Question

1) Describe major historical events in development of contemporary wound care (pressure ulcer care)( 50-100 word)

2)

19)   Wound Specimens
Briefly describe the following types of wound specimen:

19.1)   Wound Swab

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19.2)   Wound Fluid Sample

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19.3)   Deep tissue biopsy

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20)   Haematology and Wound Healing
Briefly explain following lab tests and its relation on wound healing( 30-50 word each)

20.1)   Haemoglobin and Haematocrit

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20.2)   Leucocytes

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20.3)   Thrombocytes

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20.4)   Serum albumin

Answer 1

The history of wound healing is, in a sense, the history of humankind. One of the oldest medical manuscripts known to man is a clay tablet that dates back to 2200 bc. This tablet describes, perhaps for the first time, the “three healing gestures”—washing the wounds, making the plasters, and bandaging the wound.

The history of wound care spans from prehistory to modern medicine. Wounds naturally heal by themselves, but hunter-gatherers would have noticed several factors and certain herbal remedies would speed up or assist the process, especially if it was grievous. In ancient history, this was followed by the realisation of the necessity of hygiene and the halting of bleeding, where wound dressing techniques and surgery developed. Eventually the germ theory of disease also assisted in improving wound care.

What the ancients and early moderns referred to as plasters is the present-day equivalent of wound dressings. These plasters were mixtures of substances including mud or clay, plants, and herbs. Plasters were applied to wounds to provide protection and to absorb exudate. One of the most common ingredients used in plasters was oil. Oil may have provided some protection from infection as bacteria grow poorly in oil, and oil would have prevented the bandage from sticking to the wound as a nonadherent dressing.

Over time, different civilizations began to create their own herbal medicinal treatments for wounds depending on the trees, shrubs, or any other type of plants located in their environment. These herbal treatments became the oldest form of wound therapy. It is logically assumed that this may not have been a very safe way of treating humans with wounds due to overdosing or choosing the wrong plants to treat a person until the right one was found. Nevertheless, most of the ancient people who were given the duty of healers through the usage of herbs were well accustomed with which plants from their local flora could be used to help the injured. This knowledge was learned and passed down after healers repeatedly used an herbal remedy for a specific wound with the belief that it promoted healing.

Numerous ancient herbal remedies and poisons now serve as models for modern medicine. For example, curare, which was an ancient South American arrow poison, was used in the 20th century as the muscle relaxant tubocurarine. Tribesmen conducted various observations on the effects of different plant parts, meaning roots, leaves, etc., on specific wounds. They also observed what seasons, time of day, or moon phase would result in a most active plant. The former however resulted in a minimal influence in modern medicine as compared to plants parts or seasons of growth.

The Egyptians may have been the first people to use adhesive bandages and were most certainly the first people to apply honey to the wounds. Honey, grease, and lint were the main components of the most common plaster used by Egyptians. Lint made from vegetable fiber probably aided drainage of the wound; grease and honey may have protected the wound from infection. Grease made from animal fat may have provided a barrier to bacteria. While honey appears to be an effective antibacterial agent, it has many other healing properties. Honey has been used for thousands of years and is still part of many advanced wound dressings. Honey was also used for wound care in India long before the time of Christ, demonstrating that separate medical cultures empirically arrived at the same successful therapy.

The Greeks stressed the importance of cleanliness. They recommended washing the wound with clean water, often boiled first, vinegar (acetic acid), and wine. The Greeks also differentiated between “fresh,” or acute, and nonhealing, or chronic, wounds. One of the interesting excerpts from the Hippocratic collection about wound healing is, “For an obstinate ulcer, sweet wine and a lot of patience should be enough.” An early description of the “four cardinal signs of inflammation”—rubor, tumor, calor, et dolor (redness, swelling, heat, and pain)—came from the Romans.

It was not until the 18th century that surgery began to be considered as a distinct and respected branch of medicine. In the 19th century, the antiseptic technique was a major breakthrough. The introduction of antibiotics helped control infections and decrease mortality.

In the 20th century came the advent of modern wound healing. At the present time, there are more than 5,000 wound care products. Most modern dressings contain materials that are highly absorbent, such as alginates, foam, or carboxymethylcellulose. There are occlusive dressings and semiocclusive dressings. There are growth factors, advanced honey-based dressings, and hypochlorous acid–based cleansers. Bioengineered tissue, negative pressure therapy, and hyperbaric oxygen therapy have changed the way we treat a lot of chronic wounds today.

In summary, The first wound treatments were described 5 millennia ago. Since then, various principles of wound care have been passed on from generation to generation. In contrast to large numbers of general technological inventions over the past 100 years, progress beyond ancient wound care practices is a recent phenomenon. It is essential to know the historical aspects of wound treatment (both successes and failures) in order to continue this progress and provide future direction.

19.1)   Wound Swab
A sterile swab may be used to collect cells or pus from a superficial wound site. From deeper wounds, aspirations of fluid into a syringe and/or a tissue biopsy are the optimal specimens to allow for the recovery of aerobic and anaerobic bacteria.

19.2)   Wound Fluid Sample
A culture is performed by collecting a sample of fluid, cells or tissue from the wound and placing it on or in appropriate nutrient media. Typically, only one kind of pathogenic bacteria is causing the infection in a wound. However, there may be several types of normal skin bacteria present in the culture.

19.3)   Deep tissue biopsy
A biopsy is a medical procedure to remove a small piece of tissue or sample of cells from the body for physical (through a microscope) or chemical examination. A biopsy can be conducted on any area of the body, and is the only diagnostic technique able to definitively identify cancerous tissue and cells.

20)   Haematology and Wound Healing
Haematology is the specialty responsible for the diagnosis and management of a wide range of benign and malignant disorders of the red and white blood cells, platelets and the coagulation system in adults and children. Haematologists care directly for patients on hospital wards and out patient clinics.
Wound healing is a complex process in which the skin, and the tissues under it, repair themselves after injury. In this article, wound healing is depicted in a discrete timeline of physical attributes (phases) constituting the post-trauma repairing process.

20.1)   Haemoglobin and Haematocrit
Hemoglobin or haemoglobin, abbreviated Hb or Hgb, is the iron-containing oxygen-transport metalloprotein in the red blood cells of almost all vertebrates as well as the tissues of some invertebrates. Haemoglobin in blood carries oxygen from the lungs or gills to the rest of the body.
The hematocrit, also known by several other names, is a blood test that measures the volume percentage of red blood cells in blood. The measurement depends on the number and size of red bloods cells. It is normally 40.7% to 50.3% for men and 36.1% to 44.3% for women.

20.2)   Leucocytes
White blood cells (also called leukocytes or leucocytes and abbreviated as WBCs) are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders.

20.3)   Thrombocytes
Thrombocytes are pieces of very large cells in the bone marrow called megakaryocytes. They help form blood clots to slow or stop bleeding and to help wounds heal. Having too many or too few thrombocytes or having platelets that don't work as they should can cause problems.

20.4)   Serum albumin
Human serum albumin is the serum albumin found in human blood. It is the most abundant protein in human blood plasma; it constitutes about half of serum protein. It is produced in the liver. It is soluble in water and monomeric.