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CHAPTER 32 Skin Integrity & Wound Healing
■ Nonabsorbent sutures are placed in superficial tissues and require removal, usually by the nurse. For com- plete steps, See Chapter 32, Procedure 32-12A, Removing Sutures and Staples, in Volume 2. Surgical Staples Made of lightweight titanium, sur- gical staples provide a fast, easy way to close an incision (Fig. 32-6). They are also associated with a lower risk of infection and tissue reaction compared with sutures. The downside of staples is that some wound edges are more difficult to align. The most common sites for wound stapling are the arms, legs, abdomen, back, scalp, and bowel. Key Point: Wounds on the hands, feet, neck, or face should not be stapled. Surgical Glue This is safe for use in clean, low- tension wounds. It is an ideal wound closure method for skin tears. Collaborative Wound Treatments Collaborative treatments are necessary for wounds that will not heal despite aggressive care. Such treatments include the following: ■ Surgical options, such as extensive débridement, skin grafts, secondary closure of the wound, and flap techniques (partially detached tissue placed over a wound), are used for complicated wounds. ■ Hyperbaric oxygen therapy (HBOT) is the adminis- tration of 100% oxygen under pressure to a wound site. HBOT increases the oxygen concentration in the tissue, stimulates the growth of new blood vessels,
and enhances white blood cell (WBC) action. HBOT also promotes the development of fibroblasts for wound healing. ■ Platelet-derived growth factor augments the inflam- matory phase of wound healing and accelerates colla- gen formation in the wound. Types of Wound Drainage Drainage that oozes from a wound or cavity is referred to as exudate. Exudate is formed from inflammation and may take several forms: ■ Serous exudate is watery in consistency and contains very little cellular matter. Serous exudate consists of serum, the straw-colored fluid that separates out of blood when a clot is formed. Clean wounds typically drain serous exudate. ■ Sanguineous exudate is bloody drainage. It indicates damage to capillaries. You will often see sanguineous exudate with deep wounds or wounds in highly vas- cular areas. Fresh bleeding produces bright-red drain- age, whereas older, dried blood is a darker, red-brown color. ■ Serosanguineous drainage is a combination of bloody and serous drainage. It occurs most commonly in new wounds. ■ Purulent exudate is thick, often malodorous, drain- age that is seen in infected wounds. It contains pus, a protein-rich fluid filled with WBCs, fibrin, bacteria, and cellular debris. It is commonly caused by infec- tion with pyogenic (pus-forming) bacteria, such as streptococci or staphylococci. Normally, pus is yellow in color, although it may take on a blue-green shade if the bacterium Pseudomonas aeruginosa is present. ■ Purosanguineous exudate is red-tinged pus. It indicates that small vessels in the wound area have ruptured. Complications of Wound Healing Recall that wounds heal by moving through the phases of inflammation, proliferation, and maturation. At times, this process is interrupted by complications, such as hemorrhage, infection, dehiscence, evisceration, and fistulas. Hemorrhage Hemorrhage implies a profuse or rapid loss of blood. Whenever a capillary network is interrupted or a blood vessel is severed, bleeding occurs. Hemostasis (cessa- tion of bleeding) usually occurs within minutes of the injury. Hemostasis can be delayed when large vessels are injured, a clotting disorder exists, or the patient is on anticoagulant therapy. If bleeding begins again after initial hemostasis, something is probably wrong. Possi- ble causes include a slipped suture, erosion of a blood vessel, a dislodged clot, or infection. Key Point: The risk
FIGURE 32-6 Surgical staples in the scalp.
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