selection of dressings is crucial; moisture-retentive dressings help maintain an ideal condition for healing by preventing desiccation and promoting epithelial cell migration across the wound.

• Moist Wound Healing (MWH): Emphasized as a best practice, MWH focuses on the belief that moisture can facilitate healing by preventing scab formation and by supporting fibroblast migration and angiogenesis.

• Biological Dressings: These dressings, often derived from human or animal tissue, are typically reserved for severe burns and chronic wounds, aiding in healing by providing a biological framework for tissue repair.

Wound Drains

• Passive Drains: Simple gravity-driven designs, such as Penrose drains, allow for fluid to leave the wound site into a dressing, aiding in localized swelling reduction.

• Active Drains: Systems that utilize negative pressure, like Jackson-Pratt drains, effectively remove fluid buildup and prevent complications associated with seromas and hematomas.

Negative Pressure Wound Therapy (NPWT)

This technique employs sub-atmospheric pressure to promote healing, enhancing blood flow, reducing edema, and stimulating granulation tissue formation. Studies demonstrate a significant reduction in healing time with NPWT compared to traditional methods.

Topical Treatments and Pain Management

• Topical Treatments: When selecting topical medications, careful consideration of potential allergic reactions and local tissue response is vital; alternatives may include hydrogel dressings or medicated ointments.

• Pain Management: Effective strategies should incorporate a multimodal approach to pain management leveraging various analgesics (NSAIDs, opioids, local anesthetics) to ensure patient comfort; pain not controlled can lead to anxiety which negatively impacts the healing process.

Bibliography

A comprehensive selection of resources dedicated to wound care and management, providing essential guidelines and evidence-based insights into best practices for veterinary nursing, including peer-reviewed articles, textbooks, and clinical guidelines.

Kids Version, how to explain it to a child.

What is Wound Management?

Wound management is like taking care of a cut or scrape to help it heal. When someone gets hurt, their body works hard to fix itself, and we can help it do that!

Learning Goals

• Help patients heal: We learn how to help sick or hurt animals and help them feel better.

• Understand how wounds heal: Just like magic, our body has a way to fix cuts! We will learn about how blood, skin, and special helpers in our body work together.

• Different healing for cats and dogs: Just like how kids and adults may heal differently, cats and dogs have special ways to heal too. We will learn that dogs might heal faster than cats sometimes!

• Things that can slow healing: Sometimes, things like diabetes or not eating enough can make it harder for our bodies to heal cuts and scrapes.

• Care for cuts: We’ll learn how to keep cuts clean and getting the right medicine to help them heal faster.

How Wounds Heal

1. Fixing the injury: Right after you get a cut, your body makes a special bandage made of blood to stop the bleeding.

2. Building new skin: After that, the body starts to build new skin where the cut was. It’s like using building blocks to make something new!

3. Making the new skin strong: Finally, the new skin gets even stronger over time. It’s like when you lift weights to become stronger!

Tips for Taking Care of Wounds

• Keep it clean: Wash the cut with water to help keep out germs!

• Cover it up: Just like a band-aid protects a cut, we need to cover it to help it stay safe and heal.

• Do not bother it: It’s important not to pick at scabs because they’re helping the cut heal.

Learn about Cats and Dogs

• Cats might take a little longer to heal than dogs, just like how some friends can be slower at finishing their games.

• Dogs usually have more blood vessels, which help them heal faster.

Why Sometimes Wounds Don't Heal

• If you don’t have enough air (oxygen), your body can get tired and not heal well.

• If you're not feeling well (like with diabetes), your body may find it harder to get better.

• Eating well helps too! If you don’t eat enough nutritious food, it’s like trying to build a tower with missing blocks.

This is how we can be helpers to our animal friends when they get hurt and ensure they heal up just fine!