Wound Healing Guided Learning Resource
Alison Taylor Thanks to Stella Rawnson for a significant contribution towards this resource. Intended learning outcomes
By the time you have finished your study on wound healing you will be able to: Define a wound and consider the types of wounds you are most likely to see in midwifery practice Describe Compare and contrast the processes of primary and secondary wound healing Aiding your study You will need to refer to a book of your choice on anatomy and physiology throughout this study session. Dont forget the ebooks that are available online via the library website. You will need to use your athens account to access these books Choose a book that suits your learning style. Aiding your study When you see this icon, you will be asked to complete an activity, so you will need some pencils, pen and paper. Bring this work with you to the session on 10th March (East)21st January (West) You are not required to print off the whole of this PowerPoint unless through personal choice you wish to do so. Definition Read the appropriate chapter about wound healing.
Write down a definitions for Wound healing Primary healing Secondary healing Now consider the different types of wounds that you have seen in clinical practice. List them down and then identify why they occur. What is a wound? Some definitions
Wound healing: Any kind of breach in the integrity of the skin or underlying tissues. Primary healing: healing that occurs when there is minimal loss of tissue and damaged skin edges are in close proximity Secondary healing: healing that occurs when there is destruction or loss of large amounts of tissue or when the edges of the wound cannot be brought together. Online: primary and secondary healing Types of wounds Surgical wounds: LSCS or episiotomy.
Non-surgical: Perineal tears/lacerations or nipple trauma Types of wounds Wounds can also result when the skin is punctured e.g. venepuncture, IM/SC injection, wound drains, cannulation etc. Wounds can also develop as a result of a pathological process either through intrinsic or extrinsic factors e.g. Diabetes, pressure sores or infection Factors that affect the rate of wound healing?
Thinking about the wounds that you have seen in clinical practice, list down some of the factors that promote wound healing and some factors that hinder wound healing. Factors that affect the rate of wound healing?
Promoting wound healing Good nutrition Good health Local factors Good blood supply Clean environment Hindering wound healing Infection Impaired immunity Illness Diabetes Smoking Increasing age Obesity Local factors Contamination Wound stress Factors that influence wound healing
Nutritional status An adequate intake of protein, vitamin A & C, copper, and zinc is required. Proteins supply amino acids essential for tissue repair and regeneration Vitamin A & zinc are required for epithelialisation Vitamin C & zinc are required for collagen synthesis and capillary integrity Factors that influence wound healing
Smoking interferes with the uptake and release of oxygen to the tissues, resulting in poor tissue perfusion Increasing age affects all phases of wound healing due to impaired circulation and coagulation, slower inflammatory response and decreased fibroblast activity Obesity fatty tissue can have an inadequate blood supply resulting in slower healing and decrease resistance to infection Factors that influence wound healing
Wound stress e.g. prolonged or violent vomiting, abdominal distension, may cause sudden tension on the wound, inhibiting the formation of collagen networks and connective tissue Infection causes increased inflammation and necrosis which delays wound healing Other factors -include anti-inflammatory drugs or underlying disease such as diabetes mellitus Anti-inflammatory drugs suppress protein synthesis, inflammation, wound contraction and epithelialisation. Diabetes may have impaired circulation and tissue perfusion resulting in slower healing. Physiology of wound healing
There are four stages of wound healing. List the four stages and under each heading briefly describe what occurs. Physiology of wound healing
There are 4 phases of wound healing Haemostasis Inflammation Proliferation Maturation The length of time taken to progress through these phases varies for each wound Haemostasis Begins immediately there is tissue damage
Vasoconstriction occurs to minimise bleeding and assist with initiating the clotting process A fibrin clot forms, temporarily closing the wound Whilst the clot forms, blood or serous fluid may exude from the wound as the body tries to cleanse the wound naturally Inflammation Heat, redness, pain, swelling and some loss of function occurs as the vessels around the wound dilate. Macrophages clear the wound of debris to prepare for new tissue growth A small necrotic area forms around the wound margin Epithelial cells from the wound margin move under the base of the clot, the surrounding epithelium thickens and a thin layer of epithelial tissue forms over the wound. This phase lasts around 36hrs, but is prolonged in the presence of infection Necrotic area where the blood supply was interupted. Proliferation involves 3 stages
Granulation Capillaries from the surrounding tissues grow into the wound bed At the same time fibroblasts produce collagen fibres, providing the framework for new connective tissue formation Healthy granulation tissue has a bright red, moist, shiny appearance, a pebbled looking base & does not bleed easily Collagen increases the tensile strength and structural integrity of the wound. Proliferation Wound contraction
Once the wound is filled with connective tissue, fibroblasts collect around the edge of the wound and contract, pulling the edges together A firmer, fibrous epithelial scar forms, as the fibroblasts and collagen fibres begin to shrink, resulting in contraction ofthe area This occurs only in healthy tissue that has not been sutured Proliferation Epithelialisation
New epithelial cells grow over the wound surface to form a new outer layer Wound appears whitish-pink andtranslucent Maturation Re-modelling occurs to increase the tensile strength of the scar tissue The scar initially appears red & raised, and then with time changes to a paler, smoother, flatter appearance Mature scar tissue is avascular and contains no sweat or sebaceous glands or hairs This phase can take up to 2 years to complete Once epithelialisation is complete Is this wound midwifery related?
(McCloskey et al. 1997) Wounds in midwifery practice!
Use your literature searching skills to find this paper. Newton, H. and Butcher, M., Investigating the risk of pressure damage during childbirth. British Journal of Nursing, 9 (6) supplement, S20-S26. When you have read it, write down your first impressions. What have you learnt from reading this paper? Morbidity after Caesarean Section
9.5% of women reported NO problems 49% of women reported three or more problems 58% had pyrexia 21% had wound leakage 11% had urinary tract infection 7% had wound infection 4% had uterine infections A quarter of these women had not spoken to any health care professional (Hillan 1995) Wound management Now use your literature searching skills to find some evidence based information regarding wound care and management. Read what you find, make notes if you wish, but be prepared to share your learning with the rest of your year group. References Brown, S. and Lumley, J., British journal of obstetrics and gynaecology, 105, Johnson, R. and Taylor, W., Skills for midwifery practice. London: Churchill Livingstone Hillan, E., Journal of advanced nursing, 22(6), Martini, F., Fundamentals of anatomy and Physiology. San Francisco: Pearson. Mccloskey, R. V. Kumar, P. D. Schechter, F. G. Carter, R. L. Nieuwenhuis, H. K. and Christiaens, G.C.M. L., Heparin-Induced Skin Necrosis. New England Journal of Medicine, 336 (8), 336:588. Newton, H. and Butcher, M., Investigating the risk of pressure damage during childbirth. British Journal of Nursing, 9 (6) supplement, S20-S26. Waugh, A. and Wilson, A., Anatomy and Physiology Colouring and Workbook. Edinburgh: Elsevier. Waugh, A, and Wilson, A., Anatomy and Physiology in Health and Illness. Edinburgh: Elsevier. Well done! You have completed Wound Healing!!
Dont forget to bring your completed work with you to the related sessions! Wound healing AMTaylor