Checklist for Factors Affecting Wound Healing

Abstract

A complete understanding of the anatomy and physiology of the skin, the phases of the healing process, the types of wounds, and the options for wound repair is essential for recognizing factors that may complicate or delay wound healing. Each consideration plays a key role in assessing and managing wounds of all types. In this column, we examine the various factors that may delay or impede healing-local and systemic. Wound healing can be delayed by factors local to the wound itself, including desiccation, infection or abnormal bacterial presence, maceration, necrosis, pressure, trauma, and edema. Desiccation. A moist environment allows wounds to heal faster and less painfully than a dry environment, in which cells typically dehydrate and die. This causes a scab or crust to form over the wound site, which impedes healing. If the wound is kept hydrated with a moisture-retentive dressing, epidermal cell migration is enhanced, encouraging epithelialization. Infection or abnormal bacterial presence. If an infection is present, as evidenced by purulent drainage or exudate, induration, erythema, or fever, a wound culture should be obtained to identify the offending bacteria and guide antibiotic therapy.When a pressure ulcer or full-thickness wound extending to the bone fails to heal, the patient should be assessed for signs of osteomyelitis. Any abnormal culture or other test results should be reported to the physician so that appropriate antibiotics are prescribed to treat the infe…