Getting the stalled wound back on the road to healing.

OSTOMY WOUND MANAGEMENT JANUARY 2009 www.o-wm.com Wound healing is an organized, four-phased system involving homeostasis, inflammation, proliferation, and maturation. If injured tissue follows these phases, the wound will close. However, this process is far from simple. A variety of physiological and environmental foes related to the individual’s past and present health status can divert the healing cascade, alter the wound bed environment, and stall healing. The first sign the wound bed environment is not conducive to healing is an extended inflammatory stage without progress to the proliferative phase. Visually, healing compromise is evident in a lack of pink vascular tissue and no significant decrease in wound size, followed by a pale white or yellow wound bed, a brown/black wound bed, and increased exudate, odor, periwound erythema, or epibole. Any of these signs calls for re-evaluation of the overall status of the patient and his/her wound. Once patient assessment is complete and potential nutritional, vascular, and pharmaceutical impediments are acknowledged and addressed, healing can be restarted. Conservative sharp surgical debridement can be of benefit by quickly and methodically removing the bacterial burden and nonviable tissue that prolongs inflammation and stalls healing. With bacteria and nonviable tissue removed, appropriate moisture balance should be addressed. Some advanced wound dressings rehydrate and then maintain a moist wound environment. Thus, to restart stalled wound healing, it is important to address factors that affect the wound environment — ie, patient and wound history, bacteria, and nonviable skin as well as moisture (often a factor of dressing characteristics). Sustaining the appropriate environment will support progression of the wound to closure. ■ PEARLS FOR PRACTICE