Wound Healing and Skin Integrity: Principles and Practice


This comprehensive text integrates related aspects of wound management, skin integrity and dermatology into a convenient, one- stop resource. It explores the theories underpinning wound management and skin integrity by reviewing the supporting evidence and making practical recommendations for busy clinicians. Wound Healing and Skin Integrity discusses current and future trends in the management of wounds and maintenance of skin integrity in respect to international healthcare initiatives and summaries the ...

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This comprehensive text integrates related aspects of wound management, skin integrity and dermatology into a convenient, one- stop resource. It explores the theories underpinning wound management and skin integrity by reviewing the supporting evidence and making practical recommendations for busy clinicians. Wound Healing and Skin Integrity discusses current and future trends in the management of wounds and maintenance of skin integrity in respect to international healthcare initiatives and summaries the principles of maintaining healthy skin to provide a practical guide that is accessible to clinicians regardless of professional background. Wound Healing and Skin Integrity fulfils the inter-professional learning agenda and will be of interest to a wide range of clinicians including; doctors, wound management, dermatology and palliative care nurse specialists, community nurses, podiatrists, pharmacists and anyone responsible for managing patients with impaired skin integrity. Key features:
• A practical, accessible, evidence-based manual on wound care and skin integrity
• Integrates related aspects of skin integrity, wound management and dermatology previously found in separate texts into one comprehensive resource
• Written from a broad international perspective with contributions from key international opinion leaders from Australia, UK, Canada and Europe
• Promotes international practice development in relation to management of skin integrity and chronic wounds
• Full colour illustrations throughout
• Contains definition of key terms, relates anatomy and physiology to clinical practice and provides a summary of easily accessible, internet learning resources
• Includes practical tips from expert practitioners, commonly presented clinical queries and discusses professional issues related to skin integrity.

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Editorial Reviews

From the Publisher
“Nurses at any stage of practice could benefit from this book as it provides good evidence based data when considering tissue viability and holistic assessment. Specialist nurses - tissue viability, diabetes, lymphedema could benefit from this book and is a vital resource to have in any clinical setting.” (Nursing Times, 25 June 2014)

“With its focus on practical information for practicing physicians, this reference is easier to understand than most wound healing books. The discussions of bacterial colonization, biofilms, and wound healing processes gone awry are clear and most helpful.” (Doody’s, 20 September 2013)

Doody's Review Service
Reviewer: Patricia Wong, MD (Stanford University Medical Center)
Description: This is a practical guide to wound management for clinicians caring for patients with chronic ulcers, skin infections, surgical wounds, delayed healing from malignancies, vasculitis, etc.
Purpose: It is intended as a guide to the diagnosis and treatment of skin wounds from all etiologies.
Audience: The audience is dermatologists and primary care physicians.
Features: Readers are initially exposed to the basics of normal wound healing, followed by discussions of factors that inhibit wound healing, and finally details of how to properly diagnose and correct conditions to optimize wound healing. Shaded boxes contain clinical tips, such as how to apply special dressings for particular wounds and how to correctly assess a wound. An informative chapter discusses what chemicals are responsible for the distinct odors in different bacterial infections.
Assessment: With its focus on practical information for practicing physicians, this reference is easier to understand than most wound healing books. The discussions of bacterial colonization, biofilms, and wound healing processes gone awry are clear and most helpful.
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Product Details

  • ISBN-13: 9780470659779
  • Publisher: Wiley
  • Publication date: 5/6/2013
  • Edition number: 1
  • Pages: 312
  • Sales rank: 1,140,317
  • Product dimensions: 7.40 (w) x 9.60 (h) x 0.80 (d)

