Principles of Wound Care

Professor Claire Hale

What is a Wound?
Any break in the continuity of body tissue

Examples:
grazes, burns, surgical incisions, stabs,
leg ulcers, decubitus ulcers ( pressure
sores)
Stages of Wound Healing

Stage 1 - traumatic inflammation ( 0-3 days)-
redness, heat, swelling
Stage 2 -destructive phase ( 2-5 days)-
polymorphs and macrophages clear the
wound of debris and stimulate new growth
Stage 3- the proliferative phase( 3-24 days
increased collagen formation
Stage 4- maturation phase ( 24 days-1 year)
scar tissue decreases granulating tissue gets
stronger and changes from reddish to pale

Closure of Surgical Wounds
Primary closure - first intention
( direct suture- if no tissue loss
Delayed primary closure- usually
when a drain is left in situ.
Secondary intention - wound closes
by a process of contraction and
epithelialisation e.g ulcers and pressure
sores

Factors Influencing Wound Healing
Good blood supply: ( oxygen, nutrients)
Good nutrition:
Rest: skin cells multiply more rapidly
during sleep
Lack of stress: increased levels of adrenaline
and steriods delay healing
Lack of infection:
Age : children heal more rapidly than older
people
Site of wound: face and neck heal more
rapidly

Factors Delaying Wound Healing
General factors
poor diet
anaemia
pulmonary disease
cardiac insufficiency
arteriosclerosis
diabetes mellitus
smoking
Jaundice
malignant disease
high blood urea
stress
lack of sleep
drug therapy e.g.
steroids and
cytotoxic
radiotherapy
Factors Delaying Wound Healing
Local to patient/wound

skin edges not lined
up
dead tissue in wound
foreign bodies in
wound
tension on wound




infection
irritant material for
suturing
too tight suturing
Complications of wounds
Haemorrhage ( surgical wounds)
Infection
non union
rupture ( dehiscence)
pressure and strain ( coughing vomiting)
over granulation of scar tissue
contractures

Caring for Wounds
Assess for:
type of wound
location of wound
size of wound
shape of wound
level of exudate
condition of wound bed
condition of surrounding skin

Caring for Wounds
Recognising inflammation
redness over area and surrounding
tissue
swelling
heat
pain/ tenderness
loss of function

Caring for Wounds
cleansing wounds
should it be done?
what should be used?
how should it be done/
types of dressing
who makes the decision

Cleansing wounds: an area where
ritualistic practice predominates

Key questions:
1. Does the wound really need cleaning?
2. What is the safest method that causes
no ill effects and maintains the wound
temperature?
3. What is acceptable to the patient?
Wounds that are clean and healthy do not
require cleaning and should be left alone

Cleansing wounds: Main reasons
Excess exudate and signs of infection
Foreign body contamination ( eg. grit in
a graze)
Presence of devitalised tissue ( slough
or necrotic tissue)
To assess the wound
psychological reasons

Types of Cleansing Fluids
Antiseptics: generally discouraged
now- can be toxic to tissue healing
Saline solutions: normal saline
sachets commonly used
Tap water: Why not!!
tip: cleansing fluids should be at body
temperature
Methods of Cleansing
Swabbing: not particularly effective,
mainly redistributes organisms
Bathing: useful for chronic wounds
such as leg ulcers. Take care with
equipment to avoid cross contamination
Irrigation: shower head, waterjug,
syringes - dont be overzealous
Choice of Dressing
The concept of moist wound healing

Modern dressing technology is based
on the principle that the wound
/dressing interface should be moist
rather than dry.

In other words scabs are bad!
Common characteristics of wound
dressings
Capable of maintaining
high humidity at wound
site
free of particles and
contaminants]
non toxic / non
allergenic
capable of protecting
the wound from further
trauma
Impermeable to
bacteria
thermally insulating
capable of allowing
gaseous exchange]
able to withstand
infrequent changes
cost effective
long lasting
Patient Factors Influencing the choice
of dressing:
Age
Lifestyle
Medical History
Care environment
Ability to maintain /change own dressing
Competence and willingness of
potential carers
Types of Dressings
Low adherent dressings-Tullegras,Tegapore
Semi permeable films- Opsite, Tegaderm
Hydrocolloids - Comfeel plus, Granuflex
Hydrogels- Intrasite, Sterigel
Alginates- Sorbisan, Kaltostat
Foam dressings- Cavicare, Lyofoam extra
Antimicrobial dressings- Actisorb plus,
Inadine
Minimising Cross Infection
Dressing and cleansing wounds is at
the very minimum a Clean Procedure
and is often an Aseptic Procedures
Thorough hand-washing and use of
gloves are the most effective methods
of preventing contamination of the
wound
If wounds are infected then care must
be taken to prevent cross
contamination