Healing Skin Breakdown

Healing Skin Breakdown

Healing Skin Breakdown Quickly Before It Gets Worse Is Essential 

Healing skin breakdown quickly and successfully is essential to prevent serious consequences to your family member’s health. Skin breakdown often leads to full-body infection (sepsis), which can lead to death. Therefore, as we have previously reviewed, (1) we want to keep it from happening (Preventing Skin Breakdown), (2) know it when we see it (Recognizing Skin Breakdown), and now (3) learn how to heal it if it happens.

Healing Skin Breakdown Once Discovered

The first step in healing skin breakdown is to remove the cause.

• Do you need to change their position more often?
• Is moisture from leaking catheters, incontinence, or excess sweating irritating the skin?
• Is friction from rubbing against the sheets with movement the cause?

Cleaning the Wound

Next, you want to clean the wound thoroughly to know your edges’ exact location, the type of drainage present, and if there is an infection or new tissue growth.

• The doctor may order specific cleaning solutions and ointments or may say clean it and nothing else. If he leaves the cleaning up to you, I recommend using newly opened gauze pads soaked in almost sterile saline (a bottle of saline as close as possible to sterile.
• Start in the center making small circles outward until the entire area is wiped clean. Touch gently.
• If you discover a wound, measure the width, length, and depth of the wound in centimeters. Depth can be measured using a clean Q-tip. Take the Q-tip and guide it carefully into the hole. Mark the distance on the Q-tip and measure against a ruler. Also, take a picture for comparison.
• Cover with a clean dressing.

Stages of Healing Skin Breakdown

Stage I Stop the Bleeding (Hemostasis)

When you get a cut, scratch, or open wound, it usually starts to bleed. The first stage of wound healing by the body is to stop the bleeding. The blood uses clotting factors within seconds to minutes to stop the bleeding. Once the clot forms, it becomes a scab and protective covering.

Stage II Scabbing Over (Clotting)

• Blood vessels narrow to stop blood flow to the injured area to reduce blood loss.
• Platelets (the blood cells that help clot blood) clump together to patch the wound.
• Clotting or coagulation includes a protein called fibrin. The fibrin is a blood glue added to the plug creating a net over the entire thing. The net is what becomes a scab.
• This process creates inflammation, which involves cleaning and healing. The inflammation looks red, swollen, and a little warm. Is that a bad thing? No. Inflammation means fresh oxygen, nutrients, and white blood cells are cleaning up the area. The white blood cells (WBC) work hard to remove the damage, creating heat. They fight infection with chemicals.

Stage III Rebuilding (Growth and Proliferative)

Once the WBC cleans up the area, your body can build back tissue. Oxygen-rich blood comes to the area with elements that tell cells to make elastic tissues called collagen. Collagen helps to repair skin and tissues in wounds. Collagen makes scars.

Stage IV Maturation (Strengthening)

Even after the wound looks closed, it’s still healing inside. So it might look pink, puckered, stretched, tight, itchy, or tingly. However, it hasn’t quite gotten all its strength back yet.

How Do I know If I’m Healing Skin Breakdown?

One of the reasons I recommend taking a measurement when you first find a wound is to know if the wound is healing. Wounds heal slowly along the edges. Often you don’t see big changes. It’s a gradual process. However, if you measure the size of the area and compare the numbers, you can tell if you are progressing with the new measurement.

If the wound has drainage, you can also determine progress by the amount of drainage, color, or odor.   If the amount gets bigger, it smells bad or has yellowish/ashen/greenish drainage, thick and sticky-like, probably pus (an infection), which is a clear sign of the wound worsening. If red streaks or fever are occurring, that’s a sign that the infection is spreading beyond just the wound and indicates that you must call the doctor promptly.

How Long Does It Take a Wound to Fully Heal?

It may take a few years to completely heal, depending on how large and deep a wound was initially. An open wound takes longer than a closed one. Most wounds are about 80% healed at three months. If an open wound is sewn shut, it heals better. Surgery cuts usually take 6-8 weeks to heal.

Wounds heal faster if covered and if you keep them clean, but they also need moister to heal. Adequate blood flow is essential to wound healing, as well as good nutrition. Individuals with diabetes, obesity, high blood pressure, or vascular disease have difficulty healing wounds.

