An injury to the human body initiates a wound healing chain reaction that occurs in four sequential but overlapping phases: hemostasis, inflammatory, proliferative and maturation. This post focuses on the second (inflammatory) phase, which begins after blood flow stops (i.e., hemostasis) and defender white blood cells, or leukocytes, migrate to the site of the injury — a process known as chemotaxis.1
Understanding the Inflammatory Stage of Wound Healing
The inflammatory stage typically lasts several days, but it can go on for much longer, making the wound chronic. Many cells and chemical reactions or signals keep the wound progressing in the inflammatory phase. Understanding these processes can jump-start a chronically stalled wound so that healing resumes. The clinician’s goals in the inflammatory phase are to limit further damage, close the wound, remove cellular debris and bacteria, and encourage cellular migration.1 Following hemostasis and chemotaxis, white blood cells and thrombocytes release more mediators and signaling cytokines, which accelerates the inflammatory process. Several growth factors work in concert to promote collagen degradation, transform fibroblasts, grow new blood vessels and work toward re-epithelialization. Platelets release mediators, including serotonin and histamine, to increase cellular permeability.1 Fibroblasts are recruited and multiplied by platelet-derived growth factors. Once the fibroblasts are in place, they produce collagen, a crucial protein the body needs for building and remodeling. During this process, a fibrin scaffold forms through platelet activation.1
The scaffold gives the inflammatory cells a place to stick. Some of the inflammatory cells attracted to the scaffold are neutrophils, monocytes and endothelial cells.1 Neutrophils digest cellular debris and bacteria through a process called phagocytosis, which helps cleanse the wound. Monocytes fight infections and help remove dead or damaged tissues.2 Endothelial cells send signals to organize the growth of connective tissue cells that eventually form the surrounding layers of blood vessel walls.3All these cells working in concert keep the wound moving to the next healing phase, known as the proliferative or granulation phase. Matrix metalloproteinases, or MMPs, are required for the migration of inflammatory cells. MMPs also break down proteins to allow new tissue to form. However, if MMP levels get too high or if MMPs are present for too long, they can break down proteins and growth factors and stall wound healing.4
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Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.Contact us for more details: [email protected].References 1. Basehore, B. M., Zito, P. M., & Wallace, H. A. (2020). Wound Healing Phases. Treasure Island, FL: StatPearls Publishing. 2. Territo, M. (2020, January). Monocyte Disorders. Retrieved from Merck Manuals. 3. Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K. & Walter, P. (2002). Molecular Biology of the Cell. New York: Garland Science. 4. Cullen, B., Gibson, D., Harding, K., Legerstee, R. & Shultz, G. (2009). MMPs Made Easy. Wounds International, 1(1), 1-6.
Chronic wound care is challenging for the entire healthcare ecosystem, from clinicians to patients, and COVID-19 has only exacerbated those challenges. Patients are delaying primary care provider and wound clinician visits for ongoing guidance and therapy to reduce possible exposure to the virus. This is understandable, as many chronic wound patients are in the high-risk category if they become ill with COVID-19.1They are also putting off elective surgeries, annual physicals, and basic preventive care, which can negatively affect long-term outcomes. A survey of wound care clinicians in March 2021 reported a decrease in patient visits from pre-pandemic numbers, and 57% of respondents stated that "wound severity has either increased or significantly increased since the start of the pandemic."2 At the same time, the pandemic has accelerated patient-driven care and increased usage of interactive devices for care administered at home, rapidly increasing the use of telemedicine across demographics. In fact, one report by the research firm Frost & Sullivan says the demand for telemedicine services in the United States grew by over 60% in 2020 due to the pandemic.3 As the pandemic continues, it’s important to look at how reduced access to care might affect wound care in the future and how patient-driven and more value-based care options will come into play in daily practice.
