Tissue Healing Overview

1.6 Tissue Healing

• Tissue healing depends on burn size and surgical intervention.
• Clinical reasoning is crucial for applying timescales.

Inflammation

• Duration: 0-5 days
• Process: Vasoconstriction followed by vasodilatation, influx of inflammatory mediators and white blood cells (WBCs). Increased capillary permeability, exudate leaks into tissues, pus may form.
• Signs: Redness, heat, swelling, pain.
• Treatment: Reduce heat and oedema, prevent infection, immobilisation, and positioning.

Proliferation (Fibroplasia)

• Duration: Day 3-5, lasting 2-6 weeks
• Process: Fibroblasts synthesize collagen, laid down haphazardly. Angiogenesis continues.
• Signs: Moist red raised tissue over wound.
• Treatment: Early positioning, immobilisation. Later, gentle stress (splinting, exercise) to reduce oedema and prevent contracture.

Remodeling (Maturation)

• Duration: Week 4-6, lasting up to 2 years.
• Process: Collagen synthesis balanced by degradation. Organisation of collagen fibres along lines of stress. Wound closure progresses to flat, pale, and pliable scar tissue.
• Signs: Wound closure, scar that's raised and red, progressing to flat, pale, and pliable. Scar tissue tightens.
• Treatment: Optimise function through splinting, positioning, exercise, and stretching, strengthening.

1.62 Complications of Healing in Burn Patients

• Oedema: Increased vascular permeability; may be exacerbated by severe burns; can last up to 36 hours.
• Post-severe burn: Scar (eschar) is inflexible; restricts skin expansion. Increased compartment pressure can lead to circulatory compromise, nerve damage/necrosis, of distal muscles.
• Escharotomy may be needed as a surgical procedure to split the scar and allow tissue expansion.

1.7 Burn Associated Pain

• High percentage of major burn patients experience severe or excruciating pain.
• 100% of burn patients experience daily pain.
• 92% of burn patients experience pain at night.

1.71 Types of Pain in Burns

• Procedural pain: Intense burning and stinging that continues after procedures. Typically throbbing and excruciating pain.
• Background pain: Prolonged, relatively constant mild to moderate intensity pain.
• Breakthrough pain: Transient worsening of pain, often associated with movement.

1.72 Pain Mechanisms

• Primary hyperalgesia
• Secondary hyperalgesia
• Neuropathic pain
• Chronic pain/Central Sensitisation

1.73 Pain Intensity

• Pain intensity may change as inflammation subsides.
• Higher pain intensity in areas of skin loss.
• Infection may lead to increased pain.
• New tissue growth may cause paraesthesia and local discomfort in healed areas.
• Mechanical hyperalgesia is possible after subsequent injury.

1.74 Anxiety and Pain Experience

• Pain experience is altered by treatment (surgery/debridement).
• Pain during treatment may be higher than after the treatment, e.g. the harvest site of grafts.
• Poor pain management results in treatment compliance issues and post-traumatic stress disorder.

3.1 Pharmacological Pain Management

• Decreased organ blood supply can affect drug clearance.
• Hyper metabolic state results in increased drug clearance.
• Variations in acute phase plasma and total body water impact analgesia effectiveness.
• Pain assessment is crucial to monitor analgesia effectiveness.

3.2 Non-Pharmacological Pain Management

• Psychological techniques (relaxation, distraction, CBT) assist in managing anxiety and pain.
• Hypnosis offers increased suggestibility, attention, and relaxation to manage procedural pain and anxiety.
• Virtual reality offers distraction from pain; more effective than handheld games.
• Musical therapy can help with pain by providing distraction.

3.26 Paediatric Burn Pain

• Children (0-4 years) represent 20% of hospitalised burn patients.
• Pain management is vital during physiotherapy, particularly pre-physiotherapy treatment to prevent pain-related anxiety.

Pain Assessment Tools

• Wong-Baker FACES® Pain Rating Scale
• FLACC Pain Rating Scale

This quiz explores the stages of tissue healing, including inflammation, proliferation, and remodeling. It focuses on the durations, processes, signs, and treatments associated with each stage, relying on clinical reasoning for effective care. Understanding these concepts is crucial for managing wounds and promoting healing.