What are the Signs that the Wound may be Infected?

• Slow healing or no healing
• Swelling
• Redness
• Pain or tenderness
• Hot or warn
• Oozing pus or liquid

How Is an Infected Wound Treated?

• Clean the wound
• Remove dead or damaged tissue
• Antibiotic medication
• Antibiotic skin ointment

Wound Irrigation Procedure for Healing Skin Breakdown

When To Use Wound Irrigation

1. perform wound irrigation when you need to clear out debris and drainage from a wound. When you rinse a wound, you direct a steady flow of irrigation solution (usually normal saline unless the doctor ordered something else) across the open wound. You can request a wound irrigation kit with everything you need or gather individual pieces.

Supplies Needed:

• a wound irrigation device (usually a 30-60 ml catheter-tip syringe),
• the solution you will use to rinse,
• a container to hold the solution,
• gloves and a gown to keep you dry,
• chucks or bed protectors to keep the bed and patient dry,
• something to collect the run-off irrigation solution
• dressing, tape, and packing materials, if indicated, to cover the wound afterward.

The Procedure:

• After gathering your supplies, drape all surfaces to keep the area around the wound dry and limit cross-contamination.
• Remove the old dressing and discard it.
• Assess the wound for any progress or changes.
• Pull up the solution into the syringe. Gain the cooperation of your family member to start the process.
• Gently depress the plunger of the syringe, spraying the wound. Move from the cleanest point to the dirtiest. Do not move back over the rinsed area once you have cleaned it until you start a new sweep.
• Repeat the irrigation process until the solution returns clear.
• Dry off the area by blotting it with sterile gauze.
• Pack the wound if ordered or apply a dressing as directed.

Resources: Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer (836)

Steps to Pack a Wound

• After cleaning the wound following the process noted above, pack the inside of the wound with sterile gauze.
• Open the gauze completely and dip it into saline or the other solution if ordered by the doctor.
• Spread it open so that it covers a large area. Then, gently insert the gauze into the wound to cover most of the inside surface but not touch the outside. Using a cotton-tip applicator can help you push the gauze underneath the lip of skin folds that may be present.
• Confirm that you covered all surfaces evenly.
• Wipe around the outside of the wound with clean gauze to remove liquid that may have seeped out.
• Cover the packing with dry gauze.
• Apply dressing over the top of the packing to hold it in place.

YouTube Video Resources

WoundIrrigation Produced by CSMD Tube
This video provides a demonstration of how to irrigate an open wound.
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Wound Packing Produced by CSMD Tube
The wound packing video continues from where the wound irrigation video left off and shows you how to pack the wound with gauze before dressing it to help absorb excess drainage.
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Jackson-Pratt Drain Wound Care Produced by Memorial Sloan Kettering

 Memorial Sloan Kettering, This video demonstrates how to milk the tubing of your Jackson-Pratt drain, empty the drainage bulb, and properly record the fluid collected in the bulb.

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YouTube Video regarding Treatment Options for Healing Skin Breakdown

Gauze Wound Dressings, Common Wound Dressings, Types of Gauze Dressings Produced by Wound Educators
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Transparent Film Wound Dressings Produced by Wound Educators
The transparent dressings are see-through and allow you to see the fluid accumulate. It looks nasty, but the fluid helps the tissue to heal faster.
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Hydrocolloid Wound Dressing Produced by Wound Educators 
Some topics covered are hydrocolloid bandages, adhesive pads, gel, the exoderm, pros and cons, absorbent dressing, and Tegaderm.
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Foam Wound Dressings Produced by Wound Educators
Topics covered; foam tape wound dressing complications, open cellular, KCI, smith nephew, wound care foam ring, and wound vac foam.
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Alginate Wound Dressings  Produced by Wound Educators
Topics included; sodium alginate dressings and calcium alginate dressings.
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Hydrogel Wound Dressing Produced by Wound Educators
More information is available at http:woundeducators.com.
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Composite Wound Dressing Produced by Vitality Medical Health
Composite dressings combine multiple components of wound protection into a single product to provide a multi-functional barrier, such as an anti-bacterial component, absorption, and adhesion. 

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