ES

Recording-2025-08-18T16:05:05.422Z

Wound assessment and healing (study notes from the video transcript)

  • Wound cues from the image

    • Pus described as purulent drainage or discharge; terminology correction: correct term for pus is drainage/discharge.
    • Basic wound care actions: clean the line, swab around the wound.
    • Consider infection but avoid labeling as infection without enough data; assessment centers on purulent drainage and surrounding signs.
    • Inflammation around stitches observed: swelling around the wound edges; redness present.
    • Count sutures (e.g., 11 sutures in the pictured wound).
    • Measure wound length/width and note whether wound edges are approximated (edges touching) rather than gaping.

  • Core concept: wound healing involves filling a gap created by injury/tissue destruction and restoring tissue continuity through three phases:

    • Inflammatory phase (Phase 1)
    • Proliferative phase (Phase 2)
    • Remodeling phase (Phase 3)

  • Inflammatory phase: purpose and sequence

    • Purpose: remove injurious agents and prepare wound for healing.
    • Inflammation signs: redness, swelling, heat, pain, potential loss of function (the classic five signs).
    • Initial event: hemostasis (blood clot formation) to seal the wound and form a scab, closing the wound.
    • Acute inflammation: blood vessels dilate, more cells enter the area; wound becomes hot, swollen, red.
    • White blood cells come to the area: neutrophils and macrophages phagocytose dead cells and microorganisms, paving the way for the next phase.

  • Proliferative phase: tissue formation and repair

    • Granulation tissue forms; fibroblasts are central.
    • Fibroblasts secrete growth factors that promote new blood vessel formation (angiogenesis) bringing oxygen and nutrients.
    • Growth factors from fibroblasts stimulate epithelial cell growth at wound edge, aiding re-epithelialization and edge retraction.
    • Fibroblasts lay down new collagen and extracellular matrix, creating a scaffold for new tissue.
    • Granulation tissue appearance: beefy red, shiny, cobblestone-like (cobblestone pathway appearance).

  • Remodeling phase: maturation and scar formation

    • Begins around three weeks after initial injury.
    • Granulation tissue is replaced by scar tissue; scar becomes avascular (loses its blood supply).
    • Collagen reorganization and contraction lead to scar remodeling; over time the scar may fade but never fully revert to original tissue.

  • Wound healing is universal across wound types; granulation indicates healing progress; scarring is a natural part of healing.

  • Rewatching and resources: the speaker notes that video materials (PowerPoint) can be rewatched for review.

  • Intention types for wound healing (three main categories)

    • Primary intention: clean wound with small gap, edges approximated (e.g., sharp incision like a scalpel).
    • Closure methods: sutures, staples, Steri-Strips to bring edges together.
    • Outcome: quicker healing and less scar.
    • Secondary intention: wound left open to heal from the bottom up (granulation and contraction); common for abrasions or pressure injuries.
    • Management: wound packing with gauze, regular dressing changes, slower healing, larger scar.
    • Tertiary intention (delayed primary closure): wound is left open initially due to contamination; later closed with sutures/staples.

  • Wound assessment framework (clock system) and measurements

    • Clock system: describe wound position relative to the patient’s head (12:00 is toward head).
    • Tunneling assessment: document tunneling at different clock positions (e.g., 01:00, 07:00) and measure depth with a sterile Q-tip; depth in centimeters (cm).
    • Wound dimensions: measure length and width in cm; depth if tissue loss present (use deepest point with a Q-tip).
    • Normal post-op expectations (early post-op): day 1–2 may have redness, swelling, drainage; these can be normal in the inflammatory response.
    • Example case: Day 1 post-op with abdominal surgery
    • Findings: temperature 99.5°F (slightly elevated but not fever), redness around incision, 30 mL serosanguinous drainage in Jackson-Pratt (JP) drain.
    • Assessment approach: interpret inflammatory response as normal for immediate post-op; link to infection indicators (e.g., higher fever, rising WBC, increasing drainage, foul odor) as red flags to reassess.
    • Discussion of JP drain: JP drain is a suction device that helps remove fluids; 30 mL/day (or in the drain bulb) may be normal in early post-op but should decrease over time.
    • Important clinical reasoning: avoid assuming infection solely from one variable (e.g., slight fever); assess the overall inflammatory response and trends over time.

  • Practical wound management concepts

    • Debriefing concepts:
    • Debridement: removal of nonviable tissue; can be surgical or mechanical.
    • Debridement context: necessary when slough/eschar is present (non