Principles of Wound Management in Clinical Environment

Question: Discuss about the Principles of Wound Management in Clinical Environment. Answer: Introduction: Arginine has around 32% nitrogen which possesses several functions in would healing. This includes stimulation of proteins regeneration and accelerating insulin secretion thus enough glucose is produced for energy in the creation of new cells. In addition, arginine is a basic donor of nitric oxide which increases oxygen and blood flow to the wound site thus, in turn, increasing collagen formation and minimizing inflammation. Arginine also helps in transportation of amino acids into the cells (Alexander, Supp, 2014). Hunan growth hormone (HCG) is one of the potent anabolic hormones that are cost effective and safest since it is produced by the body and it is increased through proper nutrition. One of the anabolic effects of HCG is that it raises the influx and reduces the efflux of amino acids into the cell. It also increases cell proliferation through protein synthesis and production of new tissues. In addition to that, the hormone also stimulates production of Insulin-like Growth factor 1 by the liver which is another anabolic agent thus raising its anabolism effects. HCG normally increases the metabolism of fats in the body as preferable nutrients for energy production thus leaving the proteins for cell growth (Amso, Cornish, Brimble, 2016). Hyperbaric oxygenation (HBO2) Hyperbaric oxygenation involves the use of 100% oxygen using a pressure that is much higher than the atmospheric pressure. The therapy has been applied in the treatment of chronic wounds that fail to heal using complementary treatment (Skiba, Pedrycz, 2016). This includes wounds like a diabetic foot, traumatic wounds, frontier gangrene, skin grafts, and radiation cystitis. Hyperbaric oxygenation therapy has two basic mechanisms of action which include hyperoxygenation and reduction of the bubble size (Skiba, Pedrycz, 2016). In hyperoxygenation, the basic principles involve the application of Henry's law and result in a rise of the dissolved oxygen in tissues due to an increase in partial pressure of capillary oxygen. Decrease in bubble size work in such a way due to an increase in pressure the bubble size decrease proportionally normally applicable in arterials embolism (Skiba, Pedrycz, 2016). However, there are some contraindications of the use of hyperbaric oxygen therapy which include conditions like untreated pneumothorax since it can lead to the establishment of tension pneumothorax (Skiba, Pedrycz, 2016). In addition, the therapy cannot be used while using some medications like Bleomycin which can lead to interstitial pneumonitis. Some medication has a mechanism of action opposite to that of hyperbaric oxygen therapy which includes Cisplatin and Sufamylon (Skiba, Pedrycz, 2016). Hypothermia normally decreases neutrophil function or else impair its functions indirectly thus leading to vasoconstriction and tissue hypoxia. In that case, studies have demonstrated that hypothermia in patients with wounds increases hospitalization by 20%. Maintaining normothermia increases neutrophil activities, arterial vasodilation thus increasing oxygen perfusion. In addition, normothermia reduces hospitalization thus reducing the risk for infections (Tsai, Hsu, Lin, 2014). The silver-containing dressing is normally used in the management of infected wounds and those that are associated to be in risk of infection (Tsai, Hsu, Lin, 2014). Silver have shown that it can provide antimicrobial activity to highly resistant bacteria like MRSA and VRE since it has a broad spectrum antimicrobial activity plus it has low tendency to induce resistance due to its activity at various target sites on bacteria (Tsai, Hsu, Lin, 2014). Cell Proliferation Induction (CPI) treatment normally increase the proliferation of epithelial cells and fibroblast in terms of amount and time. In addition to that, through the use of calcium-dependent pathway, the use of CPI treatment usually causes a sudden release of diffusible growth factors. This, in turn, leads to rapid stimulation and advancement of the growth cycle. Therefore, CPI acts as a way of promoting and fastening wounds healing process especially the chronic wounds that fail or delay to heal in certain stages (Hampton, 2016). Hyaluronic acid is a naturally occurring biodegradable polysaccharide that has non-immunogenic functions. The body uses the compound to hydrate dry and old skin as well as reducing wrinkles in the old skin. However, hyaluronic acid is used in the treatment of bed sores, wounds, and sunburns (Voigt, Driver, 2012). In would healing, Hyaluronic acid is involved in the early response to injury normally acting alongside fibrin to support epithelial cells and fibroblast influx into the site of injury thus promoting granulation of tissues. Tropical application of Hyaluronic acid has proven to be effective in chronic wounds treatment (Voigt, Driver, 2012). Negative pressure therapy is among the current medical procedures that use the vacuum dressing to promote wounds healing. This method normally uses a dressing that is sealed and attached to a pump to establish and develop a negative pressure environment in the wound (Tilley, Lipson, Ramos, 2016). There are various types of wounds that negative pressure wound therapy can benefit highly which include venous ulcers, diabetic ulcers, pressure ulcers, first and second degree burns, surgical and acute wounds which are at high risk for infection, arterial ulcers and wounds with large amount of drainage (Tilley, Lipson, Ramos, 2016). The debridement methods include surgical and sharp debridement, mechanical debridement, autolytic, enzymatic debridement, chemical debridement and biological debridement. Surgical debridement is highly selective and normally produces rapid results and also should be performed by a qualified doctor (Voigt, Driver, 2012) Inflammation phase- This is a body natural response to of the body to any injury which includes hemostasis and inflammation. It is characterized by edema, erythema, pain and heat (Harries, Bosanquet, Harding, 2016). Proliferative stage- This stage includes granulation, contraction, and epithelialization of cells and tissues. Remodeling and maturation This include formation of new collagens resulting to healing and a scar are finally formed (Harries, Bosanquet, Harding, 2016). If any of the stages is missed or delayed it results in chronic wounds and failure of healing (Harries, Bosanquet, Harding, 2016). References Alexander, J., Supp, D. (2014). The role of Arginine and Omega-3 Fatty Acids in Wound Healing and Infection.Advances In Wound Care,3(11), 682-690.doi.org/10.1089/wound.2013.0469 Amso, Z., Cornish, J., Brimble, M. (2016). Short Anabolic Peptides for Bone Growth.Medicinal Research Reviews,36(4), 579-640. https://dx.doi.org/10.1002/med.21388 Hampton, S. (2016). Dressing selection for older people with open wounds.Nursing And Residential Care,18(10), 524-525. Harries, R., Bosanquet, D., Harding, K. (2016). Wound bed preparation: TIME for an update.International Wound Journal,13(S3), 8-14.doi.org/10.1111/iwj.12662 Skiba, M., Pedrycz, A. (2016). Influence of hyperbaric oxygenation and its use in urinary tract diseases.Polish Hyperbaric Research,56(3). Tilley, C., Lipson, J., Ramos, M. (2016). Palliative Wound Care for Malignant Fumigating Wounds.Nursing Clinics Of North America,51(3), 513-531. https://dx.doi.org/10.1016/j.cnur.2016.05.006 Tsai, C., Hsu, H., Lin, C. (2014). Treatment of Chronic Wounds With the Silver-Containing Activated Carbon Fiber Dressing: Three Cases.Journal Of Medical Cases,5(11), 587-591. https://dx.doi.org/10.14740/jmc1960w Voigt, J., Driver, V. (2012). Hyaluronic acid derivatives and their healing effect on burns, Epithelial surgical wounds, and chronic wounds: A systematic review and meta-analysis of randomized controlled trials.Wound Repair And Regeneration,20(3), 317-331.