Prepare, apply and attach dressings, wound supports and drains to patients.

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ELEMENT 6.5;

Prepare, apply and attach dressings, wound supports and drains

to patients.

1. Describe the principles of wound healing and any complications that may

arise.

Wound healing comes in two processes which are;

Primary (healing by first intention)

Secondary (healing by second intention)

In both these processes there are 3 stages;

- inflammation

- Proliferation

- Maturation

Primary healing follows minimal destruction of tissue, where the wound edges

are close together.

Inflammation -Blood clot and cell debris fill the gap in the first few hours.

Phagocytes and Fibroblasts migrate into the blood clot.

- Phagocytes start to remove the clots and cell debris, which stimulates

fibroblast activity.

- Fibroblasts secrete collagen fibres, binding the surface together.

Proliferation - Epithelial cells proliferate across the wound through the clot.

The Epidermis joins and grows upwards till full thickness is restored.

The clot above the new tissue turns to scab, which seperates after 3-10 days.

New capillary buds, Phagocytes and Fibroblasts (Granulation tissue) develops,

invading the clot and returning the blood supply to the wound.

As the Phagocytes remove the clot and any bacteria, the Fibroblasts carry on

secreting collagen fibres.

Maturation - The fibrous scar tissue replaces the Granulation tissue. The

Collagen fibres re-arrange, so the strength of the wound increases.

Eventually, the scar becomes less vascular until it appears as a fine line, after

a few months.

Secondary healing follows destruction of a large amount of tissue, or when the

sides of the wound cannot be brought into appostion. E.G. Pressure sores

(Decubitus Ulcers)

Inflammation - This develops at the surface of healthy tissue and Phagocytes

migrate to the necrotic tissue (Slough) and seperate it from the healthy skin.

Proliferation - Granulation tissue develops at the base of the cavity, growing

up towards the surface, which is probably stimulated by macrophages.

Phagocytes which are in the blood supply, prevent infection of the wound by

ingesting the bacteria after the seperation of the Slough.

Some Fibroblasts in the wound develop a limited ability to contract so the

wound and the healing time is reduced.

As the granulation tissue arrives at the level of the dermis, Epithelial cells at

the edge proliferate and grow towards the centre.

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Maturation - Scar tissue replaces the granulation tissue over several months,

until the full thickness of the skin is restored.

Complications of wound healing;

Systemic infection - The wound has to compete with the infection for white

cells and nutrients. Healing may not be able to continue, until the body has

dealt with the infection.

Hypertrophic Scars - These occur because of extreme fibrous tissue response

during the healing process, which results in a large deposition of Collagen,

leaving a thick wound scar.

More common in large burns and traumatic injury. ...

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