The Trickledown Effect on Patient Outcomes and Their Wounds
While there have been improvements, access to care has not fully recovered, and continued COVID-19 surge rates suggest that delayed preventive and emergent wound care could continue to trend.4 This is a negative outcome from a public health perspective, which could prove catastrophic for wound patients as they leave themselves vulnerable to infection, sepsis, amputation, and possibly death. These problems are especially concerning in our growing senior population, whose chronic wounds are complicated by vascular disease, diabetes mellitus, and unrelieved pressure. A reduction of traditional weekly or biweekly wound care visits could increase hospitalization by a factor of 20 in the United States,5 exposing the scale and often unknown prevalence of chronic wounds and their impact on the healthcare system. The increase in the rate of untreated wounds over the last year has led some researchers to describe the situation as a “pandemic within a pandemic.” A trauma center study in Ohio found that diabetic patients were “10.8 times more likely to undergo any level of amputation and 12.5 times more likely to undergo a major amputation during the COVID-19 pandemic.” Another study reported in the same AJMC article showed that “during COVID-19 lockdowns, patients with diabetes admitted to a tertiary care center for DFU had a more than threefold risk of amputation compared with those in 2019.”6 None of this is surprising, considering how delayed care has swept across the U.S. healthcare system, especially during the stage of rising Delta variant rates. And it’s impossible to imagine how neglected wound care rates could increase when a new variant emerges. COVID-19 has had a sustained, ongoing impact on how patients receive wound care. Or even if they will be able to receive care, because patients may remain uncomfortable visiting clinics as the pandemic lingers. Widespread staffing shortages are also a concern, and wound care treatment must adapt to meet patients where they are and where they feel comfortable receiving care.
Leading Through Patient-Centered Solutions
As the healthcare industry examines existing challenges, its leaders are finding new ways to transform outcomes. One notable shift is the acceleration of telemedicine. It is already a viable choice for healthcare professionals regarding preventive care like consultations, prescriptions, wellness checks, counseling, and more. Access is an essential reason telehealth—or telemedicine—is playing such an important role. In 2019, more than half of U.S. households used the internet for health-related activities.7 And the pandemic has escalated this shift.8 During the first quarter of 2020, the number of telehealth visits increased by 50% compared with the same period in 2019.8 Solutions Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation. See a clinical care solving chronic wounds by Dermlin on Youtube: https://youtu.be/RrQsktcYmlk Contact us for more details: [email protected].
References 1.Oropallo A. COVID-19: issues related to wound care and telehealth management. UpToDate. September 2021. Accessed October 27, 2021. https://www.uptodate.com/contents/covid-19-issues-related-to-wound-care-... 2.Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 27, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-... 3.Frost & Sullivan. Telehealth to experience massive growth with COVID-19 pandemic, says Frost & Sullivan. May 13, 2020. Accessed October 27, 2021. https://www.frost.com/news/press-releases/telehealth-to-experience-massi... 4.National Center for Healthcare Statistics. Reduced access to care: RANDS during COVID-19. CDC.gov. Updated August 6, 2021. Accessed October 27, 2021. https://www.cdc.gov/nchs/covid19/rands/reduced-access-to-care.htm 5.Sen CK. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care (New Rochelle). 2021;10(5):281-292. Accessed October 27, 2021. https://doi.org/10.1089/wound.2021.0026 6.Armstrong DG. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 27, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-... 7.Johnson J. Internet usage in the United States: statistics & facts. Statista. August 4, 2021. Accessed October 27, 2021. https://www.statista.com/topics/2237/internet-usage-in-the-united-states 8.Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1595-1599. Accessed October 27, 2021. https://doi.org/10.15585/mmwr.mm6943a3
Dermlin series are developed by Jiangsu Yenssen Biotech Co., Ltd. as the advanced functional dressing in the world, containing inorganic formula with nano pores granule which has significant effects of neutralizing acidic exudation of the wound, preventing secondary infection, accelerating a proliferation of the human epithelial cells, resulting in fast healing and less scar formation.
1. Which of the following conditions cannot be used with a Band-Aid? (single choice) A. Small and deep wounds, scalds, foreign bodies in wounds, iron nail wounds, allergic to adhesive plaster B. Animal scratch bites, various skin furuncles (acute suppurative infection, formation of large red masses) C. Neither option a nor option b can be used! D. Any situation can be used!
2. How to deal with the wound before applying the band-aid? (single choice) A. Rinse the wound with clear water, then stick a Band-Aid B. Spit some saliva to clean the wound, then stick a Band-Aid C. Simple disinfection, rinse D. What to do with physiological saline? Post it directly!
