Dtsch Arztebl Int. 2008 Mar; 105(13): 239–248. Continuing Medical Education Optimal wound management remains the subject of active research. Improved knowledge of physiological wound healing, systemic research into wound dressing and the evaluation of chemical
disinfection have given rise to new approaches to wound care. Selective literature review. The primary goals of wound management are rapid wound closure and a functional and aesthetically satisfactory scar. While basic treatment for primary wound healing is often simple, a number of problems can arise in chronic wounds, especially in elderly patients and those with
multiple morbidity. It is therefore essential to maintain the basic conditions for physiological wound healing, in particular adequate wound moistness. Each dressing change should entail an evaluation of the wound status, careful cleansing, and treatment tailored to the phase of wound healing. Many therapeutic agents formerly in use are now obsolete. A variety of specific preparations are available for wound covering, including inert, interactive and bioactive substances. There remains a lack of
good evidence for these, however. New findings in molecular and cell biology have improved our understanding of physiological wound healing, and approach to wound care and dressing. Keywords: wound healing, wound care, wound dressing, chronic wounds A wound may be defined as any disruption of the integrity of skin, mucous membrane or organ
tissue. A distinction is made between simple wounds that are confined to the skin, and complicated wounds which are deeper and also involve injury to muscles, nerves, and vessels. Wounds can be caused by mechanical, thermal, chemical, and radiogenic trauma. To be distinguished from these are wounds that have their origin in underlying pathologies such as diabetes mellitus, chronic venous/arterial insufficiency, and immunological or dermatological diseases. The primary care of wounds is the task
of the surgical disciplines. The monitoring of wounds and application of further wound dressings, however, can be carried out by all physicians and may also be delegated to nursing personnel. The primary goals of all wound management are rapid wound closure and a functional and aesthetically satisfactory scar. The learning aims of this article are therefore: to assess the level of knowledge of wound healing to satisfy the requirements for practicable and efficient
dressing change. Physiology of wound healingWound healing is an exceedingly complex process and has been the subject of research for more than 120 years (1, 2). New findings in molecular biology obtained in recent years have provided greater insights into the biological processes involved. The most important treatment principle in practical terms is to support the physiological course of the wound healing process and to avoid jeopardizing it through incorrect manipulations. Wound healing is traditionally divided into four, sometimes overlapping phases (3, 2), namely: DefinitionA wound may be defined as any disruption of the integrity of skin, mucous membrane or organ tissue.
In recent English language publications, wound healing is divided into only three phases under immunological aspects: inflammation, proliferation, and wound modulation (4). Since the different phases give rise to consequences for wound care, a classification into four phases should be preferred for reasons of practicability. As an aid to understanding, the different phases will now be briefly outlined, because the dressing of wounds must be carried out in a phased manner. Every wound in which the skin integument is disrupted results in bleeding and activation of the coagulation cascade. Factors of wound healingMore than 30 cytokines involved in wound healing have so far been identified. They regenerate themselves from macrophages, platelets, fibroblasts, epidermal cells, and neutrophil leukocytes. Exudative phase: This phase is characterized by the formation of fibrin and an influx of platelets which together form a visible clot. In the exudative phase, the platelets secrete various mediators of wound healing known as growth factors. These in turn activate macrophages and fibroblasts (figure 1). The further biological processes are controlled by the mediators (growth factors) already released and by cytokines, which cause an influx of cellular structures. More than 30 cytokines have so far been identified, and are released by macrophages, platelets, fibroblasts, epidermal cells, and neutrophil leukocytes.  