tissue; control of odour; control of bacteriaNonhealing—Removal of loose nonviable tissue; control ofodour; filling of wound defects; control ofbacteria; promotion of comfortMaintenance of wound; no debridement ofintact eschar; control of odour; control ofbacteria; promotion of comfortDressings and TherapyHealingTransparent film, clear acrylic dressing,hydrogel (if additional moisture is required),calcium alginate, or hydrophilic dressing (toabsorb exudate and fill wound defects), foamHydrocolloid, hydrogel, calcium alginate, orhydrophilic dressing (to absorb exudate and fillwound defects), sodium chloride dressing,foam, charcoal dressing (to control odour),antimicrobial (silver, PHMB, or cadexomeriodine), enzymatic debriding agentHydrocolloid, hydrogel, sodium chloridedressing, foam, charcoal dressing (tocontrol odour), antimicrobial (silver, PHMB,or cadexomer iodine), enzymatic debridingagentExposed bone and tendon must remain moistExposed bone and tendon must remain moistNonhealing—Povidone-iodine, cover with dry dressingPovidone-iodine, cover with dry dressingPHMB,polyhexamethylene biguinide.Figure 14-5Wounds classified by colour assessment.A,Black wound.B,Yellow wound.C,Red wound.D,Mixed-colour wound.Source: Courtesy Molnlyche Health Care, Eddystone, PA. In Potter, P. A.,& Perry, A. G. (2009).Fundamentals of nursing(7th ed., p. 1285, Figure 48-7). St. Louis: Mosby.ABCD
CHAPTER 14Inflammation and Wound Healing259Excess Granulation Tissue.Excess granulation tissueorhypergranulation tissue (“proud flesh”) may protrude above thesurface of the healing wound. If the granulation tissue is cauter-ized or cut off, healing continues in a normal manner.Fistula Formation.Afistulais an abnormal passage betweenorgans or a hollow organ and the skin.Complications of HealingComplications of wound healing may include adhesions, con-tractures, dehiscence and evisceration, excess granulation tissue,fistula formation, infection, hemorrhage, and formation of hyper-trophic scars and keloids.Adhesions.Adhesionsare bands of scar tissue between oraround organs. Adhesions may occur in the abdominal cavity orbetween the lungs and pleura. Adhesions in the abdomen maycause an intestinal obstruction. Adhesions between the lungs andthe pleura necessitate decortication, or stripping of pleura, toenable normal ventilation.Contractures.Wound contraction is necessary for healing.This process may become abnormal when contraction is excessiveand results in deformity orcontracture.A shortening of muscle orscar tissue results from excessive fibrous formation, especially ifthe wound is near a joint. Contractures frequently occur in burninjuries, in which extensive skin and subcutaneous tissue are lost(seeChapter 27).Dehiscence.Dehiscenceis the separation and disruption ofpreviously joined wound edges. It usually occurs when a primaryhealing site bursts open (Figure 14-6). There are three possiblecontributing causes of dehiscence. First, an infection may causean inflammatory process. Second, the granulation tissue may not
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