factors complicating wound repair october 25, 2005

FACTORS COMPLICATING FACTORS COMPLICATING WOUND REPAIRWOUND REPAIR

October 25, 2005

DELAYED WOUND DELAYED WOUND CLOSURECLOSURE

WOUND TAKES LONGER THAN EXPECTED TO HEAL

WOUND IS PROGRESSING TOWARDS CLOSURE

CHRONIC WOUNDCHRONIC WOUND

WOUND WHICH HAS NOT RESPONDED TO CONSERVATIVE OR SURGICAL TREATMENT

COMPLICATING WOUND COMPLICATING WOUND REPAIRREPAIR

INTRINSIC FACTORS ENVIRONMENTAL FACTORS IATROGENIC FACTORS

INTRINSIC FACTORSINTRINSIC FACTORS

RELATED TO THE PATIENT’S GENERAL PHYSICAL CONDITION (DM, CVA, INFECTION)

RELATED TO THE PATIENT’S GENERAL MENTAL CONDITION (DEMENTIA)

ENVIRONMENTAL ENVIRONMENTAL FACTORSFACTORS

MODALITY OR TREATMENT APPLIED TO THE WOUND (W/P, NEOSPORIN, BETADINE)

IATROGENICIATROGENIC

HOW THE WOUND IS PHYSICALLY MANAGED (REMOVAL OF DRESSINGS, IRRIGATION, CLEANSING)

SKIN AGINGSKIN AGING

EPIDERMAL RENEWAL TISSUE REPAIR WOUND HEALING INFLAMMATORY RESPONSE VASCULAR SUPPLY PHOTOPROTECTION PAIN PERCEPTION

AGINGAGING

EPITHELIALIZATION WOUND BREAKING STRENGTH ANGIOGENESIS BIOSYNTHETIC ACTIVITY COLLAGEN REMODELING WOUND CONTRACTION INCREASED WOUND DEHISCENCE

INFECTIONINFECTION

ERYTHEMA- WELL-DEFINED (INFLAMMATION), ILL-DEFINED (INFECTION)

IF REDNESS GOES AWAY WITH CHANGE OF POSITION (ELEVATION) MAY BE INFLAMMATION VS. INFECTION

INFECTION (cont.)INFECTION (cont.)

HEAT (SYSTEMIC-FEVER-SEPSIS), LOCAL HEAT (INFLAMMATION)

FOUL ODOR (NECROTIC TISSUE WILL SMELL LIKE GARBAGE, SWEET SMELL-PSEUDOMONAS, AMMONIA SMELL PROTEUS)

INFECTION (cont)INFECTION (cont)

EDEMA- GENERALIZED (CHF, VENOUS INSUFFICIENCY), LOCALIZED (INFLAMMATION, INFECTION), WARM, INDURATED

INFECTION (cont.)INFECTION (cont.)

DRAINAGE color odor consistency amount

INFECTION (cont.)INFECTION (cont.)

PAIN (DRESSING REMOVAL) THROBBING COMPLAINT

Infections of the NailsInfections of the Nails

MEDICATIONSMEDICATIONS

NSAIDS (COLCHICINE) STEROIDS: corticosteroids inhibit collagen

synthesis & retard wound healing, decrease tensile strength of collagen

IMMUNOSUPRESSIVE DRUGS: methylprednisolone, cyclosporine A, (prednisone may decrease wound healing)

MEDICATIONS ( cont.)MEDICATIONS ( cont.)

ANTICOAGULANTS (coumadin, heparin) ANTINEOPLASTICS ANTIPROSTAGLANDINS

IMMUNOSUPRESSIONIMMUNOSUPRESSION

DECREASE FIBROBLAST FUNCTION DECREASE COLLAGEN SYNTHESIS DECREASE PHAGOCYTIC ACTION DECREASE ABILITY TO FIGHT

INFECTION

ANTIMICROBIAL TOXICITYANTIMICROBIAL TOXICITY

PROVIDONE IODINE HYDROGEN PEROXIDE ACETIC ACID CHLORHEXIDINE HYPOCHLORITES

RADIATIONRADIATION

INJURES FIBROBLASTS & ENDOTHELIAL CELLS

DECREASES COLLAGEN DESTROYS CELLS IN MITOSIS CAUSES VASCULAR DAMAGE DECREASES TOLERANCE TO SEPSIS

CHEMOTHERAPYCHEMOTHERAPY

INCREASES SUSCEPTIBILITY TO INFECTION

ALTERS FIBROBLAST FUNCTION ALTERS COLLAGEN SYNTHESIS &

METABOLISM INTERFERES WITH MYOFIBROBLAST

FUNCTION

HYDROTHERAPYHYDROTHERAPY

MOISTENS THE WOUND IRRIGATES & CLEANSES THE

WOUND SOFTENS SLOUGH & ESCHAR FLUSHES CELLS FROM THE WOUND FLUSHES CHEMOTACTIC

SUBSTANCES FROM THE WOUND

HYDROTHERAPY (cont.)HYDROTHERAPY (cont.)

INCREASES VASCULAR CONGESTION INCREASES VENOUS HYPERTENSION

INADEQUATE NUTRITIONINADEQUATE NUTRITION

DECREASES PROTEIN SYNTHESIS DECREASES ENERGY (ATP) CAUSES ANEMIA REDUCES OXYGEN TO CELLS DECREASES PROTECTION

(PRESSURE)

INADEQUATE NUTRITION INADEQUATE NUTRITION (cont.)(cont.)

DEPRESSES IMMUNE SYSTEM GLUCOSE, PROTEINS, FATTY ACIDS,

VITAMINS, MINERALS, H20- ALL ARE ESSENTIAL

PRESSUREPRESSURE

INHIBITS BLOOD FLOW REDUCES NUTRIENTS INCREASES METABOLITES INHIBITS ANTI-MICROBIAL ASSAULT INCREASES NECROSIS INHIBITS GROWTH

DESSICATIONDESSICATION

INHIBITS CURRENT OF INJURY INHIBITS GALVANOTAXIS INHIBITS CHEMOTAXIS INHIBITS COLLAGEN FORMATION INHIBITS RE-EPITHELIALIZATION

ESCHARESCHAR

INHIBITS CURRENT OF INJURY INHIBITS GALVANOTAXIS INHIBITS CHEMOTAXIS INHIBITS COLLAGEN FORMATION INHIBITS RE-EPITHELIALIZATION