Early phase of wound healing (3rd day). The defect is filled with a fibrin clot. The platelets involved activate neutrophil granulocytes, which remove foreign bodies or bacteria and stimulate the transformation of monocytes to macrophages. Macrophages play a central role in the early phase of wound healing, as they stimulate fibroblasts and vascular endothelium to form granulation tissue. All cellular interactions are controlled by cytokines (growth factors) (from [4]). VEGF, vascular endothelial growth factor; IGF, insulin-like growth factor; TGF, transforming growth factor; PDGFAB, platelet-derived growth factor AB/BB; KFG, keratinocyte growth factor; FGF, fibroblast growth factor Resorptive phase: The resulting degradation products of fibrin lead to activation of chemotaxis in the resorptive phase. After only 24 to 48 hours, leukocytes and macrophages migrate into the wound (inflammation). These cellular components are able to autolyze and remove avital tissue by fermentative processes. Overall, a highly effective system of phagocytosis, anti-infectious defense, and immune system is created (5, 6). Proliferative phase: Between the third and seventh day, immigration of fibroblasts with vascular proliferation occurs during the proliferative phase. The characteristic feature is the formation of granulation tissue. Epidermal cells grow into the wound from the margins. A visible, delicate border forms (figure 2). From the 3rd to 7th day immigration of fibroblasts and vascular proliferation occur with ingrowth of capillaries (proliferative phase). In the repair or regeneration phase, the matrix metalloproteinases (MMP 1, 2, 3, 13) then induce remodeling of the extracellular matrix into tearing-resistant collagen structures. Depending on the size of the wound, epithelization and scar formation occur. u-pA, urokinase plasminogen activator; t-PA, tissue plasminogen activator (from [4]) These processes are also controlled by various growth factors (cytokines). The fibroblasts form a new extracellular matrix. The capillaries that have developed supply the tissue with the oxygen necessary for metabolism. The primary clot is broken down by factors of the fibrinolysis system: u-PA (urokinase plasminogen activator) and t-PA (tissue plasminogen activator). The various matrix metalloproteinases (MMP) remodel the extracellular matrix (7). Understandably, these biological processes can only take place in a controlled manner if activating and inhibiting reactions are in a balanced ratio to each other. This complex biological remodeling of the tissue of immigrating fibroblasts and capillary buds into a structured extracellular matrix demands a gentle approach when changing dressings. Phases of wound healing
Regenerative phase: This phase can last for up to a year. The maturation of collagen leads to an increase in the wound’s tearing resistance. The main characteristics of this phase are epithelization and scar formation. Remodeling and restructuring processes are also constantly in progress during this phase. For example, type III collagen is transformed into type I collagen of the more mature wound (8). The interactions between the extracellular matrix and cell structures of the wound are regulated by transmembrane cell receptors (integrins) and cytokines (6). Besides the pathological level of wound healing just described, there is also a clinical classification, in which wound healing is divided into primary wound healing (pp) "sanatio per primam intentionem" and secondary wound healing (ps) "sanatio per secundam intentionem" (1). Primary wound healingPrimary wound healing is the uncomplicated healing process of non-infected, well-adapted wounds. If the healing process is disturbed by local factors such as infections, dehiscence, inadequate blood perfusion or systemic factors such as immunocompromise, a situation of secondary wound healing develops. Every surgical wound should be inspected at least once daily in the first few postoperative days. The commonest complications of a primary wound are infection and secondary bleeding. Infection betrays its presence through the classical features "dolor, rubor, calor, tumor." If signs of abscess formation are present, an adequate incision should be made to drain the pus and the wound should be locally irrigated. Anesthesia should be provided (see secondary wound healing). Hematomas, whether in the form of bloody imbibition or coagulum, can be tolerated up to a volume of 50 to 200 mL depending on the size of the wound. Only when larger clots are present can wound healing be improved and hastened by removing the