Factors Affecting Wound Healing PDF

Kellee Harper-Hanigan, PT, DPT, PhD, WCC, GCS  Systemic  Local  Iatrogenic  Nutrition  Obesity  Vascular Status  Medications  Disease/Co-morbidities  Age  Behavior  Psychological  Malnutrition  Decreased strength  Poor response to stress  Pts w/ chronic wounds need more prote...

Kellee Harper-Hanigan, PT, DPT, PhD, WCC, GCS  Systemic  Local  Iatrogenic  Nutrition  Obesity  Vascular Status  Medications  Disease/Co-morbidities  Age  Behavior  Psychological  Malnutrition  Decreased strength  Poor response to stress  Pts w/ chronic wounds need more protein and calories  Due to the catabolic state of the wound, pts are more prone to become malnourished  Protein  Affects cell repair and regeneration  Decreased levels affect inflammation, cell proliferation, immune response, remodeling and maturation of scar tissue  Carbohydrates, vitamins, minerals  Not enough, body will use protein for energy  High body fat and poor nutritional status  High rate of delayed healing, wound dehiscence and infection  Poor blood supply to adipose tissue  Increased workload of the heart  Edema difficult to assess  Co-morbidities may be present Arterial Insufficiency Venous insufficiency  Decreased oxygen to the wound  Edema  Chronic non-healing wounds  Fibrin in the tissue spaces  Increase susceptibility to infection  High risk for infection Steroids Chemotherapeutic agents  Decrease collagen synthesis Interfere with cell proliferation Prolong inflammation  Suppress immune system Inhibit protein and fibroblast collagen synthesis NSAIDs (too many and for too long)  Vasoconstriction  Suppress inflammation and collagen Antineoplastic drugs synthesis  Fibroblast production DISEASES Immunocompromised Diabetes  Infection  Accelerated atherosclerosis  Affects phagocytosis  Neuropathy  Abnormal collagen synthesis Renal dysfunction Granulation and fibroblasts Vascular Decreased blood supply Oxygen perfusion and tissue oxygenation  Changes in cellular activity  Epidermis thinner and weaker  Atrophy  Delayed inflammatory response  Decreased macrophage function  Decreased vascularization and atrophy of dermis  Slow healing  Decreased sensation and metabolism  Decreased collagen synthesis and fibroblast function  Decreased dermal thickness  ~20% loss  Loss of insulating subcutaneous fat  Decreased collagen and elastin  Decreased sensation and metabolism  Less effective barrier to water loss  Decreased ability to manufacture vitamin D  Decreased sweat glands  Reduction in blood flow due to thinner blood vessels  Decreased epidermal regeneration and collagen synthesis  Reduction of mast cells and Langerhans cells  Friction  Two surfaces in contact move across each other  Shear  Skin remains stationary while underlying tissue is pulled in another direction  Maceration/Desiccation  Over/under hydration of tissue  Pressure  Irritants  Stripping of the acid mantle  Risk-taking behaviors  Alcohol abuse  Smoking  Stress  Depression and Anxiety  Mental illness  Wound Dimensions  Medication/topicals  May damage healthy tissue as well  Dressings  Goal is to maintain a moist wound bed  Desiccation  Necrotic tissue/eschar  Increases likelihood of infection  Eschar interferes with wound contraction  Sensation  Continued trauma to tissues  Mechanical Stress  Pressure, shear, and friction  Edema  Infection  Blood supply 100% Linear Wounds Square/Rectangular Wounds Circular Wounds Wound Size Closed Time Infection Blood supply  More injury to tissue  Inhibition of fibroblast migration and collagen  Decreased collagen production synthesis and increased cell lysis  Susceptible to infection and  Kills the cells needed for tissue breakdown healing  Result from medical treatment or examination  Failure to diagnose arterial disease  Inadequate debridement  Failure to off-load  Bad positioning  Failure to control for correct wound healing environment  Ex: make a wet wound wetter  Inappropriate treatment plan  Including referrals to other health professionals  Not following established guidelines for care  Inadequate pain control  Inadequate patient education and follow-up  Know the different factors that impact wound healing and how they do so  Be able to identify and differentiate between systemic, local, and iatrogenic factors  Be able to articulate the effects of aging and what that means with respect to risk for wound development