WOUND MANAGEMENT IN CLINICAL ENVIRONMENT

Wound Management In Clinical Environment

Wound Management In Clinical Environment

Introduction

Wound management in clinical environment is a challenging and rewarding area of clinical practice for the student nurse. This modern approach involves simple advances in practice. Firstly, modern wound management uses moist wound healing processes that have been researched and determined to be significantly more effective than the dry healing of the past. Secondly, and more importantly, it is a more holistic approach that looks at more than the wound itself, but addresses the whole patient in medical, environmental and social contexts Waldrop, Doughty (Bale, 2000).

Most sources indicate that wound healing is made up of an orderly sequence of events. This, in turn, is characterised by specific movement of specialised cells into the wound, carrying out specific tasks Bale, Harding, Leaper, (2000). According to the movement of the cells and the orderly sequence of events in healing is regulated by cytokines or growth factors. The healing stage of photo 3 appears to be the Proliferative (or regeneration) stage. Evidenced by its colour - bright red, moist and shiny appearance. As a student nurse it would always be well off to remember that healing is a continuum of complex connected processes that are divided into phases. These phases are known as the inflammatory phase, the proliferative phase, the maturation phase.( Carville, 1994)

Granulation

Is an essential ingredient for regeneration of granulation tissue. Tissue hypoxia (low oxygen) sets in following disruption to the blood flow on injury, stimulating macrophages to secrete a substance known as angiogenesis factor. The process of angiogenesis is delayed if a thick layer of surface necrosis is present. According to Hopkinson (1992) undamaged capillaries beneath the wound produce buds, stimulated by growth factors, these buds form a network of loops, which fuse with other buds to form a new capillary bed. These new loops are fragile and can be easily damaged Dealey (1994). Some types of dressing made of open weave cotton such as gauze become stuck to the granulating tissue and on removal could damage the new capillary loops. I will discuss more about gauze in the following paragraphs. If the wound edges are close, the capillaries can bridge the wound. This new tissue is known as granulating tissue. However this process can be impaired by excess inflammation, dead surface tissue, wound exudates, decreased perfusion, and corticosteroids-A steroid hormone produced by the adrenal Dealey (1994).

Epithelialisation

This describes the phase where the wound is covered epithelial tissue. At the edges of wounds, epidermis begins to thicken. The migration marginal basal cells across the wound bed begins, along fibrin strands stopping when they come in contact with each other (contact inhibition) Waldrop et al (2000). This movement only occurs on a moist surface, under a scab or a dressing that provides a moist environment Winter (1999). Therefore the wound surface should be kept hydrated. The depths of the wound at this point contain inflammatory cells and fibrin strands, as the epithelial surface thickens these are joined by a ...