Wound Healing

Okay. So first off, we're going to start talking about the phases of wound healing. Keep in mind, this applies for small wounds and big ones, but they all have the same phases in common. It just may take more or less time, depending on the type of wound. So first, we have hemostasis. The goal of hemostasis is to stop bleeding. Hemo means blood. Stasis means stop. So that's going to be through the process of vasoconstriction and using our clotting cascade and activating platelets so that we can actively stop that bleeding. We're going to move on to the inflammatory stage after that. I want you to pay careful attention important for the closing of the wound. These new cells are produced through a process called mitosis, where the existing cells divide and multiply. Additionally, during this phase, collagen production is increased, which helps strengthen the wound and promote its closure. Finally, we have the remodeling phase. In this phase, the newly formed tissue undergoes remodeling and maturation. The excess collagen fibers that were produced during the proliferation phase are broken down and reorganized, leading to a stronger and more functional scar. The remodeling phase can last for several months or even years, and the final appearance of the scar will depend on various factors such as the size and severity of the wound, as well as individual factors like genetics and overall health. Overall, understanding the different phases of wound healing can help us appreciate the complex processes that occur in our bodies to repair injuries. going to be brought together and closed with sutures, staples, or other means of closure. This is usually done for clean, small wounds that have minimal tissue loss. By bringing the edges of the wound together, we promote faster healing and minimize the risk of infection. Healing by secondary intention, on the other hand, occurs when the wound is left open to heal from the bottom up. This is often the case with larger wounds or those that have significant tissue loss. The wound is cleaned and bandaged, and the body is allowed to heal the wound naturally. This process takes longer, as the wound needs to fill in with new tissue, but it can also result in a stronger scar. Finally, healing by tertiary intention is a combination of both primary and secondary intention. The wound is initially left open to allow for cleaning and debridement, and then later closed surgically once the risk of infection is reduced. This method is often used for contaminated wounds or those with a higher risk of infection. So those are the three main ways that wounds can heal. Remember, each patient and each wound is unique, so the healing process may vary from person to person. Well approximated. Well approximated means that they are brought together well, so they are touching. I think of this surgery that I just had right here. This is healing by primary intention. I had a surgical incision made. The edges were approximated, brought together with surgical sutures, and then that's how the wound is healing. That is going to be very common with surgery. Things like paper cuts, that sort of thing, is going to heal by primary intention. Now, when we heal by secondary intention, a wound is intentionally left open to heal through granulation. So this is going to be granulation, contraction, and epithelialization. This is going to happen when we heal basically from the inside out is how you can think about it. This is going to have a higher risk of infection but longer healing times. A good example of this would be a pressure injury. It's not something where we can really approximate. The edges. They're eroded so far out from one another that they can't be brought together, so it's going to heal from the inside out. It's going to take longer and there's a higher risk of infection. And then tertiary intention is when the closure of a wound is intentionally delayed. So this might mean that it has become open or it is left open, and we delay the closure so that we can irrigate the wound, debride the wound, and observe it usually for about a week, and then we're going to close it surgically when the risk for infection is lower. Okay. Now moving on to complications and barriers of healing. This is a big one because you need to know who is most at risk for poor wound healing. If you see here, there's a ton of bold, red information on these cards here, so I would say definitely make sure you feel comfortable with all of it. Let's talk about it. So one of the complications of wound healing is going to be dehiscence. Dehiscence is when a previously closed wound opens back up. This could be for a lot of reasons, but the point here being, dehiscence refers to a closed wound separating and opening. Now evisceration is dehiscence with organs protruding. So for instance, if this wound here on my elbow were to dehisce, these layers would pop open and separate but nothing is going to eviscerate, right? It's not in a location where it can. But when I had abdominal surgery, if I had dehiscence in that area, it's possible that it could go deep enough. It could open all the way potentially and cause evisceration where my bowels, my organs are actively exposed and on the outside of my body, right? When that happens, it's a true medical emergency, and this is going to be one of the times where you need to know what to do. So we need to put saline moistened gauze. Not water, Right? We do not want bacteria, and we need the right isotonicity. We need it to be the same tonicity as our body fluids. So saline moistened gauze over the open area. I'm going to lower the head of the bed, maybe even put them in Trendelenburg. And then I'm going to notify the provider immediately. After I put saline-moistened gauze on and lower the head of the bed, there's nothing else that I can do – that I can do as the nurse, right? The only thing I can do after that point is call the provider. They need surgical intervention immediately. Now, barriers to healing, there are a lot. In general, chronic illnesses are going to complicate wound healing almost all the time, right? A big one we think of would be diabetes mellitus. That's going to be a problem with circulation. We're going to have poor circulation, and that can cause impaired healing, as well as any time we have fluctuating blood glucose levels, we can impact. Our healing as well. It is very important that we keep tight glycemic control on diabetics, meaning that we keep their blood glucose levels in a good range closely when we are trying to have them heal from some kind of injury, wound, or surgery. Other things to be aware of are immunosuppression. Corticosteroids can cause immune suppression, so things like that need to be taken into account. Lastly, we're going to talk about drainage and wound appearance. You need to know, when you are doing a dressing change or assessing a wound, "Is what I am seeing normal?" We can have different types of drainage. Serous is going to be that watery, kind of clear, maybe with a little hint of a tan color—not tan. It's not thick, but it's just kind of maybe a little off-white, I would say. Serous draining is normal. There is nothing crazy going on there. So, serous fluid mixed with blood, sanguineous, is going to be kind of pink tinged. So it's going to be maybe a light pink. Then we have sanguineous. Sanguineous means bloody, so this is going to be bright red discharge here, drainage, and then purulent. When we have something that is purulent, it means it is looking like pus. This is going to be thick, cloudy. It might be white, yellow, or beige. It's going to smell bad. Anytime discharge smells foul, we need to be concerned about that. Malodorous, mal meaning bad, odor meaning smell, right? A bad smell. It's not good. That indicates infection. And then when we talk about what the wound itself looks like, know that a red wound that has a beefy appearance, that's a healthy-looking wound. We like that. That means that there is good circulation happening. If we have a yellow wound, that probably means that. It needs to be cleaned. And if it is black, it means we need debridement. We need to actually remove the dead necrotic skin or tissue from that area so that it can heal in a good way. Okay. I hope that review was helpful. If it is, please go ahead and like this video. That would mean so much to us. If you have a great way to remember something, I definitely want to hear it in the comments below. And be sure to subscribe to the channel because you want to be the first to know when our next video posts, which is going to be talking about diabetic foot care and wound care. Thanks so much, and happy studying. I invite you to subscribe to our channel and share a link with your classmates and friends in nursing school. If you found value in this video, be sure and hit the like button and leave a comment and let us know what you found particularly helpful.