Physiology of Wound and Healing: Case Study Analysis

This article explores the physiology of wound and healing through a case study analysis of a 21-year-old woman with an infected laceration on her left foot. It covers the causes of laceration wounds, the signs of infection, and the phases of wound healing. It also discusses exogenous and endogenous pathogens, antibiotic therapy, and adverse reactions. The article is relevant for students studying physiology, nursing, and medicine.

Running head: PHYSIOLOGY OF WOUND AND HEALING
Physiology of wound and healing
Name of the student:
Name of the university:
Author note:

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PHYSIOLOGY OF WOUND AND HEALING
Table of Contents
Question 1:.......................................................................................................................................2
Question 2:.......................................................................................................................................3
Exogenous source:.......................................................................................................................3
Endogenous pathogen:.................................................................................................................4
Question 3:.......................................................................................................................................4
For ceftriaxone:............................................................................................................................4
Oral cephalexin:...........................................................................................................................5
Oral dicloxacillin:........................................................................................................................5
Adverse reaction of dicloxacillin:................................................................................................5
Question 4:.......................................................................................................................................5
References:......................................................................................................................................7

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Question 1:
This case study represents the case of a 21 years old young woman named Mary who
had presented to the emergency department with the compliant of an infected laceration on her
left foot. The patient described the origin of attaining the wound in a beach resort 4 days ago
where she stepped on a broken glass bottle and attained a deep 2 cm long jagged laceration over
the lateral aspect of her left foot. The patient further informed that after attaining the wound in
the beach she used her handkerchief to cover the wound and stop bleeding. The patient
mentioned that as she woke in the morning that day, her laceration wound was extremely painful,
swollen, and also had a purulent discharge.
Exploring the physiology of the laceration can be defined as a torn or jagged wound
which is generally caused by sharp objects (Theoret, 2016). Laceration is a type of wound that
causes irregular wound, and as the wound that the patient attained was 2 cm long and has the
chances of seeping into the subcutaneous tissues including underlying muscle, internal organs, or
bone. Such laceration wounds are accompanied by pain and significant bleeding. It has to be
mentioned that the most important course of action in case of laceration wounds are to terminate
the bleeding using sterilized techniques. In this case, the patient used her handkerchief to
bandage the wound which can be a contaminated piece of clothing transferring bacteria to the
wound and facilitating the infection of the laceration wound, which had been the case for the
patient in the case study as well (Wroblewski, Siney& Fleming, 2016).
The observations of the wound had been painful and swollen, appearing red and warm to
touch, along with having a purulent discharge. It has to be mentioned that inflammation is the
most common clinical manifestation of infection which is generally localized to the wound

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tissue. The redness observed in the wound and the surrounding tissue is generally concerned as
the normal inflammatory process of the wound healing, however for persistent and expanding
redness indicated infection progress under the tissue. Along with that, the purulent discharge or
pus discharge is a tell-tale sign of infected wound (Harper, Young &McNaught, 2014). This
purulent discharge, also known as Liquor puris, is the protein rich fluid that is whitish-yellow or
brown-yellow in colour that accumulates at the site of infection as a result of the process of
pathogenic proliferation. Lastly, the wound was also appearing warm to touch which indicates
that the innate response of the immune system of the body to fight the infection that has
occurred.
Question 2:
Exogenous source:
Exogenous contamination is one of the most common type of contamination that is
reported to infect the wound sites. The most common exogenous pathogen that can infect the
laceration wound as depicted in the case study is Pseudomonas aeruginosa. It has to be
mentioned that the patient had sustained this wound while walking on the beach and had used her
handkerchief to bandage the wound. Hence, it can be stated that the wound was properly
bandaged and was exposed to the microbiota and causing the infection. P.aeruginosais a very
common pathogen that causes wound infections very commonly (Serra et al., 2015).
Pseudomonas aeruginosais a very common gram negative, opportunistic bacteria that
causes severe acute infections, specially causing wound and burn infections. It is an
opportunistic and ubiquitous bacteria that is found mostly in soil and water. It has to be
mentioned that the patient had been on the beach while she attained this wound and used the
handkerchief that she had been using while spending her day at the beach. Hence, it is very easy