Table of Contents

List of Contributors x

Preface xii

Acknowledgements xiv

Section 1 Principles of Best Practice 1

1 Evidence and Clinical Decision-making 3
Carolina Weller

Introduction: what is effective clinical decision-making? 3

What is evidence-based health care? 4

Common misperceptions about evidence-based practice 5

Challenges to changing practice 7

Factors influencing clinical judgement 8

Evidence-based practice: hierarchy of evidence 9

Evidence-informed decisions 11

Critical appraisal frameworks 11

Clinical guidelines 13

Summary 13

Useful resources 14

Useful critical appraisal frameworks 14

Further reading 15

References 15

2 Maintaining Skin Integrity 18
Arne Langøen and Janice Bianchi

Introduction 18

Impaired skin barrier function in the clinical setting 23

Management of vulnerable skin 27

Summary 30

Useful resources 30

References 30

3 Physiology of Wound Healing 33
Mary Martin

Introduction 33

Types of wound healing 35

Wound chronicity 35

Normal wound healing 36

Optimising healing: general factors 38

Optimising healing: local factors 39

Delayed wound healing 40

Tissue repair in chronic wounds 40

The inflammatory response 41

Proliferation of new tissue 43

Wound closure 45

Summary 48

Useful resources 48

References 48

4 Assessing Skin Integrity 52
Annemarie Brown and Madeleine Flanagan

Introduction 52

Assessing skin integrity 53

Listening: problem orientation and knowledge 53

Looking: problem clarification and knowledge construction 55

Touch: hands on fact finding 56

Smell: subconscious information gathering 57

Assessing wounds 58

Wound bed preparation 58

Data collection 60

Effective documentation 63

When to seek specialist help? 63

Summary 63

Useful resources 64

References 64

5 Principles ofWound Management 66
Madeleine Flanagan

Introduction 66

Principles of wound management 67

Effective wound management 67

Controlling bacterial burden: wound cleansing 68

Controlling bacterial burden: wound debridement 69

Autolytic debridement 69

Enzymatic debridement 69

Biosurgical debridement 70

Mechanical debridement 70

Sharp debridement 70

Hydrosurgical debridement 71

Ultrasound (acoustic pressure wound therapy) 71

Regulating moisture balance 71

Wound dressings 72

Passive inert dressings 74

Interactive dressings 75

Antibacterial dressings 79

Summary 83

Useful resources 83

References 83

6 Wound Infection 87
Valerie Edwards-Jones and Madeleine Flanagan

Introduction 87

Bacterial invasion of the skin 88

Wound pathogens 88

Factors increasing the risk of wound infection 90

The significance of bacteria within wounds 90

Significance of biofilms 92

Identifying wound infection 92

Microbiological assessment of wounds 93

Principles of managing infected wounds 95

Summary 99

Useful resources 99

References 99

7 Psychological Impact of Skin Breakdown 102
Patricia Price

Introduction 102

Psychological impact on the individual and society 103

Adaptation to chronic illness 103

Stress and skin disease 103

Depression 104

Adjustment to physical change/disfigurement 105

Coping strategies 105

Social support 106

Body image 106

Living with skin breakdown and chronic wounds: symptom management 107

Measuring impact of skin breakdown 108

Factors affecting treatment 109

Interventions 111

Clinical reflection 112

Summary 113

Useful resources 113

References 113

Section 2 Challenging Wounds 117

8 Pressure, Shear and Friction 119
Keryln Carville

Introduction 119

Prevalence and incidence 120

Pathophysiology 120

Risk factors 122

Psychological impact 122

Current best practice 123

Prevention strategies 123

Pressure ulceration: assessment considerations 123

Treatment strategies: pressure ulcers 128

Education and support 132

Criteria for specialist referral 133

Summary 133

Useful resources 133

Clinical guidelines 133

Organisations 133

Further reading 133

References 133

9 Diabetic Foot Disease 136
Jan Apelqvist

Introduction 136

Aetiology 137

Psychological impact 139

Principles of diabetic foot ulcer management 140

Diabetic foot ulceration: assessment considerations 140

Assessment of vascular status 143

Assessment of wound infection 143

Management of diabetic foot ulcers 145

Vascular intervention 145

Foot surgery and amputation 146

Debridement 147

Infection in diabetic foot wounds 147

Osteomyelitis 148

Offloading – non-weight-bearing 148

Wound dressings: special considerations 149

Foot care 149

Education and support 150

Provision of specialist diabetic foot services 151

Criteria for specialist referral 151

Summary 151

Useful resources 151

References 152

10 Chronic Ulcers of the Lower Limb 155
Jeanette Muldoon

Introduction 155

Epidemiology 155

Comorbidities and underlying pathologies 156

Rheumatoid arthritis and vasculitis 156

Venous leg ulceration 156

Factors that affect venous return 158

Rarer leg ulcer aetiologies 160

Psychological impact 161

Principles of managing leg ulcers 161

Leg ulceration: assessment considerations 161

Vascular assessment for arterial disease 164

Management of chronic oedema in leg ulcers 166

Wound dressings: special considerations 168

Prevention of ulcer recurrence 169

