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Understanding chronic wound management: part 1

Wound healing — the restoration of cell structures and tissue layers after an injury — is a complex process but the mechanisms involved are rarely questioned unless a wound does not close in a timely fashion.

By Jane Flynn

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A wound can be described as any break in the skin’s integrity; this could be a small graze or, to the other extreme, a dehisced abdomen.

Wound healing can occur by primary or secondary intention. Healing by primary intention follows most surgical wounds where the skin at the wound edges is brought together and held by sutures, staples or glue.

This type of healing is normally straightforward and non-eventful. There is minimal tissue loss and minimal amounts of granulation tissue (tissue containing new blood vessels that fills the wound; see below) are needed to achieve wound closure so scarring is localised to the suture line.

Healing by secondary intention occurs where the wound edges are not brought together and are allowed to heal over time, mostly by granulation. As a result, contraction and scarring in these wounds are more noticeable.

Examples of wounds that undergo this type of healing are cavity wounds and partial to full thickness burns.

There are three phases of wound healing: inflammation, proliferation (granulation) and maturation. These occur in sequence but overlap so more than one phase can be present at the same time.

Download the attached PDF (150K) to read the full article.

Identify knowledge gaps

  1. What factors can delay wound healing?
  2. What is debridement?
  3. What dressings can be used for malodorous wounds?

Before reading on, think about how this article may help you to do yourjob better. The Royal Pharmaceutical Society’s areas of competence forpharmacists are listed in “Plan and record”, (available at:www.uptodate.org.uk). This article relates to “appropriate managementof common symptoms” (see appendix 4 of “Plan and record”).

Jane Flynn, BSc, SRN, is a tissue viability nurse specialist at Barnet Primary Care Trust, London

 

Correction (11 july 2009)

The article refers to Varidase Topical for enzymatic debridement of wounds.

This product is no longer available in the UK.

Citation: The Pharmaceutical Journal URI: 10968286

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