Wounds Healing is a quality of living tissue ; also referred to as regeneration (renewal) of tissues. Healing can be considered in terms of types of healing; having to do with the primary care providers decision on whether to allow the wound to seal itself or to purposefully close the wound, and phases of healing which refer to the steps in the body’s natural processes of tissue repair . The phases are the same for all wounds, but the rate and extent of healing depends on factor such as the type of healing , the location and size of the wound and the health of the client .
Types Of Wound
Body wounds are, either intentional or unintentional international trauma ocurs during therapy. Examples are operations or ventinal
was Although removing a tumor, for example, is therapeutic.-the must cut into body tissues thus traumatizing them. Un international wounds are accidental; for example, a person may fracture»-
Arm in an automobile collision. If the tissues are traumatized without break in the skin, the wound is closed. The wound is open when the skin or mucous membrane surface is broken Wounds may be described according to how they are acquired. They also can be described according to the likelihood and degree of wound contamination
- Clean wound are Uninfected wound in which there is minimal inflammation and the respiratory gastrointestinal are not entered
Phases Of Wound Healing
Wound Healing Can be broken down into three phases,inflammatory,Proliferative and maturation or remodeling
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Inflammatory Phase
The Inflammatory Phase begins immediately after injury and lasts 3-6 days . Two major processes occur during this phase Hemostasis and phagocytosis. During cell migration, leukocytes (specifically, neutrophils) move into the interstitial space. These are replaced about 24 hours
after injury by macrophages. These macrophages engulf microorganisms and cellular debris by a process known as phagocytosis. The macrophages also secrete an angiogenesis factor, which stimulates the formation of epithelial buds at the end of injured blood vessels. The microcirculatory network that results sustains the healing process and the wound during its life. This inflammatory response is essential to healing. Measures that impair inflammation, such as steroid medications, can place the healing process at risk.
PROLIFERATIVE PHASE
The proliferative phase, the second phase in healing, extends from day 3 or 4 to about day 21 postinjury. Fibroblasts (connective tissue cells),
which migrate into the wound starting about 24 hours after injury begin to synthesize collagen. Collagen is a whitish protein substance that adds tensile strength to the wound: As the amount of collagen increases, so does the strength of the wound, thus the chance that the wound will remain closed progressively increases, If the wound is sutured, a raised “healing ridge” appears under the intact suture line. In a wound that is not sutured, the new collagen is often visible. Capillaries grow across the wound, increasing the blood supply. Fibroblasts move from the bloodstream into the wound, depositing
fibrin. As the capillary network develops, the tissue becomes a translucent red color. This tissue, called granulation tissue, is fragile and
bleeds easily. When the skin edges of a wound are not sutured, the area must be filled in with granulation tissue. When the granulation tissue matures, marginal epithelial cells migrate to it, proliferating over this connective tissue base to fill the wound. If the wound does not close
by epithelialization, the area becomes covered with dried plasma proteins and dead cells. This is called eschar. Initially, wounds healing by secondary intention seep blood-tinged (serosanguineous) drainage. Later, if they are not covered by epithelial cells, they become
covered with thick, gray, fibrinous tissue that is eventually converted into dense scar tissue.
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MATURATION PHASE
The maturation phase begins on about day 21 and can extend 1 or 2 years after the injury. Fibroblasts continue to synthesize collagen.
The collagen fibers themselves, which were initially laid in a hap-hazard fashion, reorganize into a more orderly structure. During
maturation, the wound is remodeled and contracted. The scar becomes stronger but the repaired area is never as strong as the original
tissue. In some individuals, particularly dark-skinned individuals, an abnormal amount of collagen is laid down. This can result in a
hypertrophic scar, or keloid. One method of documenting the progress of healing in pres-
sure ulcers is to use the Pressure Ulcer Scale for Healing (PUSH) tool (National Pressure Ulcer Advisory Panel [NPUAP], 2003). This well-
validated tool assigns scores to the ulcer length, width, amount of exudate, and tissue type. The change in the total score over time can
be used as an indication of healing.
