WOUND HEALING

wound healing power point presentation

1. WOUND HEALING
PRESENTED BY-AKSHITA NEGI
( BSc.Nursing 3
rd
semester )

2. WOUND
Introduction
Wound is a breakdown in the continuity of the skin,
this breakdown may vary from a small cut to a full
thickness .
It is a circumscribed injury which is caused by
external force and it can involve any tissue or organ.

3. Definition
wound is a breakdown in the integrity of the skin ,
mucous membrane ,or any other body organ .It may
be superficial affecting only the surface structures and
may involve blood vessels ,muscles ,nerves tendons ,
ligaments and bones.

4. TYPES OF WOUND
1. According
to duration
Acute
wound
Chronic
wound

5. Acute wound
acute wound usually takes days to weeks for healing
process . The wound edges have well defined margins,
which helps in better skin closure .The chances of
infection in these wounds are very low ,
example : abrasions

6. Chronic wound
The healing process is delayed and the wound edges
are not approximated and there is risk for infection .
Example –wound related to diabetes and pressure
sores

7. 2.
According
to skin
integrity
Open
wound
Closed
wound

8. Open wound : An open wound occurs when the
skin surface gets destroyed and these kinds of
wounds allow entry of microorganisms .
example : incision and abrasion
closed wound :a closed wound may be caused
by trauma such as fall or road traffic accident .the
skin integrity is intact but damage caused to soft
tissues followed by internal haemorrhage .
Example: ecchymosis and hematoma

9. Hematoma Ecchymosis

10. 3.
According to
degree of
contamination
Clean wound
Contaminated
wound
Clean –
contaminated
wound
Dirty or
infected
wound

11. 1.Clean woundare uninfected and closed with very
less inflammation .
2.Contaminated wound are contaminated as there
is major break in the skin integrity .
3.Clean –contaminated woundare contaminated
but don’t show any signs of infection .
4.Dirty or infected wounds comprising of dead
tissue and are evident of clinical infection ,which may
present in the form of purulent drainage .

12. 4.Accordiong to depth of wound
a ) superficial wound : only epidermis involved .
b) partial wound :epidermis and dermis involved
c) full thickness wound : dermis ,epidermis
,subcutaneous fat involved .
d) deep wound :epidermis ,dermis ,subcutaneous
fat ,exposed muscle and connective tissue involved.
e) Penetrating wound : sharp objects pass through
epidermis ,dermis ,subcutaneous fats ,exposed
muscle and connective tissue involved

13. WOUND HEALING

14. Introduction
the skin is our first line of barrier .when the skin
surface gets impaired ,microorganisms gets a
portal to enter and cause infection .the body has a
natural course of healing that works by inhibiting
microorganism’s growth and to restore the
structure and function of damaged tissues .

15. Definition
It is a response produced by the body to injury for
attempt to restore normal structure and function .

16. Process of healing
the process of healing involves 2 distinct
processes
A) regeneration
B) repair

17. Regeneration: is when healing takes place by
proliferation of cells and usually results in complete
restoration of original tissues .
Repair : it is healing outcome in which tissues do
not return to their normal architecture and function
.Repair typically results in the formation of scar
tissue

18. STAGE/ PHASES OF WOUND
HEALING
1.initial vascular response –Heamostasis
Immediate after injury ,clotting cascade is initiated
which provides a temporary blood clot made of fibrin to
plug the site of injury .
Simultaneously vasoconstriction occur in the site of
injury for 5 to 10 min .These temporary responses
protect the wound and stop the bleeding .

19. The temporary clot acts as a framework for further
healing such as migration of leukocytes ,fibroblast
keratinocytes ,and endothelial cells .It also acts as a
growth factors .
After this brief vasoconstriction ,vasodilation occurs
which causes oedema and hyperthermia and initiate
the process of inflammation

20. 2. Inflammation
Neutrophils migrate to the site of injury whin first 24
hours and stay there for 2 to 5 days .they initiate the
process of phagocytosis and this process is continued
by macrophages later .
these cells debride the dead and necrotic tissue and
kill the local bacteria .neutrophils augment the
inflammatory response by releasing many
proinflammatory cytokines and also attract other
cells to the site of injury .

