Question

Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)

Explain the wound healing process according to the phase of Mr. Smith’s wound?

The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change.

Answer 1

When commonly discussing about wound healing, it mainly includes 4 stages:

1. Hemostasis phase
2. Inflammation phase
3. Proliferative phase
4. Maturation phase

Hemostasis Phase:

Its the initial phase of the wound healing process. In this wound begins to close by clotting.

When an injury occurs blood starts to leak out, the blood vessels begins to constrict to reduce the blood flow.Platelets acts as a binding agent to seal the blood vessel walls from further bleeding and oagulation occurs. Hemostasis stage of wound healing happens quickly

Inflammation Phase:

according to the above mentioned situation Mr.John smith is in 2nd stage of wound healing that is in Inflammation stage. The inflammation is a natural part in the process of wound healing unless this phase isnot prolonged.This stage begins after the injury. In this the wound begins to leak water +salt+protein mixture called transudate which causes localized swelling around the wounded area. This inflammation prevents further bleeding and entry of infection the wounded site and also helps in healing by moving repair cells to the wounded site. certain white blood cells, growth factors, nutrients and enzymes will create redness,swelling heat and pain around the injured area.

Proliferative phase:

In this stage wound is rebuilt using new tissues which is madeup of collagen and extracellulr matrix. here the wound begins to contracts and a fresh network of blood vessels must be constructed to receive sufficient oxygenated blood to the granulated tissue site. Healthy stage of wound healing shows the granulation site to be pink or red. proliferative stage ends with epithelial cells begins to resurface the injury site.

Maturation Phase.

Its the final stage of wound healing also known as remodelling phase. In this collagen will be fully remodelled and the wound closes completely generally the maturation phase begins around the 21st day after the injury and will be last for about an year or more

Wet to dry sterile dressing change:

epithelialization of tissues happens faster when the wounds are kept hydrated and moist. this will helps to remove the dead cells from the injured site.Within 48hours after the injury the wet to dry sterile dressing has to be done.

procedures:

• Check the condition of the patient and explain the procedure
• gather all articles to the dressing area
• make the patient in comfortable position
• hand washing to be done with soap solution and water and wear sterile gloves and mask before dressing
• carefully remove the old dressing. start with the edge part and bunching the old dressing in to the middle of the wound,if the dressing is so hard to remove from the wound apply sterile saline water on the dressing it will loosen them and easy to remove
• thoroughly clean the wound with saline solution and 4*4 gauze piece without disturbing the new skin.
• Pat the wound area with gauze piece to make it dry and inspect for any infection redness or bleeding
• wound has to be cleaned with the gauze piece, then with moist iodoform gauze the wound has to be covered followed by dry dressing
• secure the dressing with paper tape
• replace the articles
• hand washing
• recording and reporting