A healing pressure ulcer or any wound is an extremely complex and dynamic tissue for which scientific researchers and clinicians are continually acquiring new knowledge and different effective treatments.
Healing occurs in recognizable phases, which are usually progressive, and often overlapping. This is a collaborative process involving a wide variety of cells and components which need to continually interact in order for the skin to heal. This is the realm of cellular and molecular research and is not really appropriate for the more generalist nature of this book.
In more general terms there are certain factors that influence healing and it’s worth pinpointing these so that the various treatment options make sense to you.
FACTORS THAT INFLUENCE HEALING
Maintaining a moist wound environment has been proven to assist the healing process, providing the following advantages: a) prevents tissue dehydration, helping to stop the formation of a scab or dry crust (eschar) on the top of the wound. This eschar can hinder the migration of newly-formed skin cells (the technical name is epithelial cells) to the surface of the skin. These new cells can only move through the thin watery liquid within the wound that liquid is called the serous exudate; b) increases the growth of new blood vessels; c) assists in the interaction of growth factors target cells; d) reduces the chances of infection, and e) is associated with less pain.
This is the technical term for removing any blood clots scabs or dry crust on the wound. This can be achieved by the following four methods: a) surgical removing tissue using a scalpel or scissors; b) mechanical referring to a range of techniques like wet-to-dry dressings, wound irrigation or whirlpool or foot soaks; c) enymatic using collagens, and d) autolytic using certain dressings like hydrogels which enhance the body’s own enzymes. Debridement is needed to ensure a moist wound environment in order for the wound to heal.
Secretions of fluid are produced by the inflammatory response of the wound/pressure ulcer. This exudate actively promotes healing through its nutrients and provides an ideal fluid for the new skin cells to move or migrate to the new skin “building sites.”
Wounds should be kept covered to maintain optimum physiological temperatures. Cleansing agents should be used at body temperature.
As you would expect, infection slows down the healing process and extends the inflammatory response. Infections must be eliminated as soon as possible; the physician will use creams, ointments or antibiotics to clear up this problem.
Advancing age, combined with a slower metabolic process and associated reduced collagen and poor circulation can impede the healing process.
A range of disease processes can adversely affect the ability of the wound to heal; these include anemia, arteriosclerosis, cancer, cardiovascular disorders, diabetes, immune disorders, inflammatory diseases, liver problems, rheumatoid arthritis and uremia.
Psychological facts like stress and anxiety can also affect the immune system and can disturb sleep which is important for the healing of wounds.
Malnutrition, smoking, certain drug therapies, radiotherapy and fluid balance can also affect the healing process.
The main point in the healing process is to remove all adverse influences. Nature has set a healing time for each type of wound and that healing will only occur if there is a favorable environment.