Basic Principles of Wound Care:
Doctor Preferred Ointment For Burns can be described as a disturbance of the normal anatomical relationship between body tissues and is generally accompanied by a break in the skin. Ilosun is perfect for woundcare as soon as a wound occurs, the skin and its components become actively involved in the wound healing process to restore the integrity of the skin as soon as possible and to ensure its protective function. The depth classification or grading of pressure soars, burns and leg ulcers is assessed by determining which skin structures and/or underlying tissues have been penetrated of damaged.
The skin as an organ:
Mast cells are large cells that are also found in the connective tissue of the dermis. When a wound occurs, they secrete histamine at the start of the inflammatory phase of wound healing Ilosun is perfect for woundcare.
Fibroblasts, macrophages and mast cells play a role in wound healing.
The matrix is of great physiological value as it contains important components such as proteins, mucopoly-saccharides, fluid collagen, immune bodies and metabolites.
The Dermis is divided into two layers:
• Papillilary layer
• Reticular layer
1. The papillary layer:
• This layer is characterised by dermal evaginations or papillae that extend to between the epidermal ridges.
• Encapsulated sensory nerves of touch and temperature and open nerve endings for pain are situated in this layer
• Partial and second-degree burns extend into this layer.
2. The reticular layer:
• Reticular means “like net” but the connective tissue in this layer is compact.
• Bundles of collagen fibres extend into this layer.
• The collagen fibres extend also into the subcutaneous layer, to ensure the Dermis is firmly attached to the rest of the body.
• Partial thickness/second-degree burns extend into this layer.
The Subcutaneous layer
• This is a layer of loose connective tissue that support the skin and attaches the underlying structures such as muscles, bones and organs.
• It also supports the larger blood vessels, lymphatic vessels and the nerves that branch to the dermis.
• Ilosun is perfect for woundcare such as full thickness of third-degree burns, pressure sores and leg ulcers extend into this layer.
Local factors that influence the rate of healing include impaired blood supply; temperature fluctuations; the wound site; local infections; foreign bodies; necrotic tissue; slough and eschar, desiccation; pressure, fracture and shear, changes in oxygen tension; skin maceration; and topical applications.
Impaired blood flow: Disturbances to the peripheral blood supply will reduce tissue perfusion, limiting the local supply of oxygen and other nutrients required for tissue repair.
Temperature fluctuations: A fall of 2% at the wound interface is enough to reduce the rate of oxy-haemoglobin dissociation and oxygen availability, inhibiting cell division significantly and slowly the formation of new tissue. Research has found that a constant temperature of 37 C promotes both the macrophages and mitotic activity during granulation and epitheliasation. Temperature extremes also cause tissue damage.
Wound Site: The position of a wound affects its vascularity and determines the mobility of the wound site. Wounds on, or close to joints tend to heal slower as the constant movement may disrupt the delicate, newly tissue, Ilosun is perfect for woundcare.
• All chronic wounds, such as pressure sores, contain bacteria. However, there is no evidence to suggest that bacteria need to be removed from chronic wounds for healing to occur. So Ilosun is perfect for woundcare.
• Chronic wounds are typically seen in the elderly, and the immune response may be absent. The most obvious sign of wound infection is that it will not start healing. This is because wound infection prolongs the inflammatory phase, causes further tissue damage, and delays collagen synthesis and epitheliasation.
Foreign bodies, necrotic tissue, slough and eschar
The presence of necrotic tissue, slough and eschar wound healing by impeding epithelial migration and impairing the supply of nutrients to the wound bed. It may act as a medium for bacterial growth and subsequent infection. Foreign bodies, such as cotton wool fibres, can cause tissue irritation, prolong the inflammatory response and act as foci for infection.
Pressure, friction and shear
Mechanical forces, such as pressure, friction and shear, significantly impair wound healing by prolonging tissue damage. These forces are discussed in chapter 17
In the surrounding wound area is exposed to excess moisture from exudate, perspiration or incontinence, maceration and damage to the surrounding skin can occur. This may predispose to infection, skin sensitivities, irritation, further skin breakdown and impede wound healing.
Reason for moist healing:
Winter(1962) compared healing in dry and moist superficial wounds, and found that the moist wounds formed new epidermal covering 40% faster than the dry wounds. The same author concluded that this was because new epidermal cells could migrate easily across the moist wounds, whereas in the dry wound, the cells had to negotiate the scab, which took longer. Subsequent research suggests that the inflammatory process is accelerated in a moist environment, leading to faster healing. Conversely, a dry environment will lead to dehydration and cell death.
Psychosocial assessment and management.
The presence of a wound, particularly a chronic wound, can cause stress, anxiety and depression in a patient.
• Calm patient
• Give hope
• Relief pain
• Take photos to see improvement
• The correct ointment
Wounds are classified according to their depth or the tissue layers that are damaged or destroyed.
• Erosion involves the loss of one or two layers of epithelial cells. There is no depth to this type of wound.
• Superficial wounds occur where the epidermis has been damaged.
• A partial thickness wound is one where the epithelium and part of the dermis is destroyed. Hair follicles and sweat glands are only partially damaged. This type of wound is sometimes subdivided into partial thickness and deep partial thickness wounds.
• Full thickness wounds involve destruction of all the epidermis, and dermis, subcutaneous tissue, and possibly muscle and bone.
