Wound Care

A wound is a break in the skin. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are.
Open wounds such as surgical wounds, decubitus ulcers and burns require care that will promote healing and prevent further injury or deterioration of the wound. An essential nursing responsibility is to observe and describe the wound carefully to determine its progress in healing.

There are basically 4 phases to the healing process:

•Inflammatory phase: The inflammatory phase begins with the injury itself. Narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process as to controlled bleeding. Specialized cells clear the wound of debris over the course of several days.

•Proliferative phase: in which a matrix or latticework of cells forms. New skin cells and blood vessels will form. It is the new small blood vessels, also known as capillaries, that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins. Collagen is one of the long, fibrous structural proteins whose functions are quite different from those of globular proteins such as enzymes. Tough bundles of collagen called collagen fibers are a major component of the extracellular matrix that supports most tissues and gives cells structure from the outside, but collagen is also found inside certain cells. Collagen has great tensile strength, and is the main component of fascia, cartilage, ligaments, tendons, bone and skin. The collagen acts as the framework upon which the new tissues build.
•Remodeling phase: This begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of 6 months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.

•Epithelialization: This is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis).