Advancements in wound healing have evolved from an exclusive focus on the wound itself to a deeper evaluation of external or patient's particulars including the following:
- Previous Diseases
- Physical Condition
- Alcohol, Tobacco, and Drug Use
- Presence of Anemia
- Immunological Capacity
- Diabetes and Vascular Disease
- Psychological Stand.
There are four consecutive stages to wound healing:
- Coagulation: Blood stops flowing through vasoconstriction, platelet formation, and blood clotting.
- Inflammation: Blood cells create swelling while the body fends off microbial presence.
- Granulation: Collagen and cell activity bring about new skin through epithelialization.
- Remodeling: Scar formation and strengthening.
Disturbances to any of these stages would cause delays and serious problems to wound healing including transitioning into a chronic condition. It all starts with the asepsis to ensure infection containment and a normal inflammatory phase. An extended inflammation period is indicative of infection. Complications here would lead to delays, pain, and extra expenses.
The next more complex step is to assess and take immediate actions against patient-related obstacles to wound healing. Eliminating inhibitors such as alcohol (ethanol delays the inflammatory phase and disrupts regeneration) and tobacco (causes oxygen deprivation which weakens wound closure, creates ischemia, necrosis, and delays granulation as well as wound reduction). Addressing any symptoms of anemia or poor nourishment with dosages of glucose, proteins, vitamins, and minerals. Evaluating any parallel treatments involving the use of steroids, anti-inflammatories, and chemotherapy since they are bound to interfere with normal wound healing.
Other factors to weigh in are the patient's age, obesity, diabetes, and psyche. The older the patient the greater the chances of a prolonged healing process and therefore, the increased exposure to complications. Non-healing or chronic wounds are a common occurrence among the elderly population.
Obese patients have skin folds that rub against each other and undue tension on the peri-wound area making them more prone to infections, wound ruptures, and both pressure and venous ulcers. Obesity can also have psychological implications.
The presence of diabetes is a major red flag in treating wounds. Diabetes lowers immune response therefore deterring wound healing. It is conducive to foot ulcers which in turn lead to hypoxia and neuropathy. Diabetes also diminishes vascular capacity restricting normal oxygen flow which is key to cell regeneration, collagen formation, epithelialization, and wound recession.
The patient's psychological stand is important as any imbalances will affect cell regeneration. Patients with psychological issues are prone to weaker bodies from deficient sleep, poor nutrition, and sporadic exercise routines all of which make for an inauspicious wound healing environment.
Wound healing goes far beyond applying a wound dressing. Well-managed, it is a process with multiple variables that when dealt with accordingly, lead to a positive and efficient progression of the four healing stages and the best patient outcome.