21. Macrophages arrives nearly 3 days after injury to
the site and they also release many growth
factors ,chemokines ,cytokines , and promote cell
proliferation and formation of extracellular matrix
( ECM)

22. 3. Proliferation or granulation
This phase lasts from 4 -20 days .during this
phase ,collagen is synthesized with migration of
fibroblasts to the wound site .
Collagen is a white protein that helps in
strengthening of wound .as the amount of collagen
increases the wound become stronger and risk of
wound dehiscence decreases .

23. This process also includes the angiogenesis to provide
abundant blood supply to the damaged tissues.
The tissue gets a translucent red colour with the
increase in the capillary network .this tissue is known
as granulation tissue and it mainly comprises of
collagen so that it is fragile and shiny and tends to
bleed easily

24. 4.Maturation phase ( Remodeling)
it is the last phase of wound healing it begins after the
formation of granulation tissue .during this phase
collagen continues to be synthesized and the
granulation tissue eventually hardens to white scar
tissue .
Scar tissue is false skin and does not have nerve or
blood supply .

25. The wound undergoes remodelingand it gets contract
to form a stronger scar .
In certain individuals , primarily the dark skinned
individuals ,there is an abnormal amount of collagen
aggregation ,which can result in formation of
hypertrophic scar or a keloid

27. Types of wound healing
the types of healing is influenced by the amount of
tissue loss .
Types of
wound healing
Primary
intention
Secondary
intention
Tertiary
intention

28. 1.Primary intention ( first intention
healing )
healing happens when there is complete closure of
the tissue surface and there is negligible or no tissue
loss .
This is characterized by the formation of a minimal
granulation tissue and scarring .it is also known as
primary union .

29. A closed incision is an example of wound healing by
primary intensions.it may result in less evident scar

30. 2.Secondary intention
a widespread wound includes significant tissue loss ,
where the edges are unable to get approximated and
requires secondary intention of healing .
Pressure ulcers are an appropriate example of
secondary intention wound healing .

31. Secondary intention healing differs from primary
intention healing in 3 ways :
1. the repair time is longer
2. the scarring is greater
3. increased risk for infection .

32. 3.Tertiary intention
wound that are left open for 3 to 5 days to allow edema
or infection to resolve or exudate to drain and are then
closed with sutures ,staples , or adhesive skin closure
heal by tertiary intention .this is also known as delayed
primary intention

33. FACTORS AFFECTING WOUND HEALING
Smoking
Stress
Hypertension
Pressure
Desiccation
Maceration
Trauma
Oedema
Infection
Excessive bleeding
Necrosis

34. 1.Smoking
use of tobacco cause about 80-90% peripheral
arterial disease ( PAD) the nicotine gets absorbed
into the peripheral blood flow and oxygen gets
depressed by at least 50%.carbon monoxide has the
ability to bind with haemoglobin in place of oxygen
,considerably reducing the amount of circulating
oxygen , which hinders healing .

35. 2.Stress
stress stimulates the nervous system to
vasoconstriction of peripheral blood vessels , which
eventually can decrease tissue perfusion . Stress also
upsurges the amount of circulating natural steroids
and can hamper the inflammatory response .

36. 3.Hypertension
high blood pressure can make it harder for blood to
flow through the small blood vessels that carry oxygen
and nutrients to the site of wound .this can slow
down the process and increases the risk of
complications such as infection .

37. 4.Pressure
pressure interrupts the blood supply to wound area
.continuous and excessive pressure disrupts the blood
flow to the tissue and delays healing
trauma :delayed wound healing occurs due to
recurrent trauma to a wound area .

38. 5.Dessication
desiccation is the process of drying up .
The cells dehydrate and die in a dry environment .
crust is formed over the wound ,leading to cell death
and delays healing .therefore ,wound should be kept
moist and hydrated so that epithelization is supported
by the wound bed .

