Basics of Wound Healing - LPNI

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Basics of Wound Healing

Scars are evidence of God's healing grace in our lives. We are so fearfully and wonderfully made and blessed by God's grace that even when we are wounded, God provides avenues for our healing. Physical scars come into our lives through surgeries, accidents or self-injury. Emotional scars can come from mental illness, relationship problems or abuses. Not all scars are bad. In some cultures scars are seen as a badge of courage earned from the battles of daily life. Some cultures have intentional markings as a sign of acceptance. In the USA military members are honored with a Purple Heart for wounds incurred defending our country.

We often take for granted that our physical wounds will heal; however, there are actions we may take to encourage proper healing and to minimize the effects of scarring. For a wound to heal it needs to have a good blood supply, be free of dead tissue, no infection and be moist. Evidence now supports the covering of wounds to promote faster, more thorough healing. Dressings serve to manage drainage, help control bacterial overgrowth and keep the wound moist. This supports the development of granulation tissue and the growth of a new skin covering so epithelialization can occur.

All wounds are colonized with bacteria; however not all wounds are infected. Antibiotics should be reserved for wounds that show clinical evidence of infection. There is no published evidence to support antibiotic therapy as useful to promote healing in noninfected wounds (uptodate.com 2018.) Local signs that would support antibiotic usage would include malodor, purulent drainage or hot, reddened tissue. Fever, chills, nausea or hyperglycemia may indicate infection that is spreading throughout the body and warrants provider consultation. Individuals with diabetes may not always have classic signs of infection and must take extra care to monitor blood sugar and wound progress. Early consultation with a health care provider may be indicated. Ideally, antibiotic therapy is targeted and determined by a culture and sensitivity of the wound to minimize the development of bacterial resistance.

Historically, wounds were thought to heal best when left open to the air. However, new studies are showing that wounds can heal up to 40 percent faster when occluded. The theory is that the moisture in the wound bed provides easier migration of the epidermal cells. Exposure of the acute wound to tissue fluids may also improve healing and minimize scar formation by the presence of platelet-derived growth factors that may provide a matrix for cell growth. It is also thought that covering the wound allows for accelerated healing, moving the wound more quickly through the inflammatory phase where scar tissue is formed.

There is no one ideal dressing to cover all wounds. Dressings should be chosen to “fit” the wound. The ideal dressing would:

protect the wound from further injury and protect surrounding tissue

manage excessive wound fluid and provide hemostasis

prevent bacterial invasion

minimize pain between and during dressing changes

be inexpensive, readily available and have a long shelf life.

As parish nurses we are often witness to the miracles of God's grace and mercy in the lives of our congregational members. We are privileged to see the spiritual and physical healing and are present as people learn to rebuild their lives after illness or injury. May we long be able to promote good healing to those placed in our care. “the punishment that brought us peace was upon him, and by his wounds we are healed. Isaiah 53:5b (NIV)

Carol D. Zimmermann, MS, RN

Parish Nurse, Lutheran Church of the Living Christ

Madison, WI 53715 USA czpeople@gmail.com

Information for this article was obtained from www.uptodate.com, and online subscription reference for health care providers, and may be reproduced without permission.