Need help re: time of wound healing

[DutchgirlRN, ASN, RN]

I have a patient with a BKA. The patient is 6 wks post-op, the incision line now looks wonderful except for a dime-sized area. When I first started seeing the patient she told me that that area had been draining ever since the surgery. The doctor had sent her home on antibiotics. It drained the first two times a saw her and then saw no more drainage. Last week she visited the surgeon and he debrieded that area (enlarging it slightly) and sent her home with a bottle of plain packing. The wound bed is clean, no drainage, the edges are a healthy red, no redness or swelling at the site. She asked me how the packing helps to heal the wound. I told her it debrieds the wound bed each time you remove it. She asked me how does it heal and how long does it take? I didn't have any answer for her. I did tell her it takes at least several weeks to heal and if it doesn't she may be looking at a skin graft. My question is, how does the packing help to close the wound and is there anything specific I should be looking for? I've searched the net without any luck. Thanks.......

[leslie :-D]

from my memory, there are 3 phases to wound healing:

- the inflammatory phase; the proliferative phase and maturation phase.

it is during the proliferative phase where you can see granulated tissue.

you don't want any dead space (makes it susceptible to contaminants, infection, abscesses, mining/tunneling) but it's equally important not to overpack the wound.

the tissue thrives/granulates in a warm, moist environment and in a healthy person, can take a few weeks.

as the wound site fills in w/granulation tissue, its margins pull together, decreasing the wound surface.

systemic factors that could impede wound healing are age, body build, chronic diseases, nutritional status, vascular disease/insufficiency, immunosuppression and chemo/rad therapy.

if you study the 3 phases of wound healing, you'll obtain an in-depth understanding of the hows and whys.

good luck!

leslie

[DutchgirlRN, ASN, RN]

if you study the 3 phases of wound healing, you'll obtain an in-depth understanding of the hows and whys. leslie

Thanks so much Leslie, I'm on it !

[sharlynn]

I told her it debrieds the wound bed each time you remove it. She asked me how does it heal and how long does it take? I didn't have any answer for her. I did tell her it takes at least several weeks to heal and if it doesn't she may be looking at a skin graft. My question is, how does the packing help to close the wound and is there anything specific I should be looking for? I've searched the net without any luck. Thanks.......

Actually, the packing is to keep the outside of the wound open so it can heal from the inside. If the outside closes too soon it will form a fistula. Watch for symptoms of infection, induration, fever, erythema, edema. Several weeks is a good estimate.

Sharlynn RN,WCC

[DutchgirlRN, ASN, RN]

I saw her again this past Friday and the wound looks great, already smaller. Thanks for the advice.