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Information For Physicians | Wound Care
Factors Affecting Wound Healing
Age
The physiological changes that occur with aging place the
older patient at higher risk of poor wound healing. Reduced
skin elasticity and collagen replacement influence healing.
The immune system also declines with age, making older patients
more susceptible to infection. Older people can also present
with other chronic diseases, which affect their circulation
and oxygenation to the wound bed.
Dehydration
This leads to an electrolyte imbalance and impaired cellular
function. It is a particular problem in patients with burns
and fistulae.
Hand Washing
Effective hand washing greatly reduces the risk of transferring
pathogenic organisms from one patient to another by direct
contact or by contamination of inanimate objects that are
shared.
Infection
Infection has been defined as the deposition and multiplication
of organisms in tissue with an associated host reaction.
If the host reaction is small or negligible then the organism
is described as colonizing the wound rather than infecting
it. It is important to distinguish between colonization and
infection since colonized wounds will heal without the need
for antibiotics (Cutting 1994).
Contamination is the deposition
and survival, but not the multiplication, of the organism
(Ayton 1985).
Wound infection
is a problem because, at the most fundamental level, infection
stops a wound from healing by:
Prolonging the inflammatory phase
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Disrupting the normal clotting mechanisms
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Promoting disordered leukocyte function and ultimately
preventing the development of new blood vessels and formation
of granulation tissue.
Assessment of a wound in order to identify wound infection
should not be limited to swabbing the wound for bacteriological
analysis.
Infection occurs when virulence factors expressed by one
or more microorganisms in a wound out-compete the person's
immune system. Subsequent invasions and spread of microorganisms
in good tissue provokes a series of local and systemic responses
such as:
i) Surgical (acute wounds)
local pain / tenderness
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local swelling / edema
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increased exudates, either serous or purulent or haemoserous
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separation of wound edges / wound breakdown
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pyrexia
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delayed healing
ii) Chronic wounds
delayed healing
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increased fragility or change in appearance of granulation
tissue
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unexpected pain / tenderness
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pocketing or bridging of epithelial tissue
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an abnormal smell
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presence of exudate either serous or purulent haemoserous
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local swelling / edema
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extending margin or erythema
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pyrexia
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wound breakdown
Medication
Anti-inflammatory, cytotoxic, immunosuppressive, and anticoagulant
drugs all reduce healing rates by interrupting cell division
or the clotting process.
Oxygenation and tissue perfusion
Personal and oral hygiene
Nutrition
Protein is required for all the phases of wound healing,
particularly important for collagen synthesis.
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Glucose balance is essential for wound healing.
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Iron, required to transport oxygen.
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Minerals, zinc, copper, are important for enzyme systems
and immune systems. Zinc deficiency contributes to disruption
in granulation tissue formation.
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Vitamins A, B complex and C are responsible for supporting
epithelialization and collagen formation. It is also important
for the inflammatory phase of wound healing.
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Carbohydrates and fats. These provide the energy required
for cell function. When the patient does not have enough,
the body breaks down protein to meet the energy needs.
Fatty acids and essential for wound healing.
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Refer to dietitian if patient is malnourished
PATIENT EDUCATION - suggest to patient that:
Food is here to be enjoyed
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Variety in what we eat is healthy
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They should eat the right amount to be a healthy weight.
This will vary for age, gender, and level of activity.
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They should try not to eat too much fat, sugar, or salt.
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The diet should provide plenty of vitamins and minerals
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Keep levels of alcohol within recommended limits
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