Wound Therapy and Prescribing

Normal repair moves through four overlapping phases: hemostasis, inflammation, proliferation, and remodeling. Platelets and clotting initially control bleeding and provide signals for repair. Inflammation then clears bacteria and damaged tissue. During proliferation, fibroblasts produce matrix, new vessels support the wound bed, granulation tissue fills the defect, and epithelium migrates across the surface. Remodeling gradually reorganizes collagen and increases tensile strength. A chronic wound is not simply a wound that needs a more sophisticated dressing. Persistent pressure, venous hypertension, arterial insufficiency, neuropathy, infection, oedema, malnutrition, impaired glycemic control, or inflammatory disease can keep the wound in a destructive inflammatory state. The prescription should therefore begin with the mechanism preventing closure. Assess the person as well as the wound. Establish onset, recurrence, precipitating trauma, previous treatment, pain pattern, mobility, continence, nutrition, smoking, diabetes, renal disease, vascular disease, immunosuppression, and medications that increase bleeding or impair repair. Measure length, width, and depth consistently; record undermining or tunnelling, tissue type, exudate, odour after cleansing, wound edges, and periwound skin. Compare measurements and photographs over time rather than judging response from one visual impression. Pain...