factors complicating wound repair october 25, 2005
TRANSCRIPT
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