(e) Fistula. A fistula is an abnormal passage between two internal
organs. A wound that healed improperly could have caused such a passage.
(4) Blood supply. Since blood supplies the products used in healing, any
factor that restricts blood circulation to a wound area interferes with healing. Dead or
edematous tissue, restrictive bandages, and damaged arteries can all slow the healing
e. Physiological Responses to Wounds. Once the skin and tissue have been
injured, the process of healing begins. Many factors influence the body's ability to grow
(1) Age. Very young and very old people heal more slowly than those in
other age groups. People in these age groups have less ability to fight infection, and
fighting infection is a major part of the healing process.
(2) Malnutrition. Malnourishment and obesity, both forms of malnutrition,
affect wound healing. A person who is undernourished has less fat and carbohydrate
reserve; therefore, body protein (necessary for wound healing) must be used to provide
energy needed for basic metabolic functions. This results in an imbalance of nitrogen
which in turn depresses fibroblastic synthesis of collagen, the connective tissue for scar
formation. A person suffering from Vitamin C deficiency may not be able to produce
fibroblast, causing a delay in wound healing. In obese individuals, fatty tissue may keep
foreign matter from being seen. Fatty tissue has relatively few blood vessels, causing
such tissue to separate easily. Tissue that separates easily heals slowly.
(3) Abnormalities in endocrine function. Healing is slow if there are such
abnormalities. In a person suffering from chronic vascular changes, the injured tissues
of the wound may not get enough blood to heal at a normal rate. Persons having
corticosteroid therapy will find that wounds heal more slowly.
(4) Hormone production and carbohydrate metabolism. The combined
effect of the increased hormone production is to increase the metabolism of
carbohydrates. The metabolism of carbohydrates is important in the body's response to
trauma. If the body's store of carbohydrates is depleted (severe crush injuries,
starvation), the body will begin to use fats and proteins in place of carbohydrates.
Eventually, there will not be enough carbohydrates to aid in the healing process.
MATERIALS NEEDED FOR WOUND CLOSURE
a. Instruments. Only a few basic instruments are required for the repair of
most wounds. Gather the following equipment: