this type of wound healing;

• incised tissue regain blood supply and begins to bind together
• slight swelling and pinkness to wound is normal
• after 3-4 days connective tissue strengthens, wound, pinkness of wound will decrease

this is the process whereby an open would closes by new tissue formation with subsequent wound contraction and reepithelialization

usually from trauma, ulcers, infeciton

larger amount of exudate

greater inflammatory reaction= more debris

this is a combination of primary and secondary

also called delayed primary intention.

• this wound needs to heal partially with secondary intention, and then is sutured closed.
• usually are infected wouns or contaminated wounds that can not be sutured closed due to the risk for infection.

• starts on day of incision, and last for 3-5 days after that. 
• skin is sutured or stapled, area clots allowing WBCs to move across
• capillary growth will be established here due to the fibrin meshwork
• increases blood flow through vasodilation

Inflammatory phase

neutrophils

inflammatory phase

(macrophages)

the activation of inflammation sends out chemical messages which attact theses to the wound. these long lived cells (weeks) orchestrate the remaining states of wound healing through the release of a variety of polypeptides known as growth factors

Cleaning the area before healing occurs.

• clotting of bleeders(1-5mins)
• increased blood flow(20-30mins)
• increse oxygen in wound
• antibodies released in wound
• increased neutrophils (bacterial killing)
• increased macrophages (provides growth factor)

begins day 2 and last 5 to 3 weeks

• involves three key processes angiogenesis, fibroblast, prolifertion and epithelial cell proliferation
• need good kind of moisture

Granulation phase

(Angiogenesis)

 this is the formation of new blood vessels. can occur easier if the tissues are approximated

secreted by macrophage

• this happens about 3 weeks after initial injury
• lasts up to one year or more
• increase in collagen and proliferation of layers of the skin
• strength of wound is increased during this phase
• scar is formed, pale and avascular

these factors do what?

• age, malnutrition, poor circulation, infection, anemia, obesity, stress on wound keeps granulation form occuring, diabetes, smoking

sugical- usually 4-5 days post op

contaminated or trauma wound- within 2-3 days

this is partial or complete separation of the outer layer of the wound

possible causes: poor suturing, distention, excessive vomiting, coughing, dehydration, infeciton

treat: reclosure in the OR or leave open and treat wound so it heals by secondary intention, possibly third

total separationof the layers and protrusino of the internal organs or viscera through the open wound

cause: same as dehiscence

treat: call for help, cover with sterile gauze/towel saturated in normal saline, keep organs moist, do not attempt to reinsert, keep in supine position, VS every 5 mins

• cleanse skin gently with NS if needed
• approximate edges of torn skin
• use steri strips if needed
• vaseline gauze
• secure with stretch webbing
• no tape to skin

• pressure
• decreased blood flow to the tissue
• interferes with cellular metabolism
• tissue ischemia results
• ischemia results in tissue death

intact skin with non-blanchable redness of a localized area usually over a bony prominence. redness in lightly pigmented skin.

temp- warm or cool

tissue consistency- firm or boggy feeling

sensation- pain, itching

partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough

• present as a shiny or dry shallow ulcer, blister or shallow crater

• used to assess risk for PU development
• nursing care is aimed at maintaing tissue integrity-obviously best if we can pervent skin breakdown
• prevention is less costly than treatment
• not to mention the psychological toll on patient

assess:

• site, stage, tunneling undermining, slough, exudate, pain, epithelialization, necrotic tissue type, color, edema, maceration

Debridement types

(mechanical)

Debridement type

Chemical

debridgement type

autolytic

debridement type

enzymatic

debridement

surgical

Debridement type

(sterile maggots)

• maintain a healthy enviroment for healing to occur
• prevent or manage infeciton
• clean the wound
• remove tissue that is dead
• facilitate exudate remove
• protect the PU
• prevention of further skin breakdown