Education and support 170

Provision of specialist services 170

Criteria for specialist referral 171

Summary 171

Useful resources 171

Further reading 172

References 172

11 Lymphoedema 175
David Keast

Introduction 175

Pathophysiology 176

Risk factors 178

Psychological impact 179

Current best practice 179

Prevention strategies: risk factor management 180

Lymphoedema: assessment considerations 180

Treatment strategies 184

Education and support 189

Provision of specialist services 190

Criteria for specialist referral 190

Summary 190

Useful resources 190

References 191

12 MalignantWounds 193
Wayne Naylor

Introduction 193

Malignant wounds: aetiology 194

Psychological impact 195

Principles of palliative wound management 196

Malignant wounds: assessment considerations 196

Management of malignant wounds 198

Education and support 204

Provision of specialist services 204

Criteria for specialist referral 204

Summary 205

Useful resources 205

References 205

13 Skin Integrity and Dermatology 208
Julia Schofield

Introduction 208

Prevalence and incidence of skin disease 209

Quality of life 209

Cost of skin diseases 209

Management principles 210

Important common skin problems and their management 211

Provision of dermatology specialist services 220

Summary 221

Useful resources 222

Further reading 222

References 222

14 Surgical Wounds 224
Alan Widgerow

Introduction 224

Classification of surgical wounds 224

Principles of surgical wound management 227

Surgical wounds: assessment considerations 227

Preoperative management 228

Intraoperative management 229

Postoperative management 230

Wound closure 231

Management of surgical scars 234

Common reconstructive surgical options 236

Education and support 237

Criteria for specialist referral 238

Summary 238

Useful resources 239

References 239

15 NeglectedWounds 242
Kim Deroo, Lesley Robertson-Laxton, Sabina Sabo and Arlene A. Sardo

Introduction 242


Risk factors (post-piercing infection) 243

Factors delaying healing 243

Complications 243

Principles of wound management 243

Practical management 243

Practical tips 244

Healing rates 244

Criteria for specialist referral 244

Summary 245

Further reading 245

References 245


Risk factors 245

Differential diagnosis 245

Clinical features 245

Factors delaying healing 246

Complications 246

Principles of wound management 246

Practical management 246

Criteria for specialist referral 246

Summary 246

Further reading 247

References 247


Risk factors 247

Differential diagnosis 247

Clinical features 247

Factors delaying healing 248

Complications 248

Principles of wound management 248

Practical management 248

Criteria for specialist referral 248

Summary 248

Further reading 249

References 249


Risk factors 249

Diagnostic procedures 249

Clinical features 249

Factors delaying healing 249

Complications 249

Principles of wound management 250

Practical management 250

Criteria for specialist referral 250

Summary 250

Further reading 251

References 251


Risk factors 251

Differential diagnosis 251

Clinical features 252

Factors delaying healing 252

Complications 252

Principles of wound management 252

Practical management 252

Criteria for specialist referral 253

Summary 253

Further reading 253

References 253


Risk factors 253

Differential diagnosis 254

Clinical features 254

Factors delaying healing 254

Complications 254

Principles of wound management 254

Practical management 254

Criteria for specialist referral 254

Summary 255

Further reading 255

References 255


Risk factors 255

Differential diagnosis 255

Factors delaying healing 255

Clinical features 255

Complications 256

Principles of wound management 256

Practical management 256

Criteria for specialist referral 257

Summary 257

Further reading 257

References 257


Risk factors 257

Differential diagnosis 258

Factors delaying healing 258

Clinical features 258

Complications 258

Principles of wound management 258

Practical management 259

Criteria for specialist referral 259

Summary 259

Further reading 259

References 259

Section 3 Improving Skin Integrity Services 261

16 Reducing Wound Care Costs and Improving Quality: A Clinician’s Perspective 263
Theresa Hurd

Introduction 263

Health economics: a clinician’s perspective 264

Barriers to best-practice wound care and prevention 265

The costs of wound care 266

Best-practice wound prevention and care programmes 267

Clinical results 268

The impact of best-practice wound prevention and care on health economics 272

Redesigning clinical care, business and information processes 274

Indirect economic benefits 274

Summary 275

Useful resources 275

References 276

17 Dressings: The Healing Revolution 278
Douglas Queen and Keith Harding

Introduction 278

Evolution of new wound dressing technologies 279

The healing revolution 280

Dressing evolution led by technology: an example 282

Patient-centred dressing evolution: an example 282

Advanced wound technologies 283

The future: wound care as a clinical specialty 284

Summary 287

Useful resources 287

References 287

Index 291

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