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JCN
2013,Vol 11, No 2
T
his session looked at chronic
wounds and why they
sometimes fail to heal, with
particular emphasis on the role of the
nurse in stimulating the biochemical
process that provides the right
environment for healing.
The main aim of the session was
to explore how familiar the delegate’s
were with the following elements:
The wound-healing process:
How dressings can impact on
wound healing
How to choose the best dressing
for the wound.
The session began with some
questions to gauge the extent of the
delegates’ knowledge. Questions
included:
What is your profession?
What is the most important cell
during the proliferative phase of
healing?
Do you believe that wound
dressings can influence healing?
What factor do you look for when
choosing a wound dressing?
After the initial question-and-
answer session helped to establish the
extent of the delegate’s knowledge,
the session moved on to a discussion
of the mechanics of wound healing.
NORMAL WOUND HEALING
Wound healing is a natural process
with many overlapping stages as
defined by Calvin (1998):
‘A dynamic, natural and efficient
process that involves the overlapping of
Particularly crucial to the
proliferative phase of healing are
the fibroblasts. These are known as
the ‘workhorses’ of wound repair
and produce components of the
extracellular matrix, including
collagen and fibronectin, to help
form new granulation tissue.
Fibroblasts appear in large numbers
three days post injury and reach
peak levels at day seven, with their
main function being to form new
connective tissue.
Specialised fibroblasts
(myofibroblasts) draw the edges of
the wound together (contraction),
which reduces the size of the wound,
lessens the potential for infection,
and speeds healing.
WHY DO WOUNDS NOT HEAL?
When delegates were asked why
wounds sometimes become chronic
they gave a range of responses,
including ‘poor nutrition’, infection’
and ‘comorbidities’, all of which can
be a factor in impeded healing.
Healing is a local process that
takes place within the wound bed,
but it is also influenced by systemic
and environmental factors (
Figure 1
).
Julie Trudgian, lead nurse tissue
viability, Royal Cornwall Hospitals
NHS Trust
Simplifying the
wound-healing matrix
JCN Roadshow
4
2015
‘The session outlined how
construction work can be
a useful metaphor for the
wound-healing process...’
various healing stages, with a continual
sequence of regulatory mechanisms that
bring about the ultimate healing of the
wound.’
The session outlined how
construction work can be a useful
metaphor for the wound-healing
process, with the immediate
aftermath of a wound requiring an
emergency response (haemostasis);
working through demolition
(inflammation); to rebuilding and
interior design (proliferation and
maturation) (Asmussen and Sollner,
1993) (see
Table 1
).
Table 1:
The normal wound-healing process
Phase
Time
Cells
Building function
Haemostasis
Immediate
Platelets
Emergency services
Inflammation
Day 1–4
Neutrophils
Demolition team
Proliferation
Days 4–12
Macrophages
Project manager
Fibroblasts
Scaffolding team
Keratinocytes
Roofers
Maturation
Fibrocytes
Interior designer
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