What factors have a negative impact on wound healing?

What is a chronic wound?

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time or wounds that do not heal within three months are often considered chronic.

What factors can impose a negative impact on wound healing?

DIABETES MELLITUS

  • Abnormal and prolonged inflammation which delay wound healing

  • Reduced collagen formation

  • Decreased collagen strength causing wound dehiscence

  • Impaired epithelial cell migration across the wound bed with resultant delayed wound healing

  • High glucose levels compromise the function of neutrophils (a type of white blood cell that promotes wound healing)

SMOKING/TOBACCO USE

  • Nicotine, carbon monoxide and hydrogen cyanide reduce the amount of oxygen in the blood, impair the immune system, reduce cells called fibroblasts which are essential in the formation of connective tissue, increase platelet adhesion( platelets sticking together) which can lead to clot formation

  • Smoking causes significantly higher rates of wound infection

POOR DIET

  • Adequate nutrition intake is essential for wound healing

  • The diet must contain nutrients including micronutrients namely vitamins and minerals, key amino acids and adequate protein which are needed for collagen formation, optimal function of the immune system

OBESITY

  • Adipose tissue (fat cells) have fewer blood vessels

  • Large volumes of fat cells put additional stress on surgical incisions, and this increases the risk of surgical site dehiscence (partial or complete opening of surgical wound).

LEAVING A WOUND OPEN TO AIR

  • Dressing change should be performed as quickly as possible

  • Once the wound dressing is removed the wound bed temperature falls. As a result there is less oxygen for neutrophils to fight any potential infection.

  • The wound bed can take up to 4 hours to return to normal healing temperature

  • Lack of moisture to the wound bed delays healing and predisposes the wound to infection

MAINTAINING A CLEAN WOUND BED

  • The wound should be cleansed regularly with to eliminate ded tissue and remove bacteria

  • The appropriate topical product should be applied and the wound covered with an appropriate dressing to keep the wound clean and maintain a moist environment

Dr. Clare Scott received her Doctor of Nursing Practice (DNP) from Quinnipiac University, Hamden, CT in 2022 and Master of Science in Nursing (MSN) from the University of Medicine & Dentistry, Newark, NJ in 2007. Her doctoral work was focused on prevention pressure injury among residents of long -term care facilities. Dr. Scott is a Certified Wound Specialist (CWS), American Board of Wound Management, and a Board Certified Adult Nurse Practitioner. Dr. Scott is a passionate advocate, committed to providing her patients with the highest quality of care and to helping them achieve their goals of healing and recovery.

Clare Scott, DNP, APN-C, CWS

Lauren CaplanComment