\r\n| \r\n Phase<\/strong><\/p>\r\n<\/td>\r\n| \r\n \u00a0Additional Information<\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n\r\n| Hemostasis phase<\/td>\r\n | Blood vessels constrict and clotting factors are activated. Clot formation blocks the bleeding and acts as a barrier to prevent bacterial contamination. Platelets release growth factors, which alert various cells to start the repair process at the wound location.<\/td>\r\n<\/tr>\r\n | \r\n| Inflammatory phase<\/td>\r\n | Vasodilation occurs, allowing plasma and leukocytes (white blood cells) into the wound to start cleaning the wound bed. This process is seen as edema, erythema, and exudate. Macrophages (another type of white blood cell) work to regulate the cleanup.<\/td>\r\n<\/tr>\r\n | \r\n| Proliferative phase<\/td>\r\n | Four important processes occur in this phase:\r\n\r\n \t- Epithelialization: new epidermis and granulation tissue are developed<\/li>\r\n \t
- New capillaries: angiogenesis occurs to bring oxygen and nutrients to the wound<\/li>\r\n \t
- Collagen formation: this\u00a0provides strength and integrity to the wound<\/li>\r\n \t
- Contraction:\u00a0the wound begins to reduce in size<\/li>\r\n<\/ol>\r\n<\/td>\r\n<\/tr>\r\n
\r\n| Maturation (remodelling) phase<\/td>\r\n | Collagen continues to strengthen the wound, and the wound becomes a scar.<\/td>\r\n<\/tr>\r\n | \r\nData source: British Columbia Provincial Nursing Skin and Wound Committee, 2011;\u00a0Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n\r\n\r\n[caption id=\"attachment_6722\" align=\"aligncenter\" width=\"713\"] ![\"Phases](\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/10\/713px-Wound_healing_phases.png\") <\/a> Figure 4.1 Phases of wound healing[\/caption]\r\nTypes of Wounds<\/h2>\r\nTo determine how to treat a wound, consider the etiology, amount of exudate, and available products to plan appropriate treatment. Wounds are classified as acute (healing occurs in a short time frame without complications) or chronic (healing occurs over weeks to years, and treatment is usually complex). Examples of acute wounds include\u00a0a surgical incision or a traumatic wound (e.g., a gunshot wound). Examples of chronic wounds include venous and arterial ulcers, diabetic ulcers, and pressure ulcers. Table 4.2 lists the six main types of wounds.\r\nTable 4.2 Types of Wounds<\/caption>\r\n\r\n\r\n| \r\n Type<\/strong><\/p>\r\n<\/td>\r\n| \r\n \u00a0Additional Information<\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n\r\n| Surgical<\/td>\r\n | Healing occurs by primary, secondary, or tertiary intention.\r\n\r\nPrimary intention<\/strong> is where the edges are sutured or stapled closed, and the wound heals quickly with minimal tissue loss. The healing time for a surgical wound is usually short, depending on the surgery.\r\n\r\nA surgical wound left open to heal by scar formation is a wound healed by secondary intention<\/strong>. In this type of\u00a0wound, there is a loss of skin, and granulation tissue fills the area left open.\u00a0Healing is slow, which places the patient at risk for infection. Examples of wounds healing by secondary intention include severe lacerations or massive surgical interventions.\r\n\r\nHealing by tertiary intention<\/strong> is the intentional delay in closing a wound. On occasion, wounds are left open (covered by a sterile dressing) to allow an infection or inflammation to subside. Once the wound is closed with staples or sutures, the scarring in minimal.<\/td>\r\n<\/tr>\r\n\r\n| Traumatic<\/td>\r\n | Examples are gunshot wounds, stab wounds, or abrasions. These wounds may be acute or chronic.<\/td>\r\n<\/tr>\r\n | \r\n| Diabetic\/neuropathic ulcer<\/td>\r\n | This is a nerve disorder that results in the loss or impaired function of the tissues affecting nerve fibres. These wounds generally occur as a result of damage to the autonomic, sensory, or motor nerves and have an arterial perfusion deficit. They are usually located in the lower extremity on the foot. Diabetic\/neuropathic ulcers are often\u00a0small with a calloused edge. Pain may be absent or severe depending on the neuropathy.<\/td>\r\n<\/tr>\r\n | \r\n| Arterial ulcer<\/td>\r\n | Arterial ulcers occur when tissue ischemia occurs due to arterial insufficiency from the narrowing of an artery by an obstruction (atherosclerosis). They are located on the distal aspects of the arterial circulation, and can be anywhere on the legs, including feet or toes.