PHR2002 Wound Care & Management

Module Overview

• Course Title: MPharm 202 - Wound Care & Management

• Module Leader: Dr. Emma Wright

• University: University of Lincoln

Module Learning Outcomes

• LO2: Apply the science behind pharmacy in all activities.

• LO7: Utilizing knowledge of:

  • Mechanism of action

  • Pharmacology

  • Formulation and chemistry

  • Evidence-based national guidelines

  • Patient factorsSelect, identify, and plan appropriate treatments, including OTC preparations, for managing various patient presentations and discussing health promotion strategies.

Session Learning Outcomes

• Revise skin structure and anatomy.

• Understand wounds and their healing processes.

• Learn about scar formation.

• Recognize factors affecting wound healing.

• Understand different types of wound dressings.

• Explore new innovations in wound dressing technologies.

Skin Anatomy: The First Line of Defense

• Function: Acts as a barrier between internal organs and external pathogens.

• Significance: Skin is one of the largest organs; breaches (wounds, burns) may lead to infection.

• Consequence of Breach: Can result in morbidity and mortality.

Skin Cell Structure

• Epidermis: Comprises the stratum corneum (stratified epithelium with keratin) and contains various cell types (melanocytes, Langerhans cells, Merkel cells).

• Basement Membrane: Junctional layer holding the epidermis and dermis together.

• Dermis: Contains blood vessels, hair follicles, sweat glands & nerves embedded in an elastocollagenous matrix.

• Subcutaneous Layer: Composed of adipose tissue.

Understanding Wounds

• Definition: A break in the structure of an organ or tissue caused by external factors.

• Examples of Wounds: Bruises, grazes, tears, cuts, punctures, and burns.

Types of Wounds and Their Classifications

• Burns: Can result from heat, chemicals, electricity, sunlight, or nuclear radiation.

  • Classification:

    • First Degree: Affects only the epidermis.

    • Second Degree: Affects epidermis & dermis.

    • Third Degree: Extends to full skin depth & underlying tissues.

• Ulcers: Breaks in the skin associated with inflammation; classified into four stages.

• Assessment: Pressure ulcer risk evaluated using the Waterlow score, although its clinical use is now limited.

Factors Affecting Wound Healing

• Diabetic Ulcer Pathway: Poorly controlled diabetes leads to complications such as poor healing, ulceration, amputation, and infection.

• Wound Healing Phases:

  • Haemostasis: Immediate response involving blood clotting and inflammatory mediator release.

  • Inflammation: Characterized by pain, redness, heat, swelling; essential for clearing debris and preventing infection.

  • Proliferation: Involves re-epithelialization, collagen formation, and angiogenesis to rebuild tissue.

  • Remodeling: Can last years involving scar tissue formation and restoration of tissue architecture.

Factors That Impair Wound Healing

• Local Factors: Oxygenation is critical; inadequate oxygen can delay healing.

• Systemic Factors:

  • Age: Older age affects healing efficiency.

  • Sex Hormones: Impact healing differently; estrogen aids healing, while androgens may hinder it.

  • Obesity: Increases risk of infection and pressure ulcers.

  • Alcohol & Smoking: Both impair healing by diminishing immune responses and causing vascular issues.

  • Nutrition: Essential nutrients like carbohydrates, proteins, and vitamins optimize healing.

  • Diabetes: Complicates wound healing through poor blood supply and immune deficiencies.

  • Medications: Certain drugs like glucocorticoids and chemotherapeutics can retard wound healing due to their anti-inflammatory effects.

Innovations in Wound Dressings

• Wound Dressings' Purpose: Aid healing, prevent infection, absorb fluids, and promote healing.

• Types of Dressings:

  • Haemostatic

  • Occlusive (absorbent, antimicrobial, foam)

  • Hydrogel

  • Negative pressure dressing

• Emerging Technologies: Address issues like biofilm resistance, introduce smart dressings that monitor infection risks, and utilize hydrogel formulations that enhance healing efficiency and reduce scarring.

Summary of Future Directions in Wound Care

• Research Areas: Include new hemoconversion methods, innovative wound sealants, and bioengineered skin grafts, advancing the field to improve patient outcomes significantly.