3.2 Wound Healing and Tissue Repair

Wound healing is a complex process involving four stages: hemostasis, inflammation, proliferation, and remodeling. Each stage plays a crucial role in repairing damaged tissue and restoring skin integrity. Understanding these stages helps nurses provide effective care.

Factors like age, nutrition, and underlying health conditions can impact wound healing. Nurses play a vital role in assessing wounds, providing proper care, educating patients, and collaborating with the healthcare team to promote optimal healing outcomes.

Wound Healing Process

Stages of wound healing

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• Hemostasis
  • Vasoconstriction narrows blood vessels reducing blood flow
  • Platelet aggregation forms platelet plug at injury site
  • Fibrin clot formation creates temporary protective barrier (scab)
• Inflammation
  • Vasodilation increases blood flow to wound area
  • Increased capillary permeability allows immune cells to enter
  • Neutrophil and macrophage infiltration removes debris and bacteria
  • Phagocytosis engulfs and destroys foreign particles and dead cells
• Proliferation
  • Fibroblast migration and proliferation produces new tissue
  • Angiogenesis forms new blood vessels to supply oxygen and nutrients
  • Granulation tissue formation creates pink, bumpy appearance
  • Collagen synthesis provides strength and structure to new tissue
  • Epithelialization covers wound surface with new skin cells
• Remodeling
  • Collagen reorganization improves wound strength over time
  • Scar tissue maturation can take up to 2 years
  • Wound contraction pulls edges together minimizing scar size

Primary vs secondary intention healing

• Primary intention healing
  • Wound edges approximated with sutures or staples
  • Minimal tissue loss results in faster healing
  • Less scarring due to precise alignment of edges
  • Examples: surgical incisions, clean cuts from sharp objects
• Secondary intention healing
  • Wound edges not approximated heal from the bottom up
  • Significant tissue loss requires more time to fill in
  • More granulation tissue formation creates larger scars
  • Examples: large burns, pressure ulcers, diabetic foot ulcers

Factors affecting wound healing

• Systemic factors
  • Advanced age decreases cellular regeneration capacity
  • Malnutrition impairs protein synthesis and immune function
  • Diabetes mellitus causes poor circulation and neuropathy
  • Immunosuppression increases infection risk
  • Chronic diseases (renal failure, liver disease) affect overall health
  • Medications (corticosteroids, chemotherapy) suppress healing processes
• Local factors
  • Infection introduces harmful bacteria delaying healing
  • Poor blood supply reduces oxygen and nutrient delivery
  • Tissue hypoxia slows cellular metabolism and repair
  • Excessive tension on wound edges impairs closure
  • Foreign bodies in the wound trigger ongoing inflammation
  • Repeated trauma to the wound site disrupts healing progress
• Lifestyle factors
  • Smoking constricts blood vessels reducing oxygen supply
  • Alcohol consumption impairs nutrient absorption and immune function
  • Stress increases cortisol levels suppressing healing
  • Lack of sleep disrupts cellular repair processes

Nursing role in wound healing

• Assessment
  • Regular wound evaluation measures progress and detects complications
  • Documentation of wound characteristics tracks healing over time
  • Identification of potential complications allows early intervention
• Wound care
  • Proper cleaning techniques remove debris without damaging tissue
  • Appropriate dressing selection and application maintains optimal environment
  • Debridement as ordered removes dead tissue promoting healing
• Patient education
  • Wound care instructions ensure proper home management
  • Nutrition guidance promotes intake of healing-supportive nutrients
  • Importance of medication adherence optimizes overall health
• Pain management
  • Administration of prescribed analgesics improves comfort and mobility
  • Non-pharmacological pain relief methods (repositioning, relaxation techniques)
• Infection prevention
  • Aseptic technique during wound care reduces contamination risk
  • Monitoring for signs of infection allows early treatment
• Promoting tissue perfusion
  • Encouraging mobility improves circulation to wound area
  • Proper positioning reduces pressure on wound site
• Collaboration
  • Communication with healthcare team ensures coordinated care
  • Referrals to specialists when necessary addresses complex wound issues
• Psychosocial support
  • Addressing patient concerns improves treatment adherence
  • Promoting body image and self-esteem supports overall well-being