Wound Management

Presented by Meagan Simmonds

Objectives
 Provide

education to all staff of 3east on wound care management  Provide education to all staff on appropriate dressing selection

Wound Management Principles



Successful wound healing is largely dependent on the patient. Expensive dressings will do little to improve healing if the patient does not also have:


A good blood supply to deliver essential wound repair components to the wound site e.g oxygen, nutrients (such as protein, vitamins and minerals) and essential wound repair cells (such as monocytes/macrophages, neutrophils, fibroblasts, monocytes/macrophages, neutrophils, myofibroblasts and growth factors) Adverse influences impeding wound healing being controlled odema, odema, infection, disease, malnourishment etc.

Principles of Management
        

Understand the clinical significance of our actions in promoting or hindering wound healing i.e. the need to be knowledgeable about normal wound healing physiology. Systematically determine the cause of a wound by history taking and requesting relevant clinical investigations. Medical management of the cause of the wound is complimenting topical management Acknowledge patient variables with potential to delay healing. Systematically determine the objective of management Routinely use non-irritating, pH friendly, cleansing solutions nonUse effective cleansing/debriding techniques dependent on cleansing/debriding wound/patient type. Always promote prevention of wounds Objectively evaluate wound progress/deterioration

ANATOMY & PHYSIOLOGY OF THE SKIN

Functions of the Skin

 Thermoregulation  Protection  Sensation  Cosmesis  Metabolic

synthesis

Structure of the Skin

 The
  

skin comprises three layers:

Epidermis Dermis Subcutaneous

Epidermis
Does not have a blood supply  Contains 4 distinct cell types



Keratinocytes (produces keratin which helps waterproof the skin) Melanocytes (produces melanin which is a skin pigment) Langerhans & Granstein cells (involved in immunity)

Contains four or five cell layers. High friction areas (palms & soles) have five layers

 Stratum

basale  Stratum spinosum  Stratum granulosum  Stratum lucidum  Stratum cerneum

Dermis
 Is

composed of connective tissue containing many nerve endings, hair follicles, glands and blood vessels.  Is thick on the soles of feet and on the palms of the hand, but is thin on the eyelids, penis & scrotum.

Subcutaneous Layer
 Main

constituent is adipose tissue, nerve fibres, arteries, veins and sweat glands.

TYPES OF WOUND HEALING

Primary Intention Healing

 Full

thickness wound edges are approximated (brought together) shortly after the primary wound has been created e.g. Clean surgical wounds with no tissue loss.

Delayed Primary Closure

 This

is when closure of grossly contaminated wounds e.g. Animal bites is delayed (4-5 days) to allow time for host (4inflammatory and immune responses (neutrophils & macrophages) to reduce the risk of infection.

Superficial Wound Healing

Wound care products



Moist Wound Healing Products

   

Lightly exudating superficial wounds Moderately exudating superficial wounds Heavily exudating superficial wounds Very heavily exudating superficial wounds

Dry Necrotic Wounds Excoriated Skin Treatment Cavity wound- moderately exudating woundCavity wound- Heavily exudating woundCavity Wound- Very heavily exudating Wound Fragile Skin  Critically Colonised wounds
    

Physiology of wound healing

 Inflammation

Phase

Modes of wound healing

Factors affecting healing

Wound Assessment

Wound Management

Acute wound Management

Chronic wound management