39. 6.Maceration
the process of softening and breakdown of skin due to
prolonged exposure to moisture is termed as
maceration .urinary and faecal incontinence cause
over hydration of cells and lead to maceration and
impaired skin integrity .
the type of skin impairment is also associated with
moisture changes in the pH of the skin , overgrowth of
bacteria , infection of the skin and erosion of skin from
friction on moist skin .

40. 7.Oedema
oedema at the wound site restrict the blood flow to
the wound area ,causes inadequate supply of oxygen
and nutrients to the tissue
infection :contamination of wound site increases
body’s immune response causing excess use of
energy .therefore only a minimal amount of energy
reserves is left for the wound healing

41. 8.Necrosis
dead tissue affects the wound healing process . Dead
tissue generally appears as a moist ,yellow ,stringy
tissue as dry ,black ,leathery tissue .
Healing of the wound never heals along with a necrotic
tissue in the wound so the wound healing begins after
the removal of the dead tissue

42. Other factors unrelated to the wound can also delay
the wound healing i.eage ,lifestyle ,comorbidities or
secondary diagnosis and nutrition .

43. MANAGEMENT OF WOUND
topical agents are used in the treatment of the wound
like antiseptic solutions , normal saline ,hydrogen
peroxide ,povidone iodine solution ,antibiotic solution
( gentamycin ,Neosporin )
1. control underlying cause of wound
2. remove dead tissues from the wound
3.after surgery : in order to relieve pain , Opoid
analgesics PCM may be given

44. 4. Apply hot and cold applications if prescribed
5.Non pharmacological pain relief measures such as
relaxation therapies ,distraction can be used .
6.Nutritional therapy : diet rich in protein ,
carbohydrate and vitamin C and fluid .

45. NURSING MANAGEMENT
maintain body temperature
1, assess patients temperature in every 2-4 hourly
2. keep normal environment temperature
3. avoid heavy layers of clothing or bed covers .
4.Change linen of patient frequently ,if is profusely
sweating .
5.Encourage more fluid intake by patient
6.administer antipyretics or analgesics as prescribed

46. Improve tissue perfusion
1.frequent assessment of the oedematous area is
needed
2.assess circumference ,pulse ,skin temperature
,capillary refill ,sensation and movement in area
distal to inflammation .
3. apply cold compress over affected site if
prescribed .
4. elevate edematousextremity .
5.keep edematousskin lubricated and protected
from injury

47. 6. Compression bandage can be used
7. Give prescribed anti-inflammatory agent .
Maintain skin integrity
1. use aseptic techniques while cleaning wound .
2.Change position of patient every 2 hourly ,if bed
ridden
3. clean wound properly with normal saline or
hydrogen peroxide .
4.keep surrounding skin dry and wound are moist .

48. 5. Wound debridement should be done ,if
indicated.
6. Diet rich in protein ,carbohydrate ,vitamin
,minerals should be provided .

49. COMPLICATIONS OF WOUND HEALING
1.infection : this may arise from the microbial
contamination usually by bacteria and result in
formation of pus
2. primary neuralgic : pain at wound area which
persist for abnormal period may be local at wound
area or extended along the nerve

50. 3. Cellulitis : spread of infection in the connective
tissue subcutaneously the affected area tends to
suppurate and necrosed.
4. keloid or contractures: this is an overgrowth
scar tissue ,it tends to get progressive whereas
contracture is the shortening of muscle or scar
tissue , which produces deformity .

51. 5.Venous thrombosis and embolism : venous
thrombosis occur frequently because blood flow is
slower it occur due to phlebitis in the vein that pass
through wound area .
6. wound dehiscence : when wound fails to heal and the
layers of skin may separate .it is the partial or total
separation of the wound layers .it mainly involves
abdominal wounds and occur after sudden strain .

52. 7.Wound evisceration : it is the protrusion of
abdominal organs through gap formed by separation of
wound layers .

