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Healing of a wound is actually a complex process. Patient’s physiologic status and comorbidities play significant role in the healing process. Recognition of the stage of the wound healing allows the selection of appropriate method and materials for the surgical dressings.
Wound may be defined as any damage leading to a break or breach in the continuity of the skin. From the aetiological point of view, a wound may be of different types. Some types are given below.
a) Traumatic type – mechanical, chemical, physical
b) Intentional – Iatrogenic (Surgery)
c) Ischaemic – e.g. arterial ulcer,
d) Neuropathic – e.g. diabetic ulcer
e) Pressure – e.g. pressure ulcer (bedsore)
Commonly in case of traumatic and intentional injury there is hemorrhage as there is rupture of the blood vessels in the affected areas. This is followed by clot formation there. In contrary, in wounds resulting from ischaemia, neuropathy or pressure, the blood supply is diminished or disrupted for the local segmental occlusion of the microcirculation. Local tissue necrosis usually is the result and later the ulcer formation occurs, possibly with eschar or scab.
Another wound classification is there depending on tissue loss and possible repair by apposition of skin. Its of two types – first one known as tidy wound, where minimal skin loss and skin approximation possible and another one is untidy wound that defines a significant skin and tissue loss for which skin approximation not possible. This classification also has implications in healing.
Healing has been classified in two types, classically that was first described by Hippocrates around 350BC – Healing by first intention and Healing by second intention. The former is when there is no tissue loss and the skin edges are held in apposition to each other, such as a sutured wound while the latter means a wound where there is significant tissue loss and the skin edges are far apart, apposition is difficult or not possible usually, such as a leg ulcer.
Wound healing process consists of several stages with duration. The stages in a nutshell are – a) inflammation, b) reconstruction. c) epithelialization and d) maturation. Several factors play role to promote or delay healing of a wound.
Impaired wound healing may result to in formation of a chronic wound, hypertrophic scar, keloid, contracture (ankylosis). Sometime there is possibility of developing even a local skin cancer for non-healing of a wound or ulcer, known as Marjolin’s Ulcer (which is histologically a squamous cell carcinoma).
A patient should be assessed and evaluated for appropriate care planning with close follow up to reduce wound complications and to promote wound healing. Cost reduction in treatment is possible by appropriate and effective nursing interventions.