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Skin
y Largest organ of the body y Primary function is protective y Composed of several layers
y Outer Epidermis y Dermis, containing the capillary network y Subcutaneous layer (hypodermis, adipose
layer)
To be regenerated
Cell egeneration vascular Regeneration C regeneration
Wound
A wound can be defined as A cut or break in the continuity of any tissue, caused by injury or operation
Types of healing
Healing by primary intention Healing by secondary Intention Delayed primary healing
given antibiotics and closure is delayed for a few days e.g. bites y Delayed primary closure or secondary suture y The wound is initially cleaned, debrided and observed y The wound is purposely left open
Phases of healing
y All wounds heal following a specific
sequence of phases which may overlap y The phases are: y Inflammatory phase y Proliferative phase y Remodelling or maturation phase
Phases of healing
Inflammatory phase
y HEMOSTASIS
In the inflammatory phase clotting takes place in order to obtain hemostasis y INFLAMMATION various factors are released to attract cells that phagocytose debris, bacteria, and damaged tissue and release factors that initiate the proliferative phase of wound healing
Inflammatory phase
y Day 0 5 y The inflammatory phase is characterised by
heat, swelling, redness, pain and loss of function at the wound site y Early (haemostasis) y Late (phagocytosis) y This phase is short lived in the absence of infection or contamination
Proliferative phase
y Angeogenesis y Epithelialization y Extracellular matrix
Angiogenesis
y Collagen first detected at day 3 and rapidly
Angiogenesis
y Endothelial cells from the side of vessels
closest to the wound begin to migrate in response to angiogenic stimulus forming capillary buds y VEGF, TGF
ranulation
y Day 3 14 y Granulation tissue consists of a combination
of cellular elements including: Fibroblasts, inflammatory cells, new capillaries embedded in a loose extracellular collagen matrix
Epithelialization
y The epidermis immediately adjacent to the
wound edge begins to thicken within 24hrs after injury y They migrate to the wound breaking collagen in healing wound
aturation
y Can last up to 2 years y New collagen forms, changing the shape of
the wound and increasing the tensile strength y Scar tissue, however is only ever approx. 5080% as strong as the original tissue y During the remodelling process there is a gradual reduction in cellularity and vascularity of the tissue
Contraction
hen there is unacceptable tissue loss and an unsatisfactory cosmetic result y Wound contraction usually begins from day 5 and is complete at approx. day 12 - 15
y
Factors affecting
y Immune status y Blood glucose levels (impaired white cell
function) y Hydration (slows metabolism) y Nutrition y Oxygen and vascular supply y Corticosteroids (depress immune function)
rowth factors
y EGF y PDGF y FGF y TGF-B y Interlukins y Interferons
Wound assessment
Signs of infection Size, depth & location
Odour or exudate
WOUND ASSESSMENT
Wound bed: necrosis
Wound edge
granulation
Wound dressing
y y y y y y y y
Non-adherent wound contact materials Films Hydrogels Hydrofibre dressings Hydrocolloids Foams Alginates Miscellaneous
Film dressings
y Semi-permeable primary or secondary
dressings y Clear polyurethane coated with adhesive y Conformable, resistant to shear and tear y Do not absorb exudate y Examples: Tegaderm, Op-site
Hydrocolloids
y Pectin, gelatin, carboxymethylcellulose and y y y y
elastomers Environment for autolysis in sloughy or necrotic wounds Occlusive --> hypoxic environment to encourage angiogenesis Waterproof e.g. Urgotul
Foam dressings
y Advanced polymer technology y Highly absorptive y Semi-permeable y Various types
Hydrogels
y Sheets or gels y Starch and polyacrylamide (94% water) y Low exudate, shallow wounds y Re-hydrates necrotic tissue y Secondary dressing needed y May cause skin maceration
Alginates
y Seaweed dressings y Form a gel over the wound y Moderate to high exudate wounds y Easily removed y Can cause pain y Help to debride a wound