Table Of ContentTissue
Viability
The prevention, treatment and
management of wounds
SYLVIEHAMPTON, MA, BSC(HONS), DPSN, RGN
and
FIONACOLLINS, MSC, DIPCOT, SROT
with contributions from
Katherine Martyn, BSc, BED, DipNS, SRN, RNT
Kate Springett, BSc, BED, DipNS, SRN, RNT
Mathew Philip, BSc(Hons), PhD, CEng, CPhys,
M Inst, MIM
and
Leyton Stevens, MBA
W
WHURR PUBLI S HERS
LOND ON AND P HIL ADELPH IA
Tissue Viability
The prevention, treatment
and management of wounds
Acknowledgement
The editors and publisher are grateful for the
support of the following companies.
Sareo Health Care
and
Smith and Nephew
Tissue
Viability
The prevention, treatment and
management of wounds
SYLVIEHAMPTON, MA, BSC(HONS), DPSN, RGN
and
FIONACOLLINS, MSC, DIPCOT, SROT
with contributions from
Katherine Martyn, BSc, BED, DipNS, SRN, RNT
Kate Springett, BSc, BED, DipNS, SRN, RNT
Mathew Philip, BSc(Hons), PhD, CEng, CPhys,
M Inst, MIM
and
Leyton Stevens, MBA
W
WHURR PUBLI S HERS
LOND ON AND P HIL ADELPH IA
© 2004 Whurr Publishers Ltd
First published 2004
by Whurr Publishers Ltd
19b Compton Terrace, London N1 2UN England and
325 Chestnut Street, Philadelphia PA 19106 USA
Reprinted 2005
All rights reserved. No part of this publication may be repro-
duced, stored in a retrieval system, or transmitted in any form or
by any means, electronic, mechanical, photocopying, recording
or otherwise, without the prior permission of Whurr Publishers
Limited.
This publication is sold subject to the conditions that it shall not,
by way of trade or otherwise, be lent, resold, hired out, or other-
wise circulated without the publisher’s prior consent in any form
of binding or cover other than that in which it is published and
without a similar condition including this condition being
imposed upon any subsequent purchaser.
British Library Cataloguing in Publication Data
A catalogue record for this book
is available from the British Library.
ISBN 1 86156 237 3
Printed and bound in the UK by Athenaeum Press Ltd,
Gateshead, Tyne & Wear.
Contents
Preface vii
Introduction ix
Chapter 1 1
The skin and wound healing
Chapter 2 40
Holistic wound assessments
Chapter 3 76
Dressings and treatments
Chapter 4 132
Wound infection and colonization
Chapter 5 160
Assessment, management and treatment of leg and foot
ulceration
Chapter 6 211
Nutrition and wound healing
Katherine Martyn
Chapter 7 224
Surgical wounds
v
vi Tissue Viability
Chapter 8 240
Fungating tumours
Chapter 9 255
Pressure ulcer prevention
Chapter 10 311
The relationship of seating to pressure ulcer prevention
Chapter 11 342
Foam technology and its role in wound management and prevention
Fiona Collins, Kate Springett, Mathew Philip, Leyton Stevens
and Sylvie Hampton
Chapter 12 376
The process of audit and research in tissue viability
Chapter 13 391
Ethics, the law and accountability in wound care
Chapter 14 406
The specialist nurse in wound management
Appendix 1 425
Some recognized dressings
Bibliography 445
Index 475
Preface
There are many excellent books written on wound management,
mainly for nurses with basic knowledge of tissue viability, or, on a
higher level, for tissue viability specialists and doctors. This book
provides a comprehensive and extensive view of wound prevention,
management and treatment and will be useful to all tissue viability
enthusiasts, whether requiring basic or advanced information. The
nursing student will be able to obtain the information they require at
a level that suits them, whilst nurses with previous knowledge of
wound management, specialist nurses, physiotherapists, occupa-
tional therapists and doctors will find useful and advanced informa-
tion and tips. There are 14 chapters with each chapter devoted to a
different aspect within tissue viability. It will be up to the individual
reader to select where their level is at present and use the chapters
accordingly. The book is a mixture of evidence-based nursing and
the reality of wound care, and is based on the authors’ and contribu-
tors’ years of experience and knowledge gained acting as Tissue
Viability Nurse and Tissue Viability Consultant, a Senior Lecturer
in Occupational Therapy and Tissue Viability Consultant, a Senior
Lecturer in Nursing, a Senior Lecturer in Podiatry and a Senior
Lecturer at the University of Brighton.
Whilst this book concentrates on the technical and scientific
aspects of wound healing, it also investigates the philosophy of holis-
tic patient assessment, providing the practitioner with guidance in
treatment or prevention of individual patient wounds. The informa-
tion is derived from researched evidence and also draws on the expe-
riences of the authors, with examples provided in the form of case
studies and anecdotes. The contents cover every aspect of wound
vii
viii Tissue Viability
management, such as prevention and treatment of pressure ulcers,
wound treatment, undertaking clinical audit, the role of the specialist
nurse, ethics and treatment of leg ulcers.
Discussion of audit and how audit of wound and pressure injury
prevention can be used to develop research and good practice in
tissue viability is included. An audit tool is provided, which has been
developed to offer a method of prevalence audit and will be useful to
tissue viability nurses or hospital trusts, nursing homes and commu-
nity nurses wishing to undertake audit in pressure ulcers.
Advances in wound management are covered along with the
authors’ own experiences in using leeches, maggot therapy and
vacuum-assisted closure. Bacterial resistance to antiseptics and
antibiotics, use of antiseptics in wound care, infection and the future
for treatment of methicillin-resistant Staphylococcus aureus is included.
The microbiology of wounds, how wounds heal and the part that
wound dressings play in the provision of the optimum wound healing
environment in colonized or infected wounds are reviewed.
The broad scope of this book is designed to enable practitioners,
whether nurse, doctor, physiotherapist or occupational therapist, to
develop knowledge of wound management, how pressure ulcers may
be prevented and to develop understanding, practice and research
appreciation. The purpose of the book is to probe deeper than just
practical issues in wound management and to enable practitioners to
provide high quality service in tissue viability. Dedication and knowl-
edgecanmade a difference to healing in a wound.
