![]() ![]() ![]() What red flags indicate that critical colonization or infection may be present? Moderate pitting edema with severe venous refluxĢ–3/10 pain with touch or prolonged standingģ+ dorsalis pedis and posterior tibialis pulses The following objective information was obtained:įriable granulation tissue that bled very easily Has no history of smoking occasional alcohol Is compliant with all medications, takes vitamins Spends a lot of time standing and walking ![]() The following subjective information was obtained at the time of the evaluation: ILGF-1 also directly engages fibroblasts, endothelial and epithelial cells. Wounds deprived of 90% of their IGFs demonstrate impairment in cell replication and deposition of collagen and a constitutive decrease in wound macrophage numbers. Insulin-like growth factor (ILGF-1) is a major regulator of wound healing. 11 Specifically TGF-β is mitogenic for fibroblasts and stimulates the production of fibronectin and collagen. The effects of TGF-β on ECM formation are more profound than any other growth factor, and in the absence of TGF-β, matrix deposition and angiogenesis are impaired. 9, 10 The effect of steroid-mediated, delayed healing has been demonstrated to occur largely through the down-regulation of TGF-β and ILGF-1 and is apparent in all phases of wound healing. When steroids have been part of the patient’s medication regime prior to wounding, the elevated corticosteroid levels delay the appearance of inflammatory cells and fibroblasts decrease the deposition of ground substances and collagen and inhibit angiogenesis, wound contraction, and epithelial migration ( FIGURE 11-6A, B). 3 Bactericidal agents (eg, toxic oxygen-derived products, nitric oxide, AMPs, and enzymes) are released by the phagocytic cells and are intended to render the invader harmless however, these agents have consequences-they damage the surrounding host tissue and may potentiate the chronic proinflammatory state observed in chronic wounds (see FIGURES 11-2 and 11-3).Īnti-inflammatory steroids, including glucocorticosteroids, are known to significantly affect many aspects of wound healing. Pathogens have developed a variety of strategies to avoid immediate destruction by the host, including covering themselves in a thick polysaccharide capsule termed biofilm, 1, 2 or in the case of mycobacterium (eg, Mycobacterium leprae, Mycobacterium tuberculosis), growing inside the macrophage phagosomes while inhibiting the phagosomal acidification and subsequent fusion with lysosomes. One distinguishing feature of pathogenic (vs nonpathogenic) microorganisms is their ability to evade the host innate and adaptive immune defenses. Pathogens, defined as any microorganism that can cause disease in its host, can either damage or infect any wound tissue, or they can adhere to and colonize the wound surface. Headache, dizziness, altered mental status, malaise Pale or anemic granulation or failure to progressįailure to progress (patient may show signs of congestive heart failure or COPD) Signs of infection, inflammation, necrosis, trauma, or stressįailure to initiate immune response against bacteria The factors are categorized into infection, medications, nutritional deficits, comorbidities, and extrinsic/psychosocial behaviors. This chapter focuses on those factors that are known to impede wound healing, some more obvious than others, and provides suggestions on how to identify and minimize the effect on the healing process. Sometimes the wound will respond initially and make measureable progress, then stall again for no apparent reason. ![]() When progress is not observed, the second question-Why is the wound not healing?-becomes even more imperative to answer. Chapter 3, Examination and Evaluation of the Patient with a Wound, presented the two questions that need to be answered in order to successfully treat a patient with a wound: (1) Why does the patient have a wound? and (2) Why is the wound not healing? Once a wound diagnosis has been determined and standard care has been initiated, the wound should progress through the stages of wound healing discussed in Chapter 2, Healing Response in Acute and Chronic Wounds. ![]()
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