\u00a0Wound margins are well defined with a pale wound bed\u00a0with little or no granulation. Necrotic tissue is often present. There is minimal to no exudate present. Pedal pulses are usually absent or diminished. Pain occurs in limb at rest, at night, or when limb is elevated.\r\n\r\nArterial ulcers account for 5% to 20% of all leg ulcers. Perfusion must be assessed prior to initiating treatment.<\/td>\r\n<\/tr>\r\n | \r\n| Venous ulcer<\/td>\r\n | A venous ulcer is a lower extremity wound. Tissue ischemia occurs due to the failure of the venous valve function to return blood from the lower extremities to the heart. It is usually located in the ankle to mid-calf region, usually medial or lateral, and can be circumferential. Drainage can be moderate to heavy. A venous ulcer can be irregularly shaped, large, and shallow with generalized edema to lower limbs. Pulse may be difficult to palpate.\r\n\r\nVenous ulcers account for 70% to 90% of all leg ulcers. Perfusion must be assessed prior to initiating treatment.<\/td>\r\n<\/tr>\r\n | \r\n| Pressure ulcer<\/td>\r\n | Also known as a pressure sore or decubiti wound, the pressure ulcer is a localized area of tissue damage that results from compression of soft tissue between a hard surface and a bony prominence (coccyx, ankle, shoulder blade, or hip). As blood supply decreases to the area of compression, tissue anoxia occurs, which can lead to eventual tissue death. Wounds are usually circular and may have viable or necrotic tissue, and exudate can vary from none to heavy. Pressure ulcers are classified depending on the level of tissue damage (stages 1 to 4). Treatment is based on stage, exudate, type of available dressing, and frequency of dressing changes.<\/td>\r\n<\/tr>\r\n | \r\nData source:\u00a0British Columbia Provincial Nursing Skin and Wound Committee, 2011, 2014; Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nWound Healing<\/h2>\r\nWounds require different treatment throughout the phases of healing. There are multiple factors that affect how a wound heals as it moves through the phases of healing. It is important to look at the \"whole patient\" rather than the \"hole in the patient\"\u00a0to identify the correct treatment and work efficiently and effectively\u00a0from the beginning of the healing process.\r\n\r\nTable 4.3 lists a number of factors that inhibit the ability of tissues and cells to regenerate, which can delay healing and contribute to wound infections.\r\nTable 4.3: Patient Considerations for Wound Healing<\/caption>\r\n\r\n\r\n| \r\n Influencing Factors<\/strong><\/p>\r\n<\/td>\r\n| \r\n \u00a0Additional Information<\/strong><\/p>\r\n<\/td>\r\n<\/tr>\r\n\r\n| Patient's age<\/td>\r\n | Vascular changes occur with increasing age, skin\u00a0is less pliable, and scar tissue is tighter.\r\n\r\nFor example, an older adult's skin tears more easily from mechanical trauma such as tape removal.<\/td>\r\n<\/tr>\r\n | \r\n| Patient's nutritional status<\/td>\r\n | Tissue repair and infection resistance are directly related to adequate nutrition.\r\n\r\nPatients who are malnourished are at increased risk for wound infections and wound infection-related sepsis.<\/td>\r\n<\/tr>\r\n | \r\n| Patient's size<\/td>\r\n | Inadequate vascularization due to obesity will decrease the delivery of nutrients and cellular elements required for healing.\r\n\r\nAn obese person\u00a0is at greater risk for wound infection and dehiscence or evisceration.<\/td>\r\n<\/tr>\r\n | \r\n| Oxygenation<\/td>\r\n | Factors\u00a0such as decreased hemoglobin level, smoking, and underlying cardiopulmonary conditions will decrease oxygenation.\r\n\r\nAdequate oxygenation at the tissue level is essential for adequate tissue repair.\r\n\r\nHemoglobin level and oxygen release to tissues is\u00a0reduced in smokers.<\/td>\r\n<\/tr>\r\n | \r\n| Patient's medications<\/td>\r\n | Steroids reduce the inflammatory response and slow collagen synthesis.\r\n\r\nCortisone depresses fibroblast activity and capillary growth.\r\n\r\nChemotherapy depresses bone marrow production of white blood cells and impairs immune function.<\/td>\r\n<\/tr>\r\n | \r\n| Chronic diseases or trauma<\/td>\r\n | Chronic diseases and traumas such as diabetes mellitus or radiation\u00a0decrease\u00a0tissue perfusion and oxygen release to tissues.<\/td>\r\n<\/tr>\r\n | \r\n| Data source: Gallagher-Camden, 2012;\u00a0Perry et al., 2014; Stotts, 2012<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n | | | | | | | | | | |
![Phases of wound healing<\/a> by](\"https:\/\/commons.wikimedia.org\/wiki\/File:Wound_healing_phases.svg\"){kind=link}