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Integumentary system: Wounds

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Content Reviewers:

Lisa Miklush, PhD, RNC, CNS

A wound is an injury to the skin and its underlying tissue. An intentional wound is made by a healthcare professional for therapeutic purposes and interventions, like surgery.

An unintentional wound is a result of an accidental injury like skin tears and trauma from a car crash or a fall. It is possible to prevent unintentional wounds in healthcare settings by using proper techniques to reposition and transfer clients.

If there is a break in the skin, the wound is open. If the skin is intact, the wound is closed. A bruise is a good example of a closed wound. Immediately after an injury, blood vessels constrict and blood clots are formed to stop the bleeding.

Once the bleeding is stopped, the first stage of wound healing called the inflammatory stage begins. In this stage, the body is starting to heal itself and clear out any microbes that may have entered the wound.

The blood flow increases, and there are signs of inflammation, like redness, warmth, swelling, and pain. The second stage is called the proliferative stage.

In this stage, cells divide to increase their numbers and repair the damage. A structural protein called collagen is laid to make the tissue stronger.

The last stage is called the maturation stage. This is when the collagen becomes more organized and stronger, the wound matures, and the scar is formed.

There are a few factors that contribute to wound healing. First, there must be a good blood flow to the area to supply the cells in the area with oxygen and nutrients.

Next, there’s proper hydration and nutrition. Protein is essential for building collagen, so adequate protein intake is required for wounds to heal properly.

Lastly, protection from infection is needed because infected wounds take longer to heal. Some other factors can prolong wound healing, like advanced age, low blood flow, diabetes, and malnourishment.

Sometimes, there can be some complications during wound healing. A wound can be contaminated with microbes, which is called an infection. Signs of infection include redness, warmth, swelling, and foul odor.

Dehiscence is when a closed wound opens up again. Evisceration is when abdominal organs protrude through an open wound.

Hemorrhage is excessive bleeding, and if too much blood is lost, then the organs are not getting enough oxygen. This causes another wound healing complication called shock.

There are three ways a wound can heal. First intention healing happens when a wound is closed with sutures or staples. Because the edges of the wound are close to each other, the wound can heal faster, and scarring is minimal.