Factors Influencing Laceration Healing (Nursing)

00:00 Most people want to know what is this going to look like after it heals.

00:05 Well, there's some risk factors that can actually impact the healing.

00:08 So as someone who's involved in patient care, it's important that you understand what those are.

00:13 So I've divided them into three categories.

00:16 There's risk factors that go along with the patient, risk factors that are associated with the wound, and risk factors that are associated with the environment where the patient received the wound.

00:26 So let's take a look at ten patient related factors that will impact wound healing.

00:31 First of all, it's advanced age. Older clients will have delayed wound healing.

00:37 If the client has diabetes they have impaired microcirculation and they also have impaired immunity. This will cause the wounds to take longer to heal.

00:46 Remember, this is particularly difficult if it happens on an extremity, like a foot or a toe. Now, if the client is immunosuppressed, that might be because of medications or because of autoimmune conditions that they have.

00:58 They will also have delayed healing.

01:01 Malnutrition plays a role, particularly if the patient is low in protein, vitamin C, or zinc. Now, obesity can also play a factor because that will decrease tissue perfusion.

01:12 Decreased tissue perfusion means the body's not going to be able to deliver enough oxygen and remove things that need to be done, because it doesn't have as good a blood supply.

01:21 So obesity is another factor that you may not have considered.

01:25 Smoking.

01:26 Well, we know smoking isn't great for many things, but smoking causes vasoconstriction.

01:31 With that, vasoconstriction also comes an impact on perfusion and the ability to have oxygen delivered to those tissues.

01:39 So it also ends up in tissue hypoxia.

01:42 Now peripheral vascular disease is another thing that compromises blood flow which is therefore going to delay healing. Chronic steroid use has an anti-inflammatory effect and that will impair healing. Now there's other medications.

01:56 But I listed steroids specifically by themselves because they have an incredibly strong anti-inflammatory effect that will impact healing.

02:05 Now the last two are previous scarring or keloid formation.

02:09 Remember that skin has been changed.

02:11 If they already have a scar there, or if there's someone who can develop keloids, which are these really thick, fibrous responses to laceration? Last one is alcohol use disorder.

02:22 This makes it difficult for the wound to heal.

02:25 It also puts them at higher risk for further injury.

02:28 Let's take a look at the wound related factors.

02:30 Now I want you to remember five key things.

02:33 Location, contamination, crushing, jagged and age.

02:39 So location means where was that cut? Is it in an area that's moved a lot or has high tension on the skin? Or is it on a forearm where it's not likely to have that tension that's going to make a difference in how easily that wound heals? What if it's been contaminated? What caused that wound? Or is there even a foreign body still in the wound that's going to make an impact? Was the tissue crushed or devitalized? Those can impair healing and also cause a longer healing time, which is why it's a wound related factor.

03:12 The last two. What about the edges of the wound? Is it jagged? How old is the wound before it's being treated? We know that the quicker the patient is seen and the wound can be treated, the better the outcome will be.

03:26 Now we talk about what do you do if the wound is open? Well. Primary closure is one of the things that we consider.

03:33 When should that wound be closed.

03:35 So it's generally recommended for most simple lacerations.

03:38 And that means they're small.

03:40 They're less than five centimeters in length.

03:42 They don't have that gross contamination.

03:44 And they're not located on the lower extremities.

03:48 These wounds can be closed up to 12 to 18 hours after injury.

03:51 We're not really that concerned about infection.

03:55 Now there's some different spots like facial and scalp wounds.

03:58 Those can be closed up to 24 hours after injury.

04:02 Now, why would that be? Well, if you have ever had a laceration on your face or on your scalp, you know, they bleed like crazy.

04:10 That's because they have a really rich blood supply in your face and in your scalp.

04:15 So because that has that blood supply, we can wait up to 24 hours before it's closed.

04:20 Now, if it's a larger wound, that means it's longer than five centimeters or if it's been contaminated or the laceration is in an individual who has risk factors for poor outcomes that we talked about. Closures beyond 12 hours after injury should generally be avoided.

04:36 But remember, each case is taken as a separate and unique experience with a complete assessment to make the best decision. Some other things.

04:46 Let's go back to your wound.

04:47 How deep is it? Does it involve just the skin or is it getting into the structures beneath the skin? How big is it? Remember, less than five.

04:55 We consider that pretty simple.

04:57 Greater than five centimeters.

04:59 That's considered a larger wound.

05:00 And larger wounds have higher complication rates.

05:04 How did you get that injury? Is it clean versus a crush or an avulsion? What went into that? Also, is it a high risk area? Now, the areas that we consider high risk hands, why we use them all the time, they get exposed to things, feet.

05:21 They may not have great circulation, genitalia, your face or even over joints.

05:27 Remember those are because of mobility.

05:28 So I would bet there's some things on that list you likely didn't picture.

05:33 But keep in mind, location really does matter and these are the high risk areas.

05:39 So if a client has a wound in any of these places that we've just talked about, there's going to be a higher risk for complications.

05:46 Okay. You did it. Now I don't know where you imagined that wound, but that's some of the ways that you can use when you're studying to help you remember the content.

05:55 Now picture a patient coming in for care for you.

05:58 Um, do you notice what will you document? These are all the same things that you will document.

06:04 And we'll get into that a little bit later.

06:06 But I just want you to keep in mind the work you're doing here.

06:09 Talking about the wound related factors also will help guide you in what needs to be documented.

06:15 Now let's talk about the environment.

06:18 Did this come from a place that has a high bacterial load, like a farm or a barnyard? That would be an increased risk for complications.

06:26 Did the patient get the wound in an aquatic environment? Was it wet? And that was you're exposed to maybe a lake or the ocean or other industrial contaminants involved. Was this a work related injury? Were they involved with soil? Has that wound been exposed to soil? I've had some clients come in with motorcycle accidents that have sheared skin off, and they had rock and gravel and soil embedded in their tissue.

06:51 And finally, the fifth one is human or animal bites.

06:55 These are all things that can put someone at an increased risk for complications.