Introduction to Wound Healing

Factors Contributing to Skin Breakdown

A. External Factors

  1. Pressure – Most common among individuals who are immobilized or debilitated on pressure point areas where tissue is squeezed between a bone and a firm surface such as a chair or mattress; Pressure results in tissue hypoxia and cell death from capillary occlusion
  2. Friction – The result of the skin being moved one way while a surface is stationary, or
    moves in the opposite direction
  3. Shear – The result of skin being pulled in one direction, however supporting structures such as muscle and bone do not move, or move in the opposite direction
  4. Thermal Damage – Frostbite/Burn
  5. Radiation – Tissue becomes fragile and poorly oxygenated; Fibrosis and vascular scarring will eventually develop
  6. Iatrogenic – Health care provider activities
  7. Smoking – Smoking reduces the amount of functional hemoglobin in the blood and therefore decreases tissue oxygenation; Smoking may also increase platelet aggregation and cause coagulability
  8. DrugsCorticosteroids reduce inflammatory response and slow collagen synthesis
    - Anti-inflammatory drugs suppress protein synthesis, wound contraction, epithelialization, and inflammation
    - Prolonged antibiotic use may increase risk of superinfection
    - Chemotherapeutic drugs can depress bone marrow function, lower number of leukocytes, and impair inflammatory response
  9. Malnutrition – Deficiencies in any of the nutrients may impair all phases of healing

B. Internal Factors

  1. Systemic – Coexisting disease; Malignancy
  2. Aging – Reduces skin ability to produce elastin and collagen making it thinner and less elastic
    - Inflammatory response is slowed
    - Reduced liver function alters synthesis of clotting factors
  3. Obesity – Tissue lacks adequate blood supply to resist bacterial infection and deliver nutrients
  4. Infection – Prolongs the inflammatory phase thereby delaying collagen synthesis, preventing epithelialization and may result in further tissue destruction

C. Internal/External Factors

  1. Body Fluids – Skin damage can occur because of urine, feces, perspiration, and fistula damage
  2. Allergic ReactionsContact dermatitis can occur when the skin is exposed to a substance that irritates or triggers the allergic response

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