Wound Healing & Wound Care

Lesson Objectives

By the end of this topic, learners should be able to:

1. Define key terms related to wound healing.

2. Understand the phases of wound healing.

3. Differentiate types of wound closure (primary, secondary, tertiary intention).

4. Recognize common wound complications and their management.

5. Apply nursing and medical student perspectives in wound care.

 Key Glossary Terms

1. Wound

• Definition: A break in the integrity of skin or underlying tissues.

• Clinical Note: May be surgical (incision) or traumatic (cut, crush).

• Nursing Relevance: Dressing changes, infection monitoring.

• Medical Relevance: Healing mechanism depends on type, depth, and infection risk.

2. Wound Healing

• Definition: Biological process of tissue repair and restoration.

• Phases (Mnemonic: HIPR)

  • Hemostasis → clot formation.

  • Inflammation → neutrophils/macrophages clean debris.

  • Proliferation → fibroblasts, collagen, angiogenesis.

  • Remodeling → scar formation, tensile strength ↑.

• Clinical Note: Normal healing takes weeks; remodeling can last months.

3. Healing by Intention

• Primary Intention – Wound edges approximated (sutures, staples, glue). Quickest healing.

• Secondary Intention – Wound left open, heals by granulation tissue; slower, scar more prominent.

• Tertiary Intention (Delayed Primary Closure) – Initially open (due to contamination), later closed.

4. Debridement

• Definition: Removal of necrotic/infected tissue.

• Types:

  • Surgical (scalpel, scissors)

  • Mechanical (wet-to-dry dressings)

  • Autolytic (body’s enzymes via occlusive dressing)

  • Enzymatic (topical agents)

• Clinical Relevance: Essential for wound healing and infection prevention.

5. Sutures

• Definition: Threads used to approximate wound edges.

• Types:

  • Absorbable (e.g., Vicryl) – internal use.

  • Non-absorbable (e.g., Nylon) – skin closure.

• Suture Techniques: Simple interrupted, continuous, mattress.

• Nursing Relevance: Monitor for suture site infection.

6. Staples & Adhesives

• Staples: Metallic clips, faster closure, common in abdomen.

• Adhesives (Dermabond/Glue): Used for small superficial wounds.

7. Wound Complications

• Hematoma – Collection of blood under wound.

• Seroma – Accumulation of serous fluid.

• Infection – Redness, pus, pain, fever.

• Dehiscence – Wound edges separate.

• Evisceration – Organs protrude from open wound (surgical emergency).

• Keloid/Hypertrophic Scar – Abnormal scar tissue growth.

8. Wound Dressings

• Types:

  • Dry dressings (gauze)

  • Moist dressings (hydrocolloids, hydrogels)

  • Negative Pressure Wound Therapy (vacuum-assisted closure)

• Nursing Role: Select appropriate dressing, ensure sterility.

9. Drains

• Definition: Tubes placed to evacuate fluids and prevent collection.

• Examples:

  • Penrose Drain – simple, passive.

  • Jackson-Pratt (JP) Drain – closed suction.

  • Hemovac – large suction drain.

• Nursing Note: Always record drain output.

10. Tetanus Prophylaxis

• Relevance: Dirty wounds require tetanus vaccine or immunoglobulin.

• Nursing Note: Always check immunization status.

 Clinical Notes & Mnemonics

• Phases of wound healing mnemonic: HIPR (Hemostasis, Inflammation, Proliferation, Remodeling).

• Complications mnemonic: HIS DK (Hematoma, Infection, Seroma, Dehiscence, Keloid).

Tables

Table 1: Types of Wound Closure

Table 2: Wound Complications