Overproduction of immature collagen during the proliferation and maturation phases. These are red raised fibrous lesions that stay within the confines of the wound.
Results from excessive immature collagen synthesis and more common in individuals with highly pigmented skin. These extend beyond the confines of the original wound.
Insufficient scar formation and separation of wound margins.
Many factors influence wound healing
Blood glucose levels
Wound healing Affected by wound characteristics
1 Mechanism of onset, trauma vs surgical wound
2 Time since onset – the longer they exist, the harder to heal
3 Wound location – over bony prominences, in less vascular areas
4 Wound dimensions – amount of tissue that needs to be repaired.
Wound healing Wound characteristics
1 Wound and environmental temperatures
2 Wound hydration – desiccation (dry) vs maceration
3 Presence of foreign bodies or necrotic tissue
Local factors for wound healing
1 Circulation – decreased circulation especially microcirculation such as with PVD and DM. Sympathetic response to cold, fear, or pain.
2 Sensory deficits – failure to perceive pressure, or trauma
3 Mechanical stress –
Wound healing Systemic factors
2 Inadequate nutrition (carbs/ protein for collagen formation and prevent edema)
3 Medications – steroids, chemotherapy, NSAIDS
4 Smoking – nicotine, vasoconstrictor – decreased perfusion to area, decreases tissue oxygenation, decreases cellular response to inflammation and wound repair, hemoglobin binds strongly to CO, and competes on sites with O2
5 Alcohol – malnutrition, falls
1 Location- Provides insight as to type of wound and problems that may be encountered.
2 Age of wound
3 Size – direct measurement, longest and widest areas, 12 o’clock method, photo, volumetrics (water droplets in wound), tracings, TBS area
4 Depth- sterile Q tip
Also look at color of periwound
---White – maceration
---Red – inflammation
---Purple – bruising or trauma
1 Wet vs dry
2 How much scant/moderate/large amount
3 Color and consistency
---Serous – light yellow
---Sanguinuous - red
---Serosanguinous - pink
---Purulent – brown, green, dark yellow (infected)