hematoma. Since a primarily healing, clean wound soon closes due to crosslinking of fibrin, gentle mechanical cleansing can already be performed after 24 hours. Primary healing wounds may be irrigated after 24 hours to cleanse them of scab tissue and residues of the surgical disinfectant. The wound should be disinfected with a wound antiseptic such as octenidine dihydrochloride 0.1%/phenoxyethanol 2%, polyhexanide 0.04% or PVP-iodine preparation (box 1). A protective dressing can then be applied. Most patients find it very pleasant to have the wound covered with an adhesive dressing (9). Wound staples or sutures should be removed as recommended by the treating surgeon, and also depending on the blood circulation conditions in the affected region of the body. Box 1Recommended antiseptics for all wounds*1
*1 modified from 15, 16 Following a thyroid operation the wound sutures can be removed on about the fourth to fifth day, in the thoracic region after seven days, and on the lower extremities after 10 to 14 days. Factors to be considered are comorbidities such as diabetes mellitus, immunosuppressive medication, increased skin tension in defect closure or edema formation, which make it necessary to leave the suture material in place for longer. Secondary wound healingWound healingThe following types of wound healing are distinguished:
ComplicationsCommonest complications of a primary wound are infection and secondary bleeding. Key words: "dolor, rubor, calor, tumor." The overriding principle of wound management in secondary wound healing is to ensure the presence of a moist, physiological environment. Air and especially oxygen are cytotoxic and, if the wound is allowed to become dry, inevitably lead to extensive tissue necroses which cause irreparable damage especially in capillary-free (bradytrophic) tissue. The second important principle is compliance with the basic requirements of hygienic wound care. An open wound is invariably contaminated with potentially pathogenic microorganisms present in the environment. The purpose of applying further wound dressings must be to allow the immune status to ward off the bacteria already present, avoid further colonization from outside and thereby prevent infection. Secondary wound healingEnsuring a moist, physiological environment is the paramount principle of wound care. For painful wounds, appropriate pain relief should be included in the dressing change schedule. An oral analgesic is recommended depending on the size and extent of the wound. Available medications include non-steroidal anti-inflammatory drugs (NSAIDs), metamizole, paracetamol or COX-2 inhibitors. These medicines should be administered about 30 to 60 minutes before changing the dressing. The findings of a meta-analysis of six studies have shown that satisfactory results are obtained with local analgesia with an ointment mixture of lidocaine and prilocaine (10). An exposure period of about one hour should be ensured. A film cover is unnecessary if it is certain that the ointment exerts its effects in a controlled manner. A swab sample for microbiological analysis should be collected if possible at the beginning of wound treatment. The sample should be analyzed for gram positive and gram negative pathogens and anaerobic microorganisms. In high-risk patients (age > 75 years, diabetes mellitus, immunocompromise, long-term hospitalization), a test for methicillin-resistant Staphylococcus aureus (MRSA) strains should be performed. An open wound does not require antibiotic treatment. If there is persisting fever, leukocytosis, and CRP elevation, a close inspection or revision of the wound – if appropriate, in the hospital setting – should be performed to clarify the possibility of an infection. In the presence of elevated inflammatory parameters, such as fever above 38.5 °C measured sublingually, leukocytosis above 10 000/µL and CRP fourfold higher than normal, systemic antibiotic therapy should be initiated (if two of the parameters are positive). For moderately severe infections, the Paul Ehrlich Society recommends aminopenicillin with ß-lactamase inhibitor, a group 1 and 2 cephalosporin or a group 4 fluoroquinolone. The need for antibiotic therapy should also be considered in the presence of immunocompromise, i.e. in patients post transplantation or with diabetes mellitus or patients undergoing chemotherapy. Occasionally an inflammation characterized by erythema, swelling and pain is present in the wound margins. If the subcutaneous tissue is also infiltrated, a phlegmon is present. This accompanying inflammation