Acute and Chronic Wounds

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Understanding Patient Needs

Presentation is for informational purposes only to help you better understand acute and chronic wound management, and you have to remember that each individual patient is unique, and you must adjust your practice and based on that particular patient’s individual needs. I think it’s important for us to understand that when we talk about wounds, we’re really talking about injury or damage to the skin and its underlying structures. So, it’s important to understand what those structures are. The skin is the largest organ in the body. It covers the entire outside and separates us from the outside world so that all the fluid doesn’t leak out of our body, all the bad things in the environmental come into our body, but just like any other organ that we have, it’s subject to failure.

Anatomic Layers of the Skin

It’s got several different layers, and each of those layers have different components within it, but we’re going to simplify it just to the two basic layers of the skin and the underlying structures that are below the skin that we use for classification of pressure ulcers.

First of all, there’s the outermost layer of the skin. It has a lot of keratinocytes that are a waterproof barrier that keep things from getting inside of our body. They don’t have a lot of blood supply to them. They are cells that have migrated up from the base up to the top, and that’s the epidermis. Directly below the epidermis is the dermis, and the dermis is what contains all of our hair follicles and sebaceous glands. Nerve endings go into the dermis. Blood supply goes into the dermis.

Below the dermis is a subcutaneous tissue. Subcutaneous tissue has a lot of fat in it. If you’re down into the subcutaneous tissue, you’ve gone all the way through the skin. So, you’re at a full thickness injury, and once you get through the subcutaneous tissue, you’ll be down to the muscle and fascial layer.

So, directly underneath the subcutaneous tissue, there’s a layer that covers the muscle itself. It’s a white, glistening appearance. That’s the fascia. Underneath the fascia is the muscle. If you go all the way through to the muscle, you get down to the bone.