The wound healing process must go through four steps to be successful: hemostasis, inflammation, proliferation, and remodeling/maturing. Inflammation is necessary for wound healing, but it can be harmful if it persists or is aided by other causes such as infection. Wound healing is most likely to slow down during this stage.
Chronic wounds are those that do not heal through the four stages of healing. The size, depth, location, and duration of the wound all have an impact on the wound healing process due to the presence of biofilm. In the treatment of non-healing or chronic wounds, wound bed preparation has been shown to be a substantial advancement. This includes things like proper wound cleansing, one or more debridement treatments as needed, moisture balance, and microbial balance. In order to identify barriers to managing and accelerating the healing of non-healing chronic wounds, practitioners must be educated on the necessity of wound bed preparation.
The best method to care for a wound is to be familiar with the different types of tissue. The color, consistency, and texture of the wound identify the tissue type. Non-viable tissue is also known as necrotic or devitalized tissue. Avascular tissue that has lost its cellular structure and physical qualities are referred to as avascular tissue. The word “viable tissue” refers to vascular tissue that is very active biologically.
The process by which the epidermis regenerates over a partial-thickness wound surface or in scar tissue that occurs on a full-thickness incision is referred to as epithelial tissue. The epithelium is pale pink in color and has a glossy luster. Epithelial cells migrate from the wound edges outward, crawling across the wound bed to the closure site. The epithelium grows stronger over time once it is produced.
Healthy granulation tissue is pink or crimson in color, and it is a strong indicator of healing. Granulation that is healthy is pink or red in color and has an uneven, mounded texture. Unhealthy granulation is black, darkish red, and bleeds easily, which could indicate infection. Excessive granulation, also known as “proud flesh,” is referred to as hypergranulation. The wound tissue will be seen above the regular wound bed surface.
Slough is fibrinous, sticky, stringy, or thickened tissue that is no longer viable or devitalized. It’s possible that one or more debridement procedures will be recommended. Yellow, gray, green, brown, and tan are some of the colors available. Slough harbors hazardous organisms, raises the risk of infection, and obstructs healing by keeping the wound in an inflammatory state; as a result, debridement therapies are required.
A full thickness wound produces eschar, which is devitalized tissue. A burn injury, gangrenous ulcer, fungal infection, necrotizing fasciitis, spotted fevers, or anthrax exposure can all cause eschar. The current standard of care guidelines suggests avoiding removing stable, intact eschar from the heels (dry, adherent, intact without erythema or fluctuation). If the eschar becomes insecure (wet, draining, loose, boggy, edematous, or red), it should be debrided according to facility procedure.
Any wound can develop a localized or systemic infection. Because it aids in the elimination of bacteria and foreign debris, wound washing is an important part of wound bed preparation. Regularly check wounds for signs and symptoms of infection, such as localized biofilm. Bacteria can be found in all chronic wounds, regardless of their cause, and the majority of chronic wounds also contain bacteria and fungi. Combining debridement methods enhances the care of complex wounds with pathological problems, according to research.
Wounds are evaluated weekly and evidence of healing progress is tracked. When there is no evidence of healing progress after two weeks, the care plan should be reevaluated. Chronic wounds or non-healing wounds are wounds that have stagnated and failed to heal as expected. These wounds are frequently full-thickness and stop healing throughout the inflammatory phase. Poor wound healing can be caused by a number of factors. These factors include the existence of biofilm, medical problems such as poorly controlled diabetes, underlying immunodeficiency, malnutrition, vascular or heart disease, and cancer.
Debridement is critical in chronic wounds with devitalized tissue or biofilm to prevent infection and encourage re-epithelialization. One or more types of debridement can be used alone or in combination to improve the healing environment. In addition to sharp debridement on a weekly basis, enzymatic and autolytic debridement therapies can be used. As a result, it will aid in the healing process, lower the risk of infection, and improve patient outcomes.
For the treatment of chronic wounds, numerous new advanced wound care dressings and technologies have been developed. Silver, polyhexamethylene biguanide, medical-grade honey, methylene blue, gentian violet, povidone-iodine, dialkylcarbamoyl chloride, copper, and chlorhexidine gluconate, as well as other antibacterial agents, may be present in these dressings. These dressings may aid to reduce bioburden and suppress protease activity in the wound.
Chronic wounds are still a major source of concern in clinical practice, and they can have a detrimental impact on patients’ quality of life. Involving patients in their care and understanding the biological processes that occur in the wound bed can help physicians optimize these conditions and choose the best treatment for patients to overcome the obstacles that cause chronic wound healing to take longer.
The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.