Wound care

Introduction

The skin is the largest organ of the body and makes up 16% of body weight. It has many vital functions, which include immune system function, temperature regulation, sensation and vitamin production.The skin is a dynamic organ in a constant state of change where the cells of the outer layers are shed and replaced by inner cells which move to the surface.

Skin structure

Cuticle:The outer layer of the skin which is made up of epithelial cells, without vessels, 0.04 mm thick and regenerated every 2-4 weeks, receives the nutrients from the layer below the dermis and consists of 4 and 5 layers, depending on the point of body.

Derm:The middle layer of the skin is about 0.5mm thick, consists of two layers, contains many vessels, nerves, collagen, elastin and specialized cells such as fibroblasts and mast cells, receptors for heat, cold, pain, pressure, itch and tickling

Hypodermis:The inner layer of the skin, also called the subcutaneous layer, supports the dermis and the epidermis.It varies in thickness and depth and consists of fatty tissue, connective tissue and blood vessels.Its function is to store lipids and protect the underlying organs.

Types of injuries

Acute injuries:is the wound of the skin as a result of injury. This can be due to accidents caused by great force, heat, electricity, chemicals or friction.An acute injury by definition is expected to progress through the stages of normal healing, resulting in complete healing.

A chronic ulcer fails to progress or respond to treatment during the normal expected healing time (4 weeks) and remains stagnant in the inflammatory phase.Delayed healing is due to the presence of endogenous and exogenous factors, including medications, poor nutrition, co-morbidity, or inappropriate dressing selection.

All patients with injuries should be evaluated by appropriate medical and nursing personnel so that appropriate treatment can be given immediately as appropriate.

Wounds can be classified according to etiology, condition and activity (duration) into acute, chronic, infected and clean. Ulcer healing is divided into 3 phases: a) Inflammation, b) Fibroplasia, and c) Maturation

The management of a wound should be done by evaluating the phase it is in and the overall clinical condition of the patient.

Phase 1 – INFLAMMATION (0-3 days)The body’s normal response to injury.This phase activates vasodilation leading to increased blood flow causing heat, redness, pain, swelling, loss of function (eg the arm swells and cannot be bent). The secretions may be high as this is also a normal reaction of the body.

Phase 2 – FIBROPLASIA (3-24 days)The phase where wound healing takes place. The body creates new blood vessels, which cover the surface of the wound.This phase includes reconstruction and epithelialization.The wound will get smaller as it heals.

Phase 3 – MATURATION PHASE (24-365 days)The final phase of healing, when scar tissue forms.The wound at this stage is still at risk and should be protected if possible.

Management

In acute wounds after first-line treatment, which mainly concerns the management of bleeding, optimal conditions for healing must be ensured.A dirty wound should at a minimum be flushed or, if necessary, cleaned by scraping or surgical debridement and then protected with an appropriate dressing.The patch to be chosen should, in addition to its protective properties, also provide the appropriate conditions that favor rapid healing with the best aesthetic result.An acute wound in which healing is delayed or completely interrupted becomes chronic.

The most common chronic ulcers are leg ulcers (venous and arterial), decubitus ulcers and diabetic foot ulcers, which are the result of a chronic condition.Therefore, the first line treatment for healing should be the treatment of the cause that causes and maintains them, i.e. the condition.At the same time as the management of the condition, however, the contribution of the appropriate local treatment of the wound is also necessary, which on the one hand will speed up the healing process and on the other hand will prevent the infection of the wound.