Wound Care Today

WOUND CARE TODAY

2017,Vol 4, No 1

n normal wound healing,

granulation tissue forms at

the base and edges of deeper

wounds and/or from islands of

epithelial tissue that originate

from intact skin appendages

(hair follicles and sweat glands)

in superficial wounds (Shultz et

al, 2003). Concurrent contraction

minimises the size and depth of the

defect, reducing wound volume and

area. These processes result in the

addition of tissue to the edges and

base of the wound until it closes. In

many chronic wounds (those with

underlying pathophysiology, e.g.

pressure ulcers, diabetic foot ulcers

and leg ulcers), the process becomes

disorganised, with new tissue that

is deposited becoming chronically

remodelled due to high levels of

inflammatory mediators (World

Union of Wound Healing Societies

[WUWHS], 2016).

dging quickly towards wound

closure: optimising the ‘E’ of TIME

Chronic wounds have been

found to have a high volume of

inhibitory factors, which results

in tissue that is fragile, prone to

repeated injury, does not support

epithelial migration and, in turn,

leads to failed closure (Shultz et

al, 2003). This can cause secondary

complications, such as wound

infection and/or biofilm formation

(WUWHS, 2016). An open wound

is a portal of entry for bacteria. An

individual’s ability to fight wound

infection is closely linked to the

body’s immune response to

the attack launched by the

invading pathogens.

ASSESSING THE EDGE

OF THE WOUND

Examination of the edge of a wound

and periwound tissue, although

not a diagnostic test, can help to

identify the wound’s origin and

cause (

Table 1

). For example, venous

leg ulcers are shallow and generally

irregular in shape, whereas arterial

ulcers are often well defined

and occur over pressure points

(Ashby et al, 2014). Rolled and/

or raised wound margins or tissue

in the wound bed should alert

the clinician to the possibility of

malignancy. If this is suspected, the

clinician should refer the patient

to a specialist service in order that

a biopsy of the affected tissue can

be taken and analysed. Once an

accurate diagnosis is achieved, this

may dictate treatment options.

Assessment of the edge of

the wound also gives clues to

other wound complications. For

example, redness and swelling are

indications of wound infection

when present with other symptoms

such as an unexplained increase in

wound exudate, pain and odour.

This should prompt the clinician

to apply a topical antimicrobial

dressing to rebalance the microbial

load. However, if this is linked with

systemic symptoms, e.g. feeling

unwell, fever, or malaise, treatment

with systemic antibiotics is

appropriate (WUWHS, 2008). Some

authors advocate that in addition

to assessing the edge of the wound

and the surrounding skin, patients

with wounds should also be

assessed for other skin conditions,

Jeanette Milne, lead nurse tissue viability,

Northumbria Healthcare NHS Foundation Trust

IN BRIEF

Recognition, understanding and addressing factors that contribute

to wound chronicity is integral to successful wound management.

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KEY WORDS:

Wound healing

Wound assessment

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Jeanette Milne

‘Examination of the edge of a

wound and periwound tissue,

although not a diagnostic

test, can help to identify the

wound’s origin and cause.’

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