 Hi everyone and welcome back to another vlog. Thank you so much as always for tuning in and taking your time out to come and watch this video. So today's video is all about wound healing and I just have to warn you now I haven't got any plasters and I've just cut myself so I have a makeshift bandage. That's not how to wound heal but you know what if that's all you got it's all you got. So the first thing we're going to talk about is the stages of wound healing and these are different stages at different points of the wound healing process and they're the amazing things that your body does to protect you in a way. So the first stage is Hema status. I'm going to put a picture here so you can have a look at it and see what sort of phase this is. So this phase is literally just the first point of action when you get a wound that's it that all of your body is going to kick in swing into action. So your vessels will start to narrow platelets are going to rush to the site as well to sort of start that clotting process to heal over so that nothing can get in and nothing can get out of your body and that's when it's going to form a little plug over the wound just to prevent any bacteria from getting in but also from your blood to stop getting out. Stage two is the inflammation stage and you might see some redness and swelling around the wound edges. This is a very good sign of inflammation and your white blood cells all race to the site to clear the area of any bacteria and growth that might be starting to develop in that wound site to try and help prevent infections. The third stage is called the proliferative stage I still can't say this word I'm going to put it here just for your information but this is really like the rebuilding your healing process is really kicking in now blood cells are starting to arrive to build a new skin and they're there just to give your cells sort of the oxygen and nutrients they need to help that skin healing process but not just the skin but actually new blood vessels as well form around it and collagen also starts forming which helps rebuild the damaged area. So basically it's just remodeling of your skin and tissues just to make it look nice and shiny and the final phase is the remodeling phase this is the final phase in your wound healing this is also the longest phase to your wound healing and this can take anywhere up to 21 days and two years would you believe even longer for some people especially if you've got other factors to count like diabetes or if you've got an impairment somewhere that's going to delay that wound healing it's going to be even longer but in this phase it's the ongoing collagen synthesis which then sort of continues to remodel and rebuild that skin and tissue that we were talking about in the previous phase and also the fibers are going to be reorganized and it's all just going to hopefully be this fresh beautiful lovely new skin on top and also in this stage you're going to have freshly healed epidermis which is the top layer of your skin and a freshly healed epidermis underneath. So next we're going to talk about the assessment of a wound. I just wanted to go through all of the different types of tissue types that you might see on a wound just to help you make that assessment to see which one it is and what stage it's at. So first is the epithelial tissue I don't know if I've said that right but I've said it anyway I'm going to put the word here and a picture here of what it should look like this is going to be a nice pink color pearly sort of skin it's going to look good and you normally see this when the wound is actually healing well and you've got that nice fresh layer coming across it's a good sign if it's doing that. Next up we have granulation tissue so if you've got an open wound this is where all of the new tissue is starting to form the new blood vessels are formed and it's going to look this red sort of meaty kind of color I'm going to put a picture again here so you can see what I'm talking about but this is kind of what it looks like however you can get a very unhealthy version of this and this is what we call over granulation so there's a number of things that can cause this some it could be a type of infection so you might want to treat it with a different type of dressing for example if you've got contact bleeding if you're starting to see blood when you're wiping it and cleaning it if little pieces are coming off that's normally a good indicator of an infection as well so it's really important that you find the underlying cause of what's causing that and sometimes it's just the environment it's in the wrong environment so maybe try a different dressing sometimes a steroid cream to reduce that just have a look at the guidelines and how to treat over granulation in your area. Slough I know one of my favorites is slough so this is this is again a stage of wound healing as well this is part of the inflammatory phase this is where you've got all of the white sort of dead blood cells hanging around and it's not normally a problem you can normally sort of wipe it away and that'll be fine and the wound will heal lovely but sometimes it can be a bit of a problem if that's starting to turn a different color for example like more of a greeny color if it's looking a bit dark in color if it's getting really really thick and an offensive smell for example you might be starting to think okay is this infected but that will then make you decide what dressing to put on that sort of wound you may see necrosis at some point and this is basically it's dead tissue that's all it is it's dead tissue and depending on the wound and where it is you will assess that differently and if it was something like on a joint or if it was on the foot for example and that was necrotic you want to be thinking okay what is this blood supply like is there a good blood supply flowing to that area because it shouldn't really be getting at that point where it's necrotic um so you might want to do a bit more of an