requires particularly close monitoring. Most authors in the literature support the use of antimicrobial chemotherapy in such cases (11). Dressing change in secondary wound healingWound cleansingWound swabFor secondary wounds, a microbiological swab sample should be taken at the beginning of treatment. In the early phases of wound healing – the exudative phase and the resorptive phase – blood and plasma constituents, clots and cell detritus are present in the wound and should be carefully removed. This mechanical wound cleansing is an important precondition for rapid, uncomplicated wound healing and is known as debridement. Bacteria and degradation products of corpuscular elements have been shown to disturb or inhibit wound healing (12). The simplest procedure for cleansing a wound is irrigation. According to existing knowledge, drinking water can safely be used for this purpose in acute and chronic wounds (13, 14). Wound disinfectionFor more than 100 years, physicians have experimented with substances to which they ascribed wound disinfectant properties. These include dye-based agents such as gentian violet, alcoholic disinfectants and a wide variety of protein precipitating agents (H2O2/NaCl 10%). When used over extended periods, however, these substances disturb wound healing and lead to chronification. Protein precipitating agents, iodoform, potassium permanganate, and boric acid are now considered obsolete. A negative list has been compiled of preparations that should no longer be used due to lacking proof of efficacy, high toxicity, and high allergy potential (15). The effect of antiseptics is to be regarded as low (evidence level D) (table) (see also the German language website www.wundzentrum-hamburg.de). Under no circumstances must antiseptics adversely affect the wound healing processes. Wound antiseptics considered to have no serious deleterious effects on the wound healing process are octenidine dihydrochlorid 0.1%/phenoxyethanol 2%, polyhexanide 0.04% or PVP-iodine preparation (box 1) (15, 16). An essential requirement is open wound treatment, which fundamentally alters the environment for the etiologic agents. Under these conditions the bacteria find it difficult to colonize and as a result hardly influence the course of wound healing. The moist environment is the most important factor for the healing process, since it promotes cell growth, angiogenesis, and fibrinolysis (2). TableNegative list of preparations for wound healing which should no longer be used due to lacking proof of efficacy, toxicity, and high allergic potential*1
Wound coverage/maintenance of a moist environmentFor physiological wound healing it is essential to maintain a moist wound environment (18, 19) (figure 3a, b, c, d) (box 2). A distinction is drawn between inactive, interactive, and (bio)active wound dressings (transplant materials). Box 2Planning and performance of dressing change
Figure 3: Wound healing: a) wound on the lateral side of the lower leg with extensive necroses and fibrin residues in an 82-year-old female patient (left caudal, right cranial). The state of the wound is a consequence of incorrect treatment (dry wound dressing). b) The wound was surgically debrided and covered with a moist dressing. Individual areas of granulation are forming (proliferative phase of wound healing). c) Continued moist dressings, continued granulation also beyond the tendon level (repair phase of wound healing). d) After placement of a secondary suture, a stable scar has formed. The care of the distal part of the wound could be improved. Cleansing of woundsThe wound is washed out with drinking water. Harder layers require debridement with moist compresses or instruments. Inactive or conventional wound dressings are distinguished by their high absorbency. They are made of cotton (gauze compresses), synthetic fibers (non-wovens) or several layers of material (wound gauzes). To maintain a moist environment, these compresses are saturated in physiological saline solution and covered with a waterproof film. The advantages of these dressings are their absorbency (usage without moistening indicated for heavily exudating wounds) and their low cost. Disadvantages are the possible desiccation of the wound and adhesion to the wound bed. Fresh granulation tissue is then destroyed on changing dressings, and is also very painful for the patient (9, 17). Moist environmentThe moist environment of open wounds promotes cell growth, angiogenesis, and fibrinolysis. Interactive wound dressings have to meet numerous requirements:
Interactive, hydroactive wound dressings which because of their special material properties enter into interaction with the wound, were devised to satisfy these criteria. They promote optimal conditions for wound healing and are used in a manner suited to the different phases of wound healing. They also offer two benefits for patients: changing the dressing is much less painful and dressings can be left in place for several days if necessary. Wound dressingsA distinction is made between:
At present about 250 different wound dressings are supplied by several manufacturers (20). Retaining an overview is difficult considering the wide variety of products (box 3). The benefits offered by individual classes of wound dressings have been analyzed in 42 controlled, randomized studies in a Cochrane Review. None of these studies provided evidence that better wound healing is achieved with hydrocolloids, alginates, foam dressings, or hydrogels. The same results were also achieved using dressings that were merely able to maintain a moist environment (17). Box 3Interactive wound dressings*
* modified from (2, 19, 20) (Bio)active dressings include autologous skin, lyophilized porcine skin, autologous keratinocytes, collagen-based wound dressings, and the use of growth factors. These (bio)active wound dressings should be reserved for special indications involving chronic wounds, if appropriate in the hospital setting (evidence level C). Skin care on dressing changeBioactive wound dressingsThese include:
A healthy wound environment is indispensable for uncomplicated wound healing. The skin must be cleaned of all exudates and dressing residues. Compresses should ensure that the skin remains dry in the interdigital regions and skin folds. For normal skin pH5 gel creams and for dry skin, especially in diabetics, also urea-containing products with a high lipid content are recommended. Vacuum sealingVacuum sealing is indicated for complicated, surgically debrided wounds in the proliferative phase. If skin macerations have occurred, the exudate should be controlled using suitably absorbent dressings. Intermittently covering the peri-wound area with hydrocolloids may also be helpful. For prophylaxis and treatment of macerations of the wound margins, a non-irritating, air-permeable and water repellent protective film may be applied to the skin. Zinc paste is obsolete because it has an occlusive effect and desiccates the wound margin. Special attention should be devoted to the treatment of hyperkeratoses as they frequently give rise to ulcerations. In addition to podological treatment, surgical removal of hyperkeratoses is often required. Also helpful are ointments containing urea (5% to 10%) and salicylic acid (2.5% to 10%). Vacuum sealingVacuum sealing involves placing a piece of foam over the wound, thereby creating a suction effect and subjecting the entire wound area to negative pressure. This technique combines three principles of wound treatment: Skin care on dressing changeA healthy wound environment is indispensable for uncomplicated wound healing. The skin must be freed from all exudates and dressing residues.
Vacuum sealing is indicated for surgically debrided wounds in the proliferative phase. Heavy exudation and deep wound pockets can be effectively treated by the inserted sponges. This creates a practicable, hygienic situation for the patient and his environment. Whether the processes involved in physiological wound healing are accelerated by vacuum sealing has not been demonstrated (21, 22). Vacuum therapy can also be performed in the outpatient setting. Its installation and use demands special knowledge on the part of the therapist and patient which in the authors’ own experience is not generally found at present. Much scientific evidence is available for the successful treatment of wounds with fly larvae. The use of maggots also requires special knowledge and should be reserved for special indications involving chronic wounds (23). The chronic woundIf the wound healing processes last for longer than four weeks and no tendency to healing is apparent, the wound is by definition chronic (2). Now at the latest, the cause of the wound healing disorder must be established. Incorrect wound treatment must always be ruled out as a primary factor. A differential diagnosis of the wound healing disorder should then be undertaken. Wound closureChronic woundIf no healing tendency is apparent over a period of four weeks, this condition is regarded as a chronic wound. The goal of all wound management is to obtain a mechanically stable and aesthetically acceptable scar, because stable scar conditions protect the tissue most effectively against wound dehiscence. Open wounds are unacceptable as a long-term situation. Depending on their extent and localization, they are a burden and hazard for the patient. The range of available closure options extends from conservative healing to coverage with free skin grafts which can be integrated by the vascular pedicle technique. General surgery, plastic and reconstructive surgery have now attained a standard that allows the closure of every defect (24) (box 4). Box 4Staged schedule for wound closure depending on the size and extent of the wound defect*1
