Wound Healing and Skin Integrity -- Contents -- List of Contributors -- Preface -- Acknowledgements -- Section 1 Principles of Best Practice -- 1 Evidence and Clinical Decision-making -- Introduction: what is effective clinical decision-making? -- What is evidence-based health care? -- Common misperceptions about evidence-based practice -- How does evidence fit into clinical decision-making in clinical practice? -- Challenges to changing practice -- Factors influencing clinical judgement -- Evidence-based practice: hierarchy of evidence -- Systematic reviews -- Randomised controlled trials -- Evidence-informed decisions -- Critical appraisal frameworks -- Clinical guidelines -- Summary -- Useful resources -- Canadian resources -- European resources -- International resource -- Useful critical appraisal frameworks -- Further reading -- References -- 2 Maintaining Skin Integrity -- Introduction -- Skin integrity and barrier function -- The epidermis as a physical barrier -- The epidermis as a chemical barrier -- The epidermis as an immunological barrier -- Impaired skin barrier function in the clinical setting -- Effect of age on skin barrier function -- Effect of humidity and moisture on skin barrier function -- Incontinence-associated dermatitis (IAD) -- Management of vulnerable skin -- Dry skin -- Principles of emollient use -- Irritant-associated dermatitis -- Summary -- Useful resources -- Guidelines -- Useful websites -- References -- 3 Physiology of Wound Healing -- Introduction -- Types of wound healing -- Primary closure -- Secondary closure -- Delayed primary closure -- Wound chronicity -- Normal wound healing -- The role of wound exudate -- Optimising healing: general factors -- Optimising healing: local factors -- Wound hypoxia -- Bioburden -- Wound pH -- Wound temperature -- Delayed wound healing -- Tissue repair in chronic wounds.

The inflammatory response -- Proliferation of new tissue -- Wound closure -- Wound contraction -- Scar maturation and collagen modulation -- Abnormal scarring -- Summary -- Useful resources -- References -- 4 Assessing Skin Integrity -- Introduction -- Assessing skin integrity -- Listening: problem orientation and knowledge -- Looking: problem clarification and knowledge construction -- Touch: hands on fact finding -- Smell: subconscious information gathering -- Assessing wounds -- Wound bed preparation -- Data collection -- Investigations -- Wound measurement -- Wound photography -- Effective documentation -- When to seek specialist help? -- Summary -- Useful resources -- References -- 5 Principles of Wound Management -- Introduction -- Principles of wound management -- Effective wound management -- Controlling bacterial burden: wound cleansing -- Temperature -- Types of wound cleanser -- Method of cleansing -- Controlling bacterial burden: wound debridement -- Autolytic debridement -- Enzymatic debridement -- Biosurgical debridement -- Mechanical debridement -- Sharp debridement -- Conservative sharp debridement -- Surgical debridement -- Hydrosurgical debridement -- Ultrasound (acoustic pressure wound therapy) -- Regulating moisture balance -- Wound dressings -- Dressing selection -- Types of wound dressings -- Passive inert dressings -- Passive inert absorbent dressings -- Passive inert non-absorbent dressings -- Interactive dressings -- Non-absorbent interactive dressings -- Polyurethane film dressings -- Silicone/polyurethane wound contact materials -- Absorbent interactive dressings -- Alginate dressings -- Hydrocolloid dressings -- Hydrofibre dressings (gelling fibres) -- Hydrogels -- Protease modulating dressings -- Polyurethane foam dressings -- Antibacterial dressings -- Cadexomer iodine dressings -- Honey dressings -- Silver dressings.

Polyhexamethylene biguanide (PHMB) -- Negative Pressure Wound Therapy -- Summary -- Useful resources -- References -- 6 Wound Infection -- Introduction -- Bacterial invasion of the skin -- Wound pathogens -- Factors increasing the risk of wound infection -- The significance of bacteria within wounds -- Contamination -- Colonisation -- Infection -- Significance of biofilms -- Identifying wound infection -- Clinical signs and symptoms -- Microbiological assessment of wounds -- Obtaining accurate wound cultures -- Interpretation of results -- Principles of managing infected wounds -- Improving immune status -- Reducing wound bioburden -- Antimicrobial treatment -- Symptom management -- Summary -- Useful resources -- References -- 7 Psychological Impact of Skin Breakdown -- Introduction -- Psychological impact on the individual and society -- Adaptation to chronic illness -- Stress and skin disease -- Depression -- Adjustment to physical change/disfigurement -- Coping strategies -- Social support -- Body image -- Living with skin breakdown and chronic wounds: symptom management -- Measuring impact of skin breakdown -- Factors affecting treatment -- Interventions -- Clinical reflection -- Summary -- Useful resources -- References -- Section 2 Challenging Wounds -- 8 Pressure, Shear and Friction -- Introduction -- Prevalence and incidence -- Pathophysiology -- Pressure -- Friction -- Risk factors -- Psychological impact -- Current best practice -- Prevention strategies -- Pressure ulceration: assessment considerations -- Classification of pressure ulcers -- Risk assessment -- Skin inspection -- Nutritional screening and assessment -- Treatment strategies: pressure ulcers -- Skin care -- Repositioning -- Pressure-redistribution support surfaces -- Management of infection -- Wound dressings: special considerations -- Education and support.