3. How long does it take to replace the wound with a new bandage? (single choice) A. Change every three days B. Change every two days C. Change at least once a day D. Use one band-aid for the aged.
4. how long is the band-aid valid? (single choice) A.6 months
B.1 years
C.3 years
D. band-aid has no validity period!
5. Which is more reliable, Band-Aid or Gauze? (single choice) A. is unreliable
B. band-aid
C. gauze
D. toilet paper only
The results of the self-test show that the parents who chose C for all the questions: Congratulating you all for choosing the right one, it seems that all the parents already know how to use the band-aid! Parents who choose other options: be careful as long as you have a question that does not choose c! Band-Aids do bring convenience to our life, but there are also many precautions when using Band-Aids. If it is not used properly, the wound may deteriorate and infection may lead to amputation! A small band-aid is regarded by many people as a “golden oil”, but do you know? Band-Aids cannot be used indiscriminately either. A girl was amputated if she did not use Band-Aids properly. A 4-year-old girl was admitted to a hospital in Suzhou. The middle finger of the girl’s left hand was blackened and had necrosis for several days. Amputation was needed to prevent the disease from deteriorating further. Surprisingly, the necrosis of the girl’s finger was caused only by a small band-aid after the injury. However, due to improper handling afterwards, the blood circulation of the finger was impeded and eventually necrosis occurred. How can I use the Band-Aid correctly? Which wounds can’t be treated with band-aids? Don’t worry, health king told you!Have you been successful in using the Band-Aid?
Myth 1: Band-aid is a panacea
Band-aid is mainly used for some small and shallow wounds, especially for cuts that are neat, clean, bleeding little and do not need stitching, such as knife cuts, cuts, glass cuts, etc.Correct approach:
For large, deep and foreign body wounds, band-aid should not be used. In this case, you should go to the hospital in time. Band-Aid is not suitable for contaminated or infected wounds, such as severe skin abrasions, burns, etc. As for folliculitis, furuncle, suppurative infection wounds and various skin diseases, band-aid is not suitable.
Myth 2: Band-aid can be pasted casually.
When we use band-aid stickers, we always try to make things convenient and stick things casually, which is incorrect. Correct approach: Before using Band-Aid, first check whether there is dirt left in the wound. If there is dirty matter, clean the wound with sterilized normal saline before applying Band-Aid. If the wound is punctured by iron nails and other materials and is relatively deep, it should be treated in hospital immediately and tetanus antitoxin should be injected. Secondly, after the band-aid is opened, contamination of the drug surface should be avoided. During application, the medicine surface must be aligned with the wound, and slightly press on both sides of the wound after application.
Myth 3: Band-Aid Can Be Lasted
Sticking band-aid to a wound does not mean “everything is fine”, nor can it be stuck for a long time and ignored. Correct approach: If there is “pulsating pain” similar to pulse beating or secretion overflow at the wound after 24 hours of application of band-aid patch, open it in time to observe whether there is red swelling and hot pain around the wound. If yes, the wound has been infected and should be treated by a doctor immediately. After using Band-Aid, do not pinch the wound with your hand frequently. The wound should move as little as possible to prevent collision and prevent the wound from splitting. Band-Aids should not be used for too long. They should be changed every day.
Myth 4: waterproof band-aid is not afraid of water.
The waterproof band-aid does not allow long-term contact with water. If the band-aid is not tightly adhered to the skin around the wound, especially in special parts, such as fingertips, knees and elbows, the waterproofing will also become less “waterproof”. Everyone knows the mistake of using Band-Aid, but do you really know how to use Band-Aid? The dressing method of the band-aid is also asked by the university. It is not simply to tear it apart and stick it around the wound. This kind of sticking method is firmer. You have to do this first: Prepare the Band-AidCut the band-aid along the dotted line in the figure.It’s okay to be like this Joint sticking: First, move the top left to the rightThen turn the upper right to the leftThe following two methods are as above
Complete First, move the upper left to the lower right.Then turn the upper right to the lower leftThen the left and right sides are attached in parallel.
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