*1 modified from (24) DocumentationMost of the relevant publications on wound dressings call for the wound and the type of dressing to be documented. While this may be considered desirable, the generation of objective findings and standardization of dressing types in an attempt to achieve comparability in scientific studies must be considered to have more or less failed (25). Digital photography, which offers the most information for little effort, would appear a simple and practicable solution. ConclusionsConsidering the great importance attached to the topic of "wounds" in daily medical practice, the lack of evidence based interdisciplinary guidelines is surprising. The reasons for this are the extreme complexity of the wound conditions, the difficulties involved in standardization and the proliferating range of therapeutic options. GuidelinesAt present there are no evidence based interdisciplinary guidelines for "wound care." The benefit of the standardized approach to wound management presented in this article lies in the fact that it can be successfully applied to all types of wounds. The complex subject matter is thereby simplified for practical use. Decubitus ulcers, arterial or venous ulcers, postoperative wound infections, and ulcers associated with diabetic foot syndrome undergo the same physiological processes and thus are subject to the same therapeutic principles of wound dressing. An underlying causative pathology, such as arterial occlusive disease, venous insufficiency or a sacral decubitus ulcer naturally also requires causal treatment. Further informationThis article has been certified by the North Rhine Academy for Postgraduate and Continuing Medical Education. Deutsches Ärzteblatt provides certified continuing medical education (CME) in accordance with the requirements of the Chambers of Physicians of the German federal states (Länder). CME points of the Chambers of Physicians can be acquired only through the Internet by the use of the German version of the CME questionnaire within 6 weeks of publication of the article. See the following website: www.aerzteblatt.de/cme Participants in the CME program can manage their CME points with their 15-digit "uniform CME number" (einheitliche Fortbildungsnummer, EFN). The EFN must be entered in the appropriate field in the www.aerzteblatt.de website under "meine Daten" ("my data"), or upon registration. The EFN appears on each participant’s CME certificate. The solutions to the following questions will be published in Volume 21/2008. The CME unit "Basic Knowledge of Refractive Surgery" (volume 9/2007) can be accessed until 11 April 2008. For volume 17/2008 we plan to offer the topic "Epilepsy in Childhood and Adolescence". Solutions to the CME questionnaire in volume 5/2008: Bieker E, Sauerbruch T: Diagnosis and Management of Upper Gastrointestinal Bleeding: 1/c, 2/a, 3/a, 4/c, 5/a, 6/a, 7/b, 8/a, 9/d, 10/b Please answer the following questions to participate in our certified Continuing Medical Education program. Only one answer is possible per question. Please select the answer that is most appropriate. Question 1: How is a simple wound defined?
Question 2: What happens during the resorptive phase of wound healing?
Question 3: A patient attends the practice with a primary healing (pp) wound. From what point onwards can the wound be cleansed?
Question 4: What is the current wisdom regarding the use of drinking water to cleanse wounds?
Question 5: When is antibiotic treatment of wounds indicated?
Question 6: What is the most important aspect in the treatment of secondary wounds?
Question 7: What scientific knowledge is available regarding the quality of different wound dressings?
Question 8: Which wound antiseptic is relatively tissue sparing and can be used for wound disinfection?
Question 9: What happens in the vacuum sealing of wounds?
Question 10: What is the best protection against wound dehiscence?