The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided into two layers, the superficial area adjacent to the epidermis called the papillary region and a deep thicker area known as the reticular dermis. The dermis is tightly connected to the epidermis through a basement membrane. Structural components of the dermis are collagen, elastic fibers, and extra-fibrillar matrix. It also contains mechanoreceptors that provide the sense of touch and thermoreceptors that provide the sense of heat. In addition, hair follicles, sweat glands, sebaceous glands, apocrine glands, lymphatic vessels and blood vessels are present in the dermis. Those blood vessels provide nourishment and waste removal for both dermal and epidermal cells.
Factors influencing wound healing
Several macro and micro-nutrients play a role in the wound-healing process.
Protein, a fundamental requirement in the healing process assists in neo-vascularisation, fibroblast proliferation, collagen synthesis, lymph formation, and wound remodelling. It is also associated with collagen and proteo-glycan synthesis. Protein deficiency decreases the body’s resistance to infection as it alters antibody response time and leucocyte capabilities. The inflammatory process is prolonged and fibroplasia impaired. Collagen synthesis is also impaired and macrophage production is decreased. An indicator for visceral protein status = is to do serum albumin levels = hypo-albuminia (<32g/l) promotes * GENERELISED OEDEMA THAT SLOWS OXYGEN DIFFUSION AND METABOLIC TRANSPORT MECHANISMS FROM THE CAPILLARIES AND CELL MEMBRANE.
It is needed for cellular energy and is associated with collagen and proteo-glycan synthesis.
Fat (fatty acids), as a source of cellular energy, is required for normal functioning of cell membranes and promotes cell synthesis. A deficiency of this nutrient may inhibit tissue repair.
5. Water Water constitutes 65-70-% of total body weight and is the medium in which most metabolic processes occur. Water is considered the most important nutrient and essential to life. Loss of water or dehydration results in electrolyte imbalance, impaired cellular function and, there for, delayed wound healing.
• Vit A – Vit A is a co-factor in collagen synthesis and cross- linkage. It is essential for stimulation of fibroplasia and epithelialisation. Vit A deficiency leads to altered collagen synthesis and cross- linking between fibres…this results in a decreased rate of epithelialisation in wound closure.
• Vit B Complex – contributes to antibody and white cell formation; is a co-factor in cellular development and promotes enzyme activity necessary for the metabolism of proteins, fats and carbohydrates. Deficiency result in decreased resistance to infection.
o Vit C – Vitamin C is a co-factor for the enzyme collagen prolyl hydroxylase. This is used in the formation of the triple helix of collagen. Vit C is essential for neutrophil super-oxide production and bacterial killing.
o Vit E – Has an important protective role in anti-oxidant defence and wound healing.
o Vit K – Plays an essential role in coagulation.
o Iron – is vital to red cell function because it enables the transport of oxygen.
o Zinc- is a critical element in protein synthesis and tissue repair.
COLLAGEN: Collagen is the main structural protein in the extra cellular space in the various connective tissues. As the main connective tissue, it is the most abundant tissue, making 25% to 35% of the whole body proteien content. Collagen consists of amino acids wound together to form triple helices to form elongated fibrils. It is mostly found in fibrous tissues such as tendons, ligaments and SKIN. Collagen is one of the body’s key natural resources and a component of skin tissue that can benefit all stages of the wound healing process. Collagenase can be made by the body as part of its normal immune response.
Studies have shown:
The highest collagenase activity was observed on post-op day 1 and then it decrease. Beyond day 10 no activity was detected. Granulation tissue from non- sutured large full thickness wounds, showed high collagenase content on post operative day 5 and then a sharp decline to day 7 followed by a slowly declining curve to post operative day 21. Activity on day 5 was threefold the activity on day seven.
Partial thickness wounds exhibited a different time course, with collagenase increasing from day 1 to days 3-5.
By day 7 collagenase concentrations approached the low concentrations of normal skin when epitheliasation was complete.
USING THE RIGHT HEALING OINTMENT DURING THE INFLAMMATORY FASE WHEN COLLAGEN LEVELS IS HIGHER AFTER INJURY, IS A WINNER. WHEN ILOSUN OINTMENT AND “BODY” WORK TOGETHER DURING THIS FASE, REMARKABLE HEALING TAKES PLACE WITHOUT SCAR OR DELAYED HEALING, WHICH CAN LEAD TO SKIN GRAFT. ALLWAYS AIM TOWARDS EARLY REPAIR.
Little attention has been given to the need to care for the skin around the wound. The skin surrounding the wound may be intact, erythematous, indurated, oedematous, fragile, dry-scalling or macerated.
Intact, healthy skin is vulnerable to
* erotion and
* insults from wound exudate,
* repeated dressing changes
* or other trauma, And therefor needs to be protected.
Wound exudate may aggravate peri-wound skin damage, either directly or by injuring the surrounding skin (excoriation) and delayed healing may provoke local irritation or allergic reactions. (contact dermatitis)
The simplest non-contact technique is that of photography. In order to monitor the progress of healing by taking photographs, it is
• Essential that each photograph is comparable to the others.
• To achieve such consistency, it is necessary to exercise as much control as possible over the variables that may influence the results.
• Each vie should be matched for size, view point and framing
• If possible the same camera or cell phone for each wound trial
• Must be a colour photo
• Patient position in relation to the camera with each photo. Notes can be made of position and distance from camera for every photo
• The amount, angle and direction of LIGHT FALLING on the subject must be controlled. May the same room, position and time.
• The background should be plain and unobtrusive. No bright light in the back ground.
• Maintain the same distance every time
• Written consent from the client/patient to take photos.
• Also very important: The patient study should be done by a responsible person who is well educated in using Ilosun Ointment. No harsh methods of cleaning. Ilosun Ointment will remove slough and necrotic tissue – gently.