assessment and have a look into the patient's history as well and work out what you're going to do with this wound so now we've talked about the terminology with looking at wounds and looking what they look like you want to put in a percentage of that in your in your documentation so if you could see some slough you want to put okay is this 10 sloughy or 50 50s at 50 slough and 50 granulation you're trying to work out how how much of something there is and it'll give a just to give a good accurate description so that if someone else looks at it they know what they're looking out for and if this has changed since you've last seen it and the way I do it is I think of it like a clock face so I split it up into sections and I go okay so that little section is only that so much so then I can work out an accurate percentage if that makes sense and that's how I normally do mine and I think thinking of it as a clock face when you're assessing wounds is just a really good tip to sort of be able to measure it as well as assessing what percentage is what which takes me nicely onto measuring your wound so like I said as a clock face you want to go to the longest points so you're going to go 12 o'clock to six o'clock and three o'clock to nine o'clock so that they're vertical horizontal every single time and you want to go to the longest points that way so if it's just slightly up or down that's okay slightly up or down that way that's okay but as long as you're all following that same pattern then you will all be measuring it actually if someone else is measuring it after you but just think of it as a clock face longest points to longest points and you want to do it in millimeters as well and also if there's a depth to it so there are little probes that you can have with little measurements on to measure the depth of a wound if you've got a cavity type wound but if it's superficial then I wouldn't worry just put superficial wound on your notes sorry I forgot to mention exudate when I was talking about slough and granulation and thing I forgot to mention exudate so I'm just going to quickly cover that now because we're going to go on to dressings which it'll just flow nicely trust me um so exudate is it I just think that as the fluid coming out of the wound it's quite clear sometimes um it can be quite yellow in colour but if that starts going green then you want to start thinking okay is this pseudomonas infection that's normally a good indicator actually if it's green in colour and a bit of an odour to it then you're going to be thinking infection do I need to treat this with antibiotics or different microbial dressings for example and again you want to measure the amount of exudate that's coming out in your notes so we go by different levels so dry if it's dry you'd put moist if it was just a little bit on the dressing wet so your dressing is wet or your dressing is completely saturated or it's leaking so it's actually leaking through the dressing and the bandaging sorry guys it just got really dark in here all of a sudden so I've had to put my um light on so yeah sorry about the change in lighting in this video not very professional I know but as long as I'm giving you the information it's fine so that last bit took us really nicely on to dressings firstly think about what you're going to wash this wound with um if you've got an open wound I would use a sterile solution so for example if this is just a superficial wound a skin tear or something like that someone's just knocked their arm or something and you're just giving it a clean up and putting a plaster on I would go with just simple saline because that's all you need but if you've got something that's quite sluffy and it's got this clear film of kind of bacteria on the top you're going to want something a bit more intense so my go to is pronto san I don't know you might have something completely different but this just helps break down that biofilm that's developed on the top of the wound so that it can heal then when you're picking your dressing you want to think about your wound assessment so we've just done that so you're looking at is it granulating is it overgranulating is there an infection is this wound just healing nicely um is the high amount of slough is the high amount of XJ if there's a lot of XU day coming out you want something that's going to really absorb that as well you want more of an absorbent dressing if this if this wound's quite dry and it's not infected then you can use more of a simple dressing so I've got a little table here just to help me remember on my laptop so that can give you the correct things all the things that I do so looking at your wound if it's barely wet and there's not much fluid coming out of it low XU day but it looks infected then you want an antimicrobial dressing so you're going to go things like medihoney idaflex or iodine maybe a silver dressing maybe an alligate dress alligate alligate alligy alligyate dressing sorry I can't speak alligyate dressing which is like a seaweed dressing and if it was a more painful wound then you might think of some soft type dressings that isn't going to irritate it or cause it more pain so things like the medihoney and the iodine or the silver dressing that will be your primary dressing the first dressing that you put it on is your primary dressing what is directly going on to that wound then on top of that you want a secondary dressing so something just to seal it in protect it keep that dressing in place because they don't come as adhesives or anything like that so you want something as a secondary dressing on top of that this again if you have got no XU day it's not leaking very much it's okay you can just use a simple dressing something like me pour soft pour um something with a film dressing on it with a little pad something like that something just really simple and soft that's going to protect your patient's wound so you could use if they were in quite a lot of pain or if they're allergic to adhesives you might