CaseWound Care A 57-year old patient had an open venous ulcer on the right lower leg for 15 years. The wound was treated by the patient’s GP and the patient himself. The wound was always covered with a dry dressing, using a variety of agents including dye solutions and powder. The patient suddenly developed an exacerbation of his symptoms accompanied by extreme pain. Fever 38.5 °C, leukocytosis 12 300/µL, CRP 180 mg/L (normal up to 5 mg/L). The external aspect showed a deep ulceration covered with layers of blackish material (figure 1). A phlegmonous erythema and swelling of the skin had developed in the peri-wound area. The microbiological swab specimen taken from the wound showed a mixed culture of group A streptococci, Bacterioides spp, and Clostridium perfringens. Surgical debridement was performed in this patient, revealing full-blown necrotizing fasciitis. All ventral fascial coats of the lower leg had to be removed. The incision extended as far as the knee joint. After surgically eliminating the source of infection, daily dressing changes were performed. The wound was irrigated without addition of a disinfectant (Ringer’s lactate). The first postoperative dressing changes showed that the exudative phase of wound healing was in progress. The wound bed was clean due to the surgical debridement. During the first five postoperative days the patient received antibiotic therapy with an acylaminopenicillin combined with a beta lactamase inhibitor. The wound was dressed with simple gauze compresses. Since the wound showed a marked tendency to desiccation during the exudative phase and at the beginning of the resorptive phase of wound healing, the daily dressing change with renewed irrigation was performed every eight hours to maintain a moist wound environment. No vacuum dressing was applied, but would have been a possible, although more expensive alternative. At the beginning of the proliferative phase the moist environment was maintained using hydrocolloid dressings. This treatment resulted in very good formation of granulation tissue (figure 2). With decreasing exudation and completed granulation (figure 3), mesh graft coverage was performed on the 18th postoperative day after harvesting skin from the right thigh (figure 4). Only after 5 days was the first dressing change performed, which showed that the mesh graft transplant had taken completely (figure 5). The graft was treated in the open manner with a greasy ointment, which led to complete epithelization of the entire wound during the further course. Ten years after this wound care the patient attended again for the treatment of a different disease. The venous leg ulcer had healed completely and a stable scar had formed. The patient showed good lower leg function and was symptom free (figure 6). It can be concluded from this case report that correctly timed surgical remediation of the infection was decisive for the success of healing. Treatment of Clostridium perfringens was unnecessary because the contamination was only superficial (Weinstein’s "simple contamination"). The principles of moist wound treatment were followed and the wound underwent surgical plastic coverage. This treatment concept allowed complete, relapse-free healing of the venous leg ulcer. AcknowledgmentsTranslated from the original German by mt-g. FootnotesConflict of interest statement The authors declare that they have no conflict of interest as defined by the guidelines of the International Committee of Medical Journal Editors. References1. Friedrich PL. Das Verhältnis der experimentellen Bakteriologie zur Chirurgie, Antrittsvorlesung 10. Juli 1897. Leipzig: Verlag von Wilhelm Engelmann; 1897. [Google Scholar] 2. Lippert H. Wundatlas, Kompendium der komplexen Wundbehandlung. 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Articles from Deutsches Ärzteblatt International are provided here courtesy of Deutscher Arzte-Verlag GmbH What are the 8 principles that should be applied when treating any type of wound?Principles of Wound Management. Preserve viable tissue and remove nonviable tissue.. Restore tissue continuity and function.. Optimize conditions for the development of wound strength.. Prevent excessive or prolonged inflammation.. Avoid infection and other impediments to healing.. Minimize scar formation.. What are the 7 Steps to Effective wound care management?Let's talk about the 7 steps for caring for wounds.. Step #1 Wash Your Hands Clean. ... . Step #2 Stop the Bleeding. ... . Step #3 Clean the Wound. ... . Step #4 Apply Antibacterial Ointment. ... . Step #5 Protect the Wound. ... . Step #6 Change the Dressing. ... . Step #7 Observe Symptoms. ... . Wound Care in Rochester, New York.. What are the 5 principles of wound dressing?In this article, the authors offer five generalisable principles that colleagues providing community care can apply in order to achieve timely wound healing: (1) assessment and exclusion of disease processes; (2) wound cleansing; (3) timely dressing change; (4) appropriate (dressing choice; and (5) considered ...
What are the steps should be applied when treating any type of wound?Wounds first aid. Control bleeding. Use a clean towel to apply light pressure to the area until bleeding stops (this may take a few minutes). ... . Wash your hands well. ... . Rinse the wound. ... . Dry the wound. ... . Replace any skin flaps if possible. ... . Cover the wound. ... . Seek help. ... . Manage pain.. |
What are the eight principles that should be applied when treating any type of wound?
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