FACTORS COMPLICATING WOUND REPAIR

1. FACTORS COMPLICATING WOUND REPAIR October 25, 2005

2. DELAYED WOUND CLOSURE • WOUND TAKES LONGER THAN EXPECTED TO HEAL • WOUND IS PROGRESSING TOWARDS CLOSURE

3. CHRONIC WOUND • WOUND WHICH HAS NOT RESPONDED TO CONSERVATIVE OR SURGICAL TREATMENT

4. COMPLICATING WOUND REPAIR • INTRINSIC FACTORS • ENVIRONMENTAL FACTORS • IATROGENIC FACTORS

5. INTRINSIC FACTORS • RELATED TO THE PATIENT’S GENERAL PHYSICAL CONDITION (DM, CVA, INFECTION) • RELATED TO THE PATIENT’S GENERAL MENTAL CONDITION (DEMENTIA)

6. ENVIRONMENTAL FACTORS • MODALITY OR TREATMENT APPLIED TO THE WOUND (W/P, NEOSPORIN, BETADINE)

7. IATROGENIC • HOW THE WOUND IS PHYSICALLY MANAGED (REMOVAL OF DRESSINGS, IRRIGATION, CLEANSING)

8. SKIN AGING • EPIDERMAL RENEWAL • TISSUE REPAIR • WOUND HEALING • INFLAMMATORY RESPONSE • VASCULAR SUPPLY • PHOTOPROTECTION • PAIN PERCEPTION

9. AGING • EPITHELIALIZATION • WOUND BREAKING STRENGTH • ANGIOGENESIS • BIOSYNTHETIC ACTIVITY • COLLAGEN REMODELING • WOUND CONTRACTION • INCREASED WOUND DEHISCENCE

10. INFECTION • ERYTHEMA- WELL-DEFINED (INFLAMMATION), ILL-DEFINED (INFECTION) • IF REDNESS GOES AWAY WITH CHANGE OF POSITION (ELEVATION) MAY BE INFLAMMATION VS. INFECTION

11. INFECTION (cont.) • HEAT (SYSTEMIC-FEVER-SEPSIS), LOCAL HEAT (INFLAMMATION) • FOUL ODOR (NECROTIC TISSUE WILL SMELL LIKE GARBAGE, SWEET SMELL-PSEUDOMONAS, AMMONIA SMELL PROTEUS)

12. INFECTION (cont) • EDEMA- GENERALIZED (CHF, VENOUS INSUFFICIENCY), LOCALIZED (INFLAMMATION, INFECTION), WARM, INDURATED

13. INFECTION (cont.) • DRAINAGE • color • odor • consistency • amount

15. INFECTION (cont.) • PAIN (DRESSING REMOVAL) • THROBBING COMPLAINT

16. Infections of the Nails

18. MEDICATIONS • NSAIDS (COLCHICINE) • STEROIDS: corticosteroids inhibit collagen synthesis & retard wound healing, decrease tensile strength of collagen • IMMUNOSUPRESSIVE DRUGS: methylprednisolone, cyclosporine A, (prednisone may decrease wound healing)

20. MEDICATIONS ( cont.) • ANTICOAGULANTS (coumadin, heparin) • ANTINEOPLASTICS • ANTIPROSTAGLANDINS

21. IMMUNOSUPRESSION • DECREASE FIBROBLAST FUNCTION • DECREASE COLLAGEN SYNTHESIS • DECREASE PHAGOCYTIC ACTION • DECREASE ABILITY TO FIGHT INFECTION

22. ANTIMICROBIAL TOXICITY • PROVIDONE IODINE • HYDROGEN PEROXIDE • ACETIC ACID • CHLORHEXIDINE • HYPOCHLORITES

23. RADIATION • INJURES FIBROBLASTS & ENDOTHELIAL CELLS • DECREASES COLLAGEN • DESTROYS CELLS IN MITOSIS • CAUSES VASCULAR DAMAGE • DECREASES TOLERANCE TO SEPSIS

24. CHEMOTHERAPY • INCREASES SUSCEPTIBILITY TO INFECTION • ALTERS FIBROBLAST FUNCTION • ALTERS COLLAGEN SYNTHESIS & METABOLISM • INTERFERES WITH MYOFIBROBLAST FUNCTION

25. HYDROTHERAPY • MOISTENS THE WOUND • IRRIGATES & CLEANSES THE WOUND • SOFTENS SLOUGH & ESCHAR • FLUSHES CELLS FROM THE WOUND • FLUSHES CHEMOTACTIC SUBSTANCES FROM THE WOUND

26. HYDROTHERAPY (cont.) • INCREASES VASCULAR CONGESTION • INCREASES VENOUS HYPERTENSION

27. INADEQUATE NUTRITION • DECREASES PROTEIN SYNTHESIS • DECREASES ENERGY (ATP) • CAUSES ANEMIA • REDUCES OXYGEN TO CELLS • DECREASES PROTECTION (PRESSURE)

28. INADEQUATE NUTRITION (cont.) • DEPRESSES IMMUNE SYSTEM • GLUCOSE, PROTEINS, FATTY ACIDS, VITAMINS, MINERALS, H20- ALL ARE ESSENTIAL

29. PRESSURE • INHIBITS BLOOD FLOW • REDUCES NUTRIENTS • INCREASES METABOLITES • INHIBITS ANTI-MICROBIAL ASSAULT • INCREASES NECROSIS • INHIBITS GROWTH

30. DESSICATION • INHIBITS CURRENT OF INJURY • INHIBITS GALVANOTAXIS • INHIBITS CHEMOTAXIS • INHIBITS COLLAGEN FORMATION • INHIBITS RE-EPITHELIALIZATION

31. ESCHAR • INHIBITS CURRENT OF INJURY • INHIBITS GALVANOTAXIS • INHIBITS CHEMOTAXIS • INHIBITS COLLAGEN FORMATION • INHIBITS RE-EPITHELIALIZATION