Chapter 18: Wound management
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Definition
A wound can be defined as a breach of the skin's epidermis, which may be attributable to an underlying, altered physiological state or a primary causation (HSE [50]). The causation of a wound may be intentional or accidental (Singh et al. [94]).
Wounds are a substantial burden for individuals and healthcare systems (Haesler et al. [40]). It has been estimated that 2.2 million wounds were managed, predominantly by nurses, in the NHS in the financial year 2012/13 (Guest et al. [37]).
Wounds can be divided into two categories: acute and chronic. There are no agreed definitions that enable differentiation between acute and chronic wounds (Kyaw et al. [59]). It is generally accepted that an acute wound is caused by a traumatic or surgical intervention (Doughty and Sparks [25]) and is expected to progress through the well‐known phases of healing (Morton and Phillips [74]) in a predictable timeframe. In contrast, a chronic wound becomes ‘stuck’ in the inflammatory phase (Martin and Nunan [66]) and therefore does not heal as expected (Broderick [11]). Most chronic wounds occur on the lower limbs (Eming et al. [29]).
A holistic approach is essential for accurate assessment and planning of care (Eagle [27]). Both external and internal factors can contribute to the formation of a wound (Dhivya et al. [24], Eagle [27], Haesler et al. [40]):
- External factors: mechanical (friction, surgery or trauma), chemical, electrical, temperature extremes, radiation, micro‐organisms, pressure and environment.
- Internal factors: circulatory system failure (venous, arterial or lymphatic), endocrine (diabetes), neuropathy, haematological causes (porphyria cutanea tarda or mycosis fungoides), nutritional status (smoking and alcohol history), malignancy, infection and age.
