1. FACTORS COMPLICATING WOUND REPAIR October 25, 2005

2. DELAYED WOUND CLOSURE l WOUND TAKES LONGER THAN EXPECTED TO HEAL l WOUND IS PROGRESSING TOWARDS CLOSURE

3. CHRONIC WOUND l WOUND WHICH HAS NOT RESPONDED TO CONSERVATIVE OR SURGICAL TREATMENT

4. COMPLICATING WOUND REPAIR l INTRINSIC FACTORS l ENVIRONMENTAL FACTORS l IATROGENIC FACTORS

5. INTRINSIC FACTORS l RELATED TO THE PATIENT’S GENERAL PHYSICAL CONDITION (DM, CVA, INFECTION) l RELATED TO THE PATIENT’S GENERAL MENTAL CONDITION (DEMENTIA)

6. ENVIRONMENTAL FACTORS l MODALITY OR TREATMENT APPLIED TO THE WOUND (W/P, NEOSPORIN, BETADINE)

7. IATROGENIC l HOW THE WOUND IS PHYSICALLY MANAGED (REMOVAL OF DRESSINGS, IRRIGATION, CLEANSING)

8. SKIN AGING l EPIDERMAL RENEWAL l TISSUE REPAIR l WOUND HEALING l INFLAMMATORY RESPONSE l VASCULAR SUPPLY l PHOTOPROTECTION l PAIN PERCEPTION

9. AGING l EPITHELIALIZATION l WOUND BREAKING STRENGTH l ANGIOGENESIS l BIOSYNTHETIC ACTIVITY l COLLAGEN REMODELING l WOUND CONTRACTION l INCREASED WOUND DEHISCENCE

10. INFECTION l ERYTHEMA- WELL-DEFINED (INFLAMMATION), ILL-DEFINED (INFECTION) l IF REDNESS GOES AWAY WITH CHANGE OF POSITION (ELEVATION) MAY BE INFLAMMATION VS. INFECTION

11. INFECTION (cont.) l HEAT (SYSTEMIC-FEVER-SEPSIS), LOCAL HEAT (INFLAMMATION) l FOUL ODOR (NECROTIC TISSUE WILL SMELL LIKE GARBAGE, SWEET SMELL-PSEUDOMONAS, AMMONIA SMELL PROTEUS)

12. INFECTION (cont) l EDEMA- GENERALIZED (CHF, VENOUS INSUFFICIENCY), LOCALIZED (INFLAMMATION, INFECTION), WARM, INDURATED

13. INFECTION (cont.) l DRAINAGE l color l odor l consistency l amount

15. INFECTION (cont.) l PAIN (DRESSING REMOVAL) l THROBBING COMPLAINT

16. Infections of the Nails

18. MEDICATIONS l NSAIDS (COLCHICINE) l STEROIDS: corticosteroids inhibit collagen synthesis & retard wound healing, decrease tensile strength of collagen l IMMUNOSUPRESSIVE DRUGS: methylprednisolone, cyclosporine A, (prednisone may decrease wound healing)

20. MEDICATIONS ( cont.) l ANTICOAGULANTS (coumadin, heparin) l ANTINEOPLASTICS l ANTIPROSTAGLANDINS

21. IMMUNOSUPRESSION l DECREASE FIBROBLAST FUNCTION l DECREASE COLLAGEN SYNTHESIS l DECREASE PHAGOCYTIC ACTION l DECREASE ABILITY TO FIGHT INFECTION

22. ANTIMICROBIAL TOXICITY l PROVIDONE IODINE l HYDROGEN PEROXIDE l ACETIC ACID l CHLORHEXIDINE l HYPOCHLORITES

23. RADIATION l INJURES FIBROBLASTS & ENDOTHELIAL CELLS l DECREASES COLLAGEN l DESTROYS CELLS IN MITOSIS l CAUSES VASCULAR DAMAGE l DECREASES TOLERANCE TO SEPSIS

24. CHEMOTHERAPY l INCREASES SUSCEPTIBILITY TO INFECTION l ALTERS FIBROBLAST FUNCTION l ALTERS COLLAGEN SYNTHESIS & METABOLISM l INTERFERES WITH MYOFIBROBLAST FUNCTION

25. HYDROTHERAPY l MOISTENS THE WOUND l IRRIGATES & CLEANSES THE WOUND l SOFTENS SLOUGH & ESCHAR l FLUSHES CELLS FROM THE WOUND l FLUSHES CHEMOTACTIC SUBSTANCES FROM THE WOUND

26. HYDROTHERAPY (cont.) l INCREASES VASCULAR CONGESTION l INCREASES VENOUS HYPERTENSION

27. INADEQUATE NUTRITION l DECREASES PROTEIN SYNTHESIS l DECREASES ENERGY (ATP) l CAUSES ANEMIA l REDUCES OXYGEN TO CELLS l DECREASES PROTECTION (PRESSURE)

28. INADEQUATE NUTRITION (cont.) l DEPRESSES IMMUNE SYSTEM l GLUCOSE, PROTEINS, FATTY ACIDS, VITAMINS, MINERALS, H20- ALL ARE ESSENTIAL

29. PRESSURE l INHIBITS BLOOD FLOW l REDUCES NUTRIENTS l INCREASES METABOLITES l INHIBITS ANTI-MICROBIAL ASSAULT l INCREASES NECROSIS l INHIBITS GROWTH

30. DESSICATION l INHIBITS CURRENT OF INJURY l INHIBITS GALVANOTAXIS l INHIBITS CHEMOTAXIS l INHIBITS COLLAGEN FORMATION l INHIBITS RE-EPITHELIALIZATION

31. ESCHAR l INHIBITS CURRENT OF INJURY l INHIBITS GALVANOTAXIS l INHIBITS CHEMOTAXIS l INHIBITS COLLAGEN FORMATION l INHIBITS RE-EPITHELIALIZATION