just put like a little soft pad over the top and then put like a little bandage over the top or a little stocking over the top just to keep it in place and that's perfect as well if there's quite a moderate amount of exudate coming out and the dressing is quite wet when you're taking the dressing off then you might want to think about getting some sort of absorbent like a super absorbent padding or a zetch of it padding which is quite a thick little padding that goes atop and it absorbs all of that moisture I would also think about protecting the skin around it as well is another thing actually you should always think about when dealing with wounds as well is what is the skin around it looking like because you don't want that to break down you don't want that to get damaged so you want to wash that down get some cream on it if it's a very very wet wound then you want to put something around it to protect the skin around it so we use lbf where I am but you can use things like a cavalon spray something that's going to protect that wound around it and stop that skin from breaking down anymore but yes if you've got a moderate amount of exudate you're going to want something to absorb all of that and also if this is an infection again you want to use your medihoney your silver your antimicrobial dressings seaweed dressings those sort of types of dressings and potentially think about some antibiotics as well from the doctor but the secondary dressing should just be like a super absorbent sort of dressing or an absorbent padding or an absorbent adhesive type of dressing we use cliniderm if it's an adhesive and also if there was no infection then you would just put the super absorbent as your primary dressing you wouldn't need any medihoney or anything like that underneath you just put that as your primary dressing and again if you've got like something that's soaking wet it's leaking through the bandaging again you're going to want to pad it out realistically just to absorb that and you might want more of an absorbent first dressing as well things like exu-fibre is really good because that absorbs it and it's got the fibres in it to help with the healing process and then you might want like a super thick padding on top of that and then bandaging around it just to absorb that moisture so just a quick rundown if you've just got a simple wound it's okay it's not leaking it's not infected you can just put a simple dressing on there if you've got something that looks a bit infected you might want to consider antibiotics you might want to treat it locally with a local dressing like antimicrobials like medihoney maybe a silver dressing an alginate dressing those sort of types dressing and then if you're having a high amount of fluid leaking out of it you want to think foam padding pad it out you also might get the opposite you might get a really dehydrated wound bed as well so something that's really dry that slough's gone really hard in the middle so you want to try and put something in there that's going to soften that and promote wound healing so something like a hydro gel something that's going to promote moisture promote all of that and just hopefully getting that healing again because that's not really not going to heal very well if that's solid so i'm just going to quickly go through the different types of dressings and first up like i said the alginate dressings is a type of seaweed and this can be used to absorb fluid promote hydration and sort of de-briding the wound if it needs de-briding and moisture control and we have the foams that i spoke about that's just to absorb any excess fluid and help that healing medihoney that i spoke about helps to rehydrate the wound it helps to de-bride the wound and it's also a really good antimicrobial hydrocolytes so this is things like you might have seen aquacel type dressing and this just helps promote moisture control as well in the wound it can absorb fluid as well and help with de-bridement hydrogels pretty much says what it says it hydrates your wound good for de-bridement cooling and moisture control as well hyodine is literally just an antimicrobial action type dressing phmb dressing is again any type of antimicrobial dressing you can also get things like activated charcoal dressings which i've never used but you can use that sort of thing for like odor control as well silver dressing is literally what it says on the tin it is a dressing that contains silver in it and that's to fight infections like the medihoney and antimicrobial dressing so yeah so like i said you really just need to assess your wound bed and how it's healing to what type of dressing you would put on it so just to summarise we have talked about what you're going to clean your wound with how you're going to assess the wound and how you're going to pick your dressings and the different types of tissues that you might see in wound healing stages and how to manage wounds out there but if in doubt you will always have your tissue viability nurses out there for any help that you might go to your mentor if you're a student nurse or you might go to a more senior nurse if you're a qualified nurse and that's okay if you if you're struggling to decide what to do with this wound like we all do it i've done it many many times i've looked at a wound i've gone i've got no idea and i've had to go to other people so yeah so don't be afraid to ask for help it's always better to get help and go from there then make the wrong decision and potentially delay that wound healing because we want to get this healed as fast as and quick as possibly and prevent infection also i'm going to put a load of links below so have a look at the details below there's going to be a load of wound care links in there for you to have a look at look around really good links that's what i use so please have a look at them get to know your wounds and make sure you're doing the right things out there guys so that is it from me for another week i shall see you all next time