53. WOUND CARE AND
TYPES OF WOUND
DRESSING

54. Wound care
1. first step is to do overall assessment of patient before
treating any wound
2. perform history taking ,clinical examination
,investigations ( blood tests , x ray scans ) any
pathological condition , implementation of the plan of
care
3. wound assessment includes tissue type ( clean ,
necrosed, infective ,granulation) wound exudate ( type ,
volume , consistency ) and periwoundcondition ,pain
level and size of wound

55. General wound care
1.wound is usually cleaned with normal saline to
remove dirt and debris from a fresh wound .
2. vaccinating for tetanus may be recommended in
some traumatic injury .
3. relieving pain with medications . pain can cause the
blood vessels to constrict ,which slow healing
if patient does not tolerate pain then paracetamol or
strong painkiller medication can be prescribed .

56. 4.In order to manage infected wound ,
prophylactically antibiotics and microbial
dressings may be started .
5. in case if the patient is already in anti-
inflammatory drugs and steroids ,drug dose or
alterative drugs can be administered to enhance
wound healing
6.instruct patient not to take anti-inflammatory
drugs as they interfere with the body’s natural
healing process .

57. 7. Encourage patient to take diet rich in vitamin C ,
protein and zinc
8. keeping wound dressed heal faster as they are kept
warm .
9. encourage patient for regular exercise because it
increases blood flow ,improve general health and
speed wound healing
10. keep blood glucose in within normal especially in
diabetes mellitus.
11. encourage patient not to smoke

58. WOUND DRESSING
it is the process of cleaning and covering the wound
with aseptic technique ,with or without medication .

59. Purposes
1.to keep the wound clean and lessen the spread of
microorganisms
2. to promote wound healing
3. to provide thermal insulation
4. to absorb drainage
5. helps to immobilized the wound site and facilitate
wound healing
6. to prevent haemorrhage

60. Types of wound dressing
1. Transparent dressing : transparent dressing
are self adhesive film dressing commonly applied
to superficial wound
They are transparent , eases wound assessment
and are water resistant .
Serve as barrier to external fluid and soiling of
wound .
makes the wound moist and retain small amount
of exudate ,it doesn’t require a secondary dressing

61. Transparent dressing

62. 2.Hydrocolloid dressing
these dressings are frequently used over the pressure
ulcers .
they lasts up to 3 to 7 days
water resistant
Can be moulded to uneven body surfaces .
Decrease pain and thus reduces the need for
analgesics
Absorb moderate drainage and contain wound odor.

63. Hydrocolloid dressing

64. 3.Hydrogels
It soothes the skin
reduce the pain
provide moist environment . helps in debridement of
necrosed tissue and easy to remove

65. 4.Saline dressing
most suitable debridement technique to use
Reduces inflammation
Maintain drainage of affected area
Promote healing by facilitating free movement of
epidermal cells

66. Summarization
wound : it is the breakdown in the continuity of the
skin , mucous membrane or any other body organ
Types of wound
1. acute wound
2. chronic wound
3. open wound
4. closed wound
5. clean wound
6. contaminated wound
7. clean contaminated wound

67. 8. Dirty or infected wound
9. Superficial wound
10. Partial wound
11.full thickness wound
12.deep wound
13.penetrating wound
Woundhealing : it is a response produced by the
body to injury for attempt to restore normal structure
and function

68. Process of healing:
1. Regeneration
2. Repair
Stages of wound healing :
1. Hemostasis
2. Inflammation
3. Proliferation
4.Maturation
Types of wound healing :
1.Primary intention
2.Secondary intention
3.Tertiary intention

69. Factors affecting wound healing
1.Smoking
2.Stress
3.Hypertension
4.Pressure
5.Trauma
6.Desiccation
7.Maceration
8.Oedema
9.Infection
10.Excessive bleeding
11.Necrosis

70. Complications:
1. Infection
2.Primary neuralgic
3.Cellulitis
4.keloid or contracture
5.venous thrombosis
6.wound dehiscence
7.wound evisceration

71. Wound dressing :
it is the process of cleaning and covering the wound
with antiseptic technique ,with or without medication
Types of wound dressing :
1.transparent dressing
2. hydrocolloid dressing
3. hydrogel dressing
4. saline dressing

72. THANK YOU