Criteria for specialist referral -- Summary -- Useful resources -- Clinical guidelines -- Organisations -- Further reading -- References -- 9 Diabetic Foot Disease -- Introduction -- Aetiology -- Psychological impact -- Principles of diabetic foot ulcer management -- Diabetic foot ulceration: assessment considerations -- Assessment of vascular status -- Assessment of wound infection -- Management of diabetic foot ulcers -- Vascular intervention -- Foot surgery and amputation -- Debridement -- Infection in diabetic foot wounds -- Osteomyelitis -- Offloading - non-weight-bearing -- Wound dressings: special considerations -- Foot care -- Education and support -- Provision of specialist diabetic foot services -- Criteria for specialist referral -- Summary -- Useful resources -- References -- 10 Chronic Ulcers of the Lower Limb -- Introduction -- Epidemiology -- Comorbidities and underlying pathologies -- Rheumatoid arthritis and vasculitis -- Venous leg ulceration -- Factors that affect venous return -- Increasing age -- Deep vein thrombosis -- Venous reflux -- Oedema -- Increased pelvic congestion -- Muscle wasting -- Immobility -- Arterial ulceration -- Mixed venous arterial ulcers -- Rarer leg ulcer aetiologies -- Tropical ulcers -- Psychological impact -- Principles of managing leg ulcers -- Leg ulceration: assessment considerations -- Skin assessment -- Tissue grading -- Vascular assessment for arterial disease -- Limb circumference measurement -- Pain assessment -- Mobility assessment -- Management of chronic oedema in leg ulcers -- Compression therapy -- Compression bandaging -- Compression hosiery -- Wound dressings: special considerations -- Prevention of ulcer recurrence -- Education and support -- Provision of specialist services -- Criteria for specialist referral -- Summary -- Useful resources -- Clinical guidelines -- Useful websites.

Further reading -- References -- 11 Lymphoedema -- Introduction -- Pathophysiology -- Risk factors -- Psychological impact -- Current best practice -- Prevention strategies: risk factor management -- Skin -- Lifestyle -- Avoid limb constriction -- Compression garments -- Avoid extremes of temperature -- Additional practices specific to lower extremity lymphoedema -- Lymphoedema: assessment considerations -- Limb volume assessment -- Assessment of skin condition -- Pain assessment -- Nutrition (obesity assessment) -- Functional assessment -- Staging lymphoedema -- Treatment strategies -- Transition management -- Long-term management -- Manual lymphatic drainage -- Exercise -- Managing the skin in lymphoedema -- Management of infection -- Compression therapy -- Multilayer lymphoedema bandaging -- Bandaging techniques -- Intermittent pneumatic compression -- Compression stockings/garments -- Other therapies -- Surgical intervention -- Pharmacological management -- Education and support -- Provision of specialist services -- Criteria for specialist referral -- Summary -- Useful resources -- Useful websites -- References -- 12 Malignant Wounds -- Introduction -- Malignant wounds: aetiology -- Psychological impact -- Principles of palliative wound management -- Malignant wounds: assessment considerations -- Management of malignant wounds -- Cancer therapy options -- Pain -- Malodour -- Exudate -- Itching and skin irritation -- Infection -- Bleeding -- Radiation skin damage -- Management of radiotherapy skin reactions -- Wound dressings: special considerations -- Education and support -- Provision of specialist services -- Criteria for specialist referral -- Summary -- Useful resources -- References -- 13 Skin Integrity and Dermatology -- Introduction -- Prevalence and incidence of skin disease -- Quality of life -- Cost of skin diseases.

What skin conditions are common?.