Wound Closure

Comments

Transcription

Wound Closure
Physiology of Tissue Repair
• Stage I: Hemostasis
Hand Therapy Review Course
Washington University
St. Louis, MO
April 7‐9, 2017
Tissue Healing and Wound Management
David Levy, MS, OTR/L, CHT
•
•
•
•
Begins at wounding and last 24 hours
Bleeding
Platelets aggregate and degranulate
Fibrinolysis
• Stage II: Inflammation
• AKA substrate, lag, exudate phase
• Onset to days 4‐6
Fibroblasts
• Critical Cells
Macrophage
• Plateletes
• Neutrophils
• Macropages
Physiology of Tissue Repair
• Stage III: Reparative
•
•
•
•
Physiology of Tissue Repair
• Stage IV: Remodeling
• AKA Fibroplasia, Migratory, Proliferative
• Days 2‐5 through 14‐28
• Mechanical integrity of wound restored
Angiogenesis
Granulation tissue formation
Wound contraction
Epithelialization
•
•
•
•
•
•
AKA Maturation phase
Starts ~day 21, and lasts up to 2 years
Cross linking of collagen increases tensile strength
Scar stabilization
Wound contraction leads to scar shrinking
Blood supply decreases, reducing redness
• Tensile strength
Fibroblasts
proliferation
Freshly healed epidermis
Freshly healed dermis
Wound Closure
• Primary intention
• Surgical closure
• Secondary intention
• Wound closes with production of connective tissue (contraction) and epithelialization
• Longer healing time
Blood clot
Wound Closure
• Delayed Primary Closure
• Tertiary or re‐epithelialization
• Used when there is a significant loss of tissue and deformity or loss of function would result with skin closure
• Skin Grafts
• Skin Flaps
Scab
Wound Assessment
• History of the wound
• Location
• Size
• Appearance
• Stage of healing
• Infection
Three Color Concept
• Red
• Yellow • Black
• Combination
• Address most severe first
The Red Wound
• Description
The Yellow Wound
• Description
• Uninfected
• Definite borders
• Granulation tissue present
• Creamy ivory or yellow
• Pseudomonas present
• Gives color and odor
• Purulent exudate
• Goals
• Protect environment
• Prevent desiccation
• Protect granulation tissue and epithelial cells
The Black Wound
• Description
•
•
•
•
Black necrotic eschar
Dark brown or black
Pus may be present
Limited closure
• Goals
• Debridement
• Dressings to protect and soften eschar
• Facilitate autolysis
• Goals
•
•
•
•
Absorb drainage
Debridement of non‐viable tssue
Cleansing
Evolve to red wound
Multicolored Wound
• Multiple stages at once
Wound Treatment
•Create optimal healing environment
• Protect Wound fluids
• Prevent and control infection
•
•
•
•
Cleansing
Disinfection
Debridement
Dressings
• Protect wound bed from contamination
• Minimize mechanical influences Dressings
• Dressings for granular, non‐draining wounds
• Non‐adherent layer
• Absorbable layer
• External layer to hold in place
• Granular, draining wounds
•
•
•
•
Gauze
Alginate
Semipermeable foam
Hydrocolloid with topical agent
Dressings continued
• Necrotic, non‐draining wounds
•
•
•
•
•
Gauze with physical agent
Impregnated gauze
Transparent film
Hydrogel
Hydrocolloid
• Necrotic, Draining wounds
• Gauze
• Alginate
• Semipermeable foam
• Hydrocolloid
• Infected wounds need to be able to drain
Scars
• Properties
• Collagen deposition
• Abnormal scar results from excess collagen production in excess of breakdown
• Abnormal scars
• Keloid
•
•
•
•
Extend beyond original wound, lack regression
More common with darker pigmented skin
From superficial or deep injuries
Timelines vary on development – even years later
Scars
• Abnormal scars, continued
• Hypertrphic
•
•
•
•
•
•
More common type
Bulky and elevated
Occur soon after injury, but regress spontaneously
Determined by initial severity
Found in areas with motion, across joints
Associated with wound tension and time of closure
• Widespread scar
• Occurs in 4th phase of healing
• Not a problem of excess collagen
Scar Management
• Begins on day one
• Prevent excessive inflammation
• Prevent excessive wound tension
• Therapy
•
•
•
•
•
Controlled motion
Massage
Compression
Stress application
Modalities
• Superficial and deep heat
• Neuromuscular e‐stim – promote tendon gliding
Thank you!
• Questions??

Similar documents