Wound Diagnosis and Management Trudie Young Director of

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Wound Diagnosis and Management Trudie Young Director of Education and Training Welsh Wound Innovation

Wound Diagnosis and Management Trudie Young Director of Education and Training Welsh Wound Innovation Centre “Health& & Wealth for Wales” “Health Wealth For Wales”

Stages of wound healing • • Inflammation Destruction Proliferation Maturation “Health& & Wealth for

Stages of wound healing • • Inflammation Destruction Proliferation Maturation “Health& & Wealth for Wales” “Health Wealth For Wales”

Inflammation 0 – 3 days • Bodily response to injury • Release of histamine

Inflammation 0 – 3 days • Bodily response to injury • Release of histamine and other mediators from damaged cells • Vasodilatation - signs of inflammation • Platelet plug – release of growth factors “Health& & Wealth for Wales” “Health Wealth For Wales”

Mediators of the healing process • Growth factors and cytokines • Coordinate the healing

Mediators of the healing process • Growth factors and cytokines • Coordinate the healing process • Released from cells and then lock on to specific target receptors on other cells • Receptor cell either migrates, divides or produces a substance “Health& & Wealth for Wales” “Health Wealth For Wales”

Inflammation “Health& & Wealth for Wales” “Health Wealth For Wales”

Inflammation “Health& & Wealth for Wales” “Health Wealth For Wales”

Clinical implications of inflammatory stage • Steroids will delay the response • Inflammation is

Clinical implications of inflammatory stage • Steroids will delay the response • Inflammation is prolonged by dead tissue and external material • Infection http: //www. woundsinternational. com/pdf/c ontent_31. pdf “Health& & Wealth for Wales” “Health Wealth For Wales”

Clinical implications of inflammatory stage • Overgranulation “Health& & Wealth for Wales” “Health Wealth

Clinical implications of inflammatory stage • Overgranulation “Health& & Wealth for Wales” “Health Wealth For Wales”

Destructive phase 1 – 6 days • Circulating neutrophils & macrophages leave the blood

Destructive phase 1 – 6 days • Circulating neutrophils & macrophages leave the blood stream and travel to the injured tissue “Health& & Wealth for Wales” “Health Wealth For Wales”

Destructive phase 1 – 6 days • Tissue macrophages release chemotactic substances to attract

Destructive phase 1 – 6 days • Tissue macrophages release chemotactic substances to attract the cells to the wound bed • Autolysis – body cleansing its own wound bed “Health& & Wealth for Wales” “Health Wealth For Wales”

Destructive phase “Health& & Wealth for Wales” “Health Wealth For Wales”

Destructive phase “Health& & Wealth for Wales” “Health Wealth For Wales”

Clinical implications of the destructive phase • Neutrophils & macrophages function at body temperature

Clinical implications of the destructive phase • Neutrophils & macrophages function at body temperature • Exposure of the wound bed • Temperature of cleansing agents • Low white cell count “Health& & Wealth for Wales” “Health Wealth For Wales”

Proliferative phase 3 -24 days • Macrophage releases growth factors to stimulate healing “Health&

Proliferative phase 3 -24 days • Macrophage releases growth factors to stimulate healing “Health& & Wealth for Wales” “Health Wealth For Wales”

Proliferative phase 3 -24 days • Fibroblast cells produce collagen and fibronectin • Angiogenesis

Proliferative phase 3 -24 days • Fibroblast cells produce collagen and fibronectin • Angiogenesis new blood vessels travel and fill the gaps in the collagen mesh - “Health& & Wealth for Wales” “Health Wealth For Wales”

Clinical implications of the proliferative phase • Granulation tissue is very delicate and requires

Clinical implications of the proliferative phase • Granulation tissue is very delicate and requires protection – red & granular in appearance • Speed of the process is age related “Health& & Wealth for Wales” “Health Wealth For Wales”

Clinical implications of the proliferative phase • Dressing is providing the optimum environment for

Clinical implications of the proliferative phase • Dressing is providing the optimum environment for healing • Dietary requirements “Health& & Wealth for Wales” “Health Wealth For Wales”

Maturation Phase 3 weeks………… • Epithelial cells at wound edges move across the granulation

Maturation Phase 3 weeks………… • Epithelial cells at wound edges move across the granulation tissue • Wound contracts • Initial collagen is replaced with a stronger more robust collagen to give the wound strength “Health& & Wealth for Wales” “Health Wealth For Wales”

Maturation phase “Health& & Wealth for Wales” “Health Wealth For Wales”

Maturation phase “Health& & Wealth for Wales” “Health Wealth For Wales”

Clinical implications of the maturation Phase • Epithelial cells can be seen at the

Clinical implications of the maturation Phase • Epithelial cells can be seen at the wound edges as a pale pink rim • Wound contraction may cause a problem in certain areas - face • After 3 months the wound is still only at 50% of its full strength • Epithelial cells move three times quicker over a moist wound bed “Health& & Wealth for Wales” “Health Wealth For Wales”

EWMA Hard-to-Heal Wounds • http: //www. woundsint ernational. com/pdf/c ontent_45. pdf “Health& & Wealth

EWMA Hard-to-Heal Wounds • http: //www. woundsint ernational. com/pdf/c ontent_45. pdf “Health& & Wealth for Wales” “Health Wealth For Wales”

Wound Bed Preparation “Health& & Wealth for Wales” “Health Wealth For Wales”

Wound Bed Preparation “Health& & Wealth for Wales” “Health Wealth For Wales”

Systematic assessment • • Identification of underlying medical conditions Clients understanding and aspirations, well

Systematic assessment • • Identification of underlying medical conditions Clients understanding and aspirations, well being Nutritional status Pain Medication Care environment Investigations “Health& & Wealth for Wales” “Health Wealth For Wales”

Wound infection “Health& & Wealth for Wales” “Health Wealth For Wales”

Wound infection “Health& & Wealth for Wales” “Health Wealth For Wales”

Colour of tissue “Health& & Wealth for Wales” “Health Wealth For Wales”

Colour of tissue “Health& & Wealth for Wales” “Health Wealth For Wales”

Wound exudate • Colour • Amount • Consistency • Surrounding skin “Health& & Wealth

Wound exudate • Colour • Amount • Consistency • Surrounding skin “Health& & Wealth for Wales” “Health Wealth For Wales”

Scar tissue “Health& & Wealth for Wales” “Health Wealth For Wales”

Scar tissue “Health& & Wealth for Wales” “Health Wealth For Wales”

International consensus document 1 www. woundsinternational. com/clinicalguidelines/international-consensusoptimising-wellbeing-in-people-livingwith-a-wound “Health& & Wealth for Wales” “Health Wealth

International consensus document 1 www. woundsinternational. com/clinicalguidelines/international-consensusoptimising-wellbeing-in-people-livingwith-a-wound “Health& & Wealth for Wales” “Health Wealth For Wales”

Conclusion • Wound healing is a complex process • Wound assessment is a systematic

Conclusion • Wound healing is a complex process • Wound assessment is a systematic process • Support clinical decision making • Make a clinical judgement • Act upon the assessment “Health& & Wealth for Wales” “Health Wealth For Wales”