Wound Healing Southern Africa - Volume 3, Issue 2, 2010
Volume 3, Issue 2, 2010
Source: Wound Healing Southern Africa 3, pp 1 –3 (2010)More Less
Granulation tissue typically consists of an abundance of blood vessels mixed with fibrous connective tissue. Granulation tissue grows from the base of a wound and is able to fill the wound, facilitating eventual epithelialisation and wound closure. Continued wound healing will only take place once internal inter- and intracellular signalling notify keratinocytes and epithelial cells that the tissue is ready for their cellular migration. Prolonged stimulation of fibroplasia and angiogenesis results in hypergranulation, a potential problem for the wound healing process.
Author Alan WidgerowSource: Wound Healing Southern Africa 3 (2010)More Less
It's been fascinating for me to watch how wound care worldwide has developed over the past few years, from a field in which therapy was directed purely in response to wound reactions (exudate, redness, maceration), to targeting anticipated wound biological changes. We see dressings and agents directed against matrix metalloproteinases, against inflammation, and against biofilm, and there is also the probability of the introduction of new peptides that are aimed at directly intervening in wound healing sequences. All this has been possible as new biologic data become available.
Source: Wound Healing Southern Africa 3, pp 11 –16 (2010)More Less
Complex wounds are often associated with inadequate perfusion with resulting decreased oxygenation. Failure to diagnose ischaemia or hypoxia could lead to complications, including loss of limb and even life. In all cases patient management should focus on restoring the arterial circulation, i.e. perfusion strategies. In selected cases this might not be possible and adjuvant modalities should be utilised to improve oxygen delivery (oxygenation strategies). This article will provide the background information to guide the clinician through the decision-making process.
Source: Wound Healing Southern Africa 3, pp 19 –23 (2010)More Less
Intra-abdominal hypertension, abdominal compartment syndrome (ACS) and poly-compartment syndrome are serious clinical problems. The key is early recognition of at risk patients so that preventative measures may be implemented. The concepts of controlled fluid resuscitation, surveillance and prophylactic operative decompression with temporary abdominal closure (TAC) are central to prevention of the events leading to multiple organ dysfunction. Where ACS develops, therapeutic operative decompression and TAC is the management of choice.
Source: Wound Healing Southern Africa 3, pp 25 –26 (2010)More Less
Correct positioning of the injured hand in the first 48 hours after injury is critical to ensure that optimal mobility of the hand is preserved. With the cooling-off regimen indicated in burns, dressings must be in contact with the burnt skin, with added dressings to keep those in place, limiting hand mobility for that period. The extensor collateral ligaments are the weakest at preserving mobility, and shortening of the collateral ligaments of the metacarpophalangial joints (MCP joints), proximal interphalangial joints (PIP joints) and distal interphalangial joints (DIP joints) occurs very quickly with incorrect positioning of the hand. Collateral ligament shortening is an irreversible condition, leading to major loss of hand function and adding to the development of contractures on either side of the hand, depending on which ligaments are damaged. The ideal position for the MCP joints is at a 90° angle, if the flat hand is taken as the 0° starting point (Figure 1 and 2). For the PIP and DIP joints, 10-15° flexion is needed for optimal protection and preservation of hand functionality.
Source: Wound Healing Southern Africa 3, pp 28 –30 (2010)More Less
Chronic wounds are often recalcitrant and resistant to treatment. The background diseases or injuries associated with chronic wounds, for example venous insufficiency, diabetes or the pathology underlying pressure ulcers, have in the past been used to explain the non-healing and chronic characteristics of these wounds. Thus, managing poor perfusion, nutrition and blood glucose control and avoiding repetitive pressure have been, and remain, priorities in the overall treatment of chronic wounds.