Wound Care and Tissue Viability
Wound care and tissue viability is a critical nursing competency in the UAE, where the high prevalence of diabetes (approximately 17% of adults) creates a large population at risk of diabetic foot ulcers and chronic wounds. Nurses must understand the science of wound healing, factors that impair healing, and evidence-based wound management strategies. For the DOH (UAE) examination, wound care questions test both your clinical knowledge and your ability to apply that knowledge in patient care scenarios.
🟢 Lite — Quick Review (1h–1d)
Rapid summary for last-minute revision before your exam.
Wound Healing Phases (In Order):
- Haemostasis (minutes–hours): Platelet plug formation, fibrin clot
- Inflammatory phase (Days 1–3): WBCs clear debris; redness, warmth, swelling; neutrophils and macrophages
- Proliferative phase (Days 3–21): Granulation tissue formation; angiogenesis; collagen deposition; wound contraction
- Remodelling/Maturation (3 weeks–2 years): Collagen remodelling; scar maturation; tensile strength increases to ~70–80% of original
Tissue Types:
- Granulation tissue: Pink, moist, beefy red — healthy; bleeds easily
- Slough: Yellow, moist, stringy — fibrinous exudate; needs debridement
- Necrotic/eschar: Black, dry, leathery — dead tissue; debride if present over pressure points or infection
Signs of Wound Infection (RIPE):
- Redness beyond wound margin
- Inflammation (persistent warmth)
- Pain (new or worsening)
- Exudate (purulent or increased)
⚡ Exam Tip: A wound that fails to heal despite appropriate management should prompt assessment for underlying causes: Ischaemia, infection, malnutrition, diabetes, immunosuppression, or malignancy. Never assume a non-healing wound is simply due to poor dressing technique.
🟡 Standard — Regular Study (2d–2mo)
Standard content for students with a few days to months.
1. Wound Classification
By Healing Intention:
- Primary intention: Edges approximated surgically (e.g., surgical incision); minimal tissue loss; heals quickly with minimal scar
- Secondary intention: Wound left open to heal by granulation from base (e.g., pressure ulcer); tissue loss; larger scar
- Tertiary/delayed primary: Wound initially left open, closed surgically after 3–5 days (e.g., contaminated traumatic wound)
By Contamination Level:
- Clean (no infection)
- Clean-contaminated
- Contaminated
- Dirty/infected
2. Dressing Selection
| Wound Condition | Dressing Choice |
|---|---|
| Dry, superficial | Gauze (passive); film dressings |
| Light exudate | Foam dressings; hydrocolloids |
| Moderate exudate | Alginate dressings; hydrofibre |
| Heavy exudate | Superabsorber dressings; alginate; negative pressure wound therapy |
| Sloughy | Hydrogel; hydrocolloid; enzymatic debridement |
| Necrotic (dry eschar) | Hydrogel to soften; surgical/sharp debridement |
| Infected | Antimicrobial dressings (silver, honey, PHMB); consider systemic antibiotics |
| Granulating | Non-adherent dressings; maintain moist environment |
| Painful | Soft silicone dressings (Mepitel); foam |
3. Debridement Methods
- Sharp/surgical: Most rapid; scalpel or scissors; done by trained clinician
- Mechanical: Wet-to-dry dressings (controversial — painful, non-selective)
- Enzymatic: Collagenase (Santyl) ointment applied to wound
- Autolytic: Hydrocolloid or hydrogel; body’s own WBCs digest necrotic tissue; slow; contraindicated in infected wounds
- Biological (maggot therapy): Lucilia sericata larvae; selectively digest necrotic tissue; used in some UAE facilities
🔴 Extended — Deep Study (3m+)
Comprehensive coverage for students on a longer study timeline.
4. Pressure Injuries — Full Staging and Management
Pressure injuries are a major quality indicator in UAE healthcare facilities, tracked and reported as part of clinical governance.
NPUAP Staging:
| Stage | Description |
|---|---|
| 1 | Non-blanchable erythema; intact skin; localized red area over bony prominence |
| 2 | Partial-thickness skin loss; shallow open ulcer; red-pink wound bed; no slough |
| 3 | Full-thickness skin loss; subcutaneous fat visible; granulation tissue; slough may be present |
| 4 | Full-thickness tissue loss; muscle/bone/tendon visible; slough or eschar present |
| Unstageable | Base covered by slough (yellow/tan) or eschar (brown/black); cannot be staged until debrided |
| DTI | Intact skin with non-blanchable maroon/purple discolouration; localized area of deep tissue damage |
Braden Scale for Pressure Injury Risk Assessment:
- Score 6–23 (lower score = higher risk)
- Subscale: Sensory perception, Moisture, Activity, Mobility, Nutrition, Friction/Shear
- Score ≤12 = High risk → initiate prevention bundle
Pressure Injury Prevention Bundle:
- Reposition every 2 hours (or more frequently)
- Skin assessment daily (or at every shift)
- Use pressure-relieving mattresses/cushions
- Keep skin clean and dry
- Nutritional support
- Manage moisture (incontinence management)
5. Diabetic Foot Ulcers — UAE Context
The UAE has a dedicated Diabetic Foot Programme, as diabetic foot ulcers are a leading cause of hospitalisation and amputation.
Wagner Classification:
- Grade 0: Pre-ulcerative lesion
- Grade 1: Superficial ulcer
- Grade 2: Deeper ulcer involving tendon/bone
- Grade 3: Deep ulcer with abscess/osteomyelitis
- Grade 4: Forefoot gangrene
- Grade 5: Whole foot gangrene
Management Principles:
- Debridement of callus and necrotic tissue
- Wound dressings (maintain moist environment)
- Offloading (removing pressure from ulcer site — total contact cast, felted foam, orthopaedic shoes)
- Infection management (broad-spectrum antibiotics → culture-directed)
- Glycaemic control (tight control accelerates wound healing)
- Revascularisation if ischaemia present
- Amputation if non-healing despite optimal care
Exam Watch: A pressure injury that develops in hospital is considered a preventable complication and a quality indicator. The DOH examiner may test whether a nurse failed to reposition a patient, failed to document skin assessment, or failed to escalate a deteriorating wound. Conversely, a pressure injury over a bony prominence in an immobile patient who was not repositioned may be deemed a nursing care failure.
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