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for the pathogen to infect the wound via direct transmission by either the infected glass bottle or
the though the handkerchief she used to bandage the wounds (Serra et al., 2015). For new host,
the infection can be facilitated by direct contact via the hands of the care staff in case they are
not following the hand hygiene protocol properly (Marieb & Hoehn, 2016).
Endogenous pathogen:
Endogenous pathogens are the microflora that are found in the body of the humans that
can opportunistically cause infections (Lee & Bishop, 2012). The most common type of
endogenous pathogen which is known for causing the endogenous infections, especially the
wound infections is the Staphylococcus aureus. This is most common pathogenic bacteria found
to inhabit the human skin and can easily infect any wound site by invading the tissues via the
broken skin (Krezalek et al., 2018).
The mode of transmission for this pathogenic bacteria is the direct contact mode of
transmission. Anyone coming in direct contact with the wound of the patient will be the likely
host for the bacteria to contaminate, hence the health care staff caring for Mary are at risk for
infection. Along with that, anyone coming into contact with the supply material or equipment
that have been used for Mary and have not been sterilized can acquire the infection as well
(Krezalek et al., 2018).
Question 3:
For ceftriaxone:
The regular treatment for wound infection begins with antibiotics, generally broad
spectrum and with higher plasma half-life to ensure optimal efficiency against the infection.
Ceftriaxone is a very commonly used broad spectrum antibiotic that is produced from

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Cephalosporiumacremonium (Craft et al., 2015). This particular antibiotic has a considerably
higher plasma half-life and is also very effective against a broad range of pathogens (Anand,
Batra, Arora, Atwal &Dahiya, 2016). Hence, it is the most common choice of antibiotic which
was given to Mary and it is most effective in intramuscular IV administration hence a stat dose
of IV ceftriaxone was given to Mary.
Oral cephalexin:
In case wound infection treatment, the initial administered of IV antibiotic is followed
with a milder oral antibiotic. Cephalexin is a common mild oral antibiotic belonging to the class
of cephalosporin. It is a systemic antibiotic prescribed for skin infection, wound infection and ear
infections (Dalen, Fry, Campbell, Eppler& Zed, 2018). This mild antibiotic mimics the
mechanism of action of penicillin stopping the growth of the pathogen by disrupting the cell wall
production of the bacteria, hence it has a very effective bacteriostatic action, and hence, was
administered to Mary.
Oral dicloxacillin:
The most common type of wound or skin infections are caused by strains of
Staphylococcus, which is mostly resistant to cephalosporin group of antibiotics. In this case, the
wound observations indicated the infection being caused by S. aureus. Hence, cephalexin was
discontinued for Mary and dicloxacillin was administered which was also gold standard
antibiotic to be used for staph infections (Nissen et al., 2013).
Adverse reaction of dicloxacillin:
Adverse reactions are heartburn and diarrhoea.

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Question 4:
Wound healing can be defined as a complicated process recruiting 4 distinct cell types, it
is a continuous process that is completed in phases, namely coagulation, inflammation,
proliferation, and remodelling. However, the healing procedure depends on various different
factors pertaining to the physiology of the wound.The first stage is coagulation that begins with
the platelets and corpuscles rushing to the bleeding areas and forming blood clots to stop
bleeding (Golebiewska& Poole, 2015). In the next phase, inflammation takes place that clears
out the damaged cells and pools nutrients in the wound area removing the debris and bacteria,
followed by deposition of collagen granules. The next phase is contraction of the wound which
will lead to repair and remodelling of the wound tissues. In this phase the deposited collagen
tissues are remodelled and aligned along the tendon lines closing the broken tissues and
completing the healing process (Bullock & Manias, 2017). However, the occurrence of infection
slows and complicates the healing process which takes close to 10 days to completely heal
(Darby, Laverdet, Bonté&Desmoulière, 2014). With the aid of antibiotic therapy the infection in
Mary’s wound will easily be eliminated and as dicloxacillin which is very effective against S.
aureus, infection will be adequately managed by the bacteriostatic activity of dicloxacillin and
wound will heal effectively within 5-8 days.

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References:
Anand, S., Batra, R., Arora, B., Atwal, S., &Dahiya, R. S. (2016). A comparative study of
preoperative intra-incisional infiltration of ceftriaxone vs. intravenous ceftriaxone for
prevention of surgical site infections in emergency cases. Journal of evolution of medical
and dental sciences-jemds, 5(64), 4537-4541. Doi: 10.14260/jemds/2016/1036
Bullock, S & Manias, E. (2017). Fundamentals of Pharmacology (8th edition) French forest ,
Austrlai: Pearson Australia
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding
pathophysiology-ANZ adaptation. Elsevier Health Sciences.
Dalen, D., Fry, A., Campbell, S. G., Eppler, J., & Zed, P. J. (2018). Intravenous cefazolin plus
oral probenecid versus oral cephalexin for the treatment of skin and soft tissue infections:
a double-blind, non-inferiority, randomised controlled trial. Emerg Med J, emermed-
2017. Doi: 10.1136/emermed-2017-207420
Darby, I. A., Laverdet, B., Bonté, F., &Desmoulière, A. (2014). Fibroblasts and myofibroblasts
in wound healing. Clinical, cosmetic and investigational dermatology, 7, 301. Doi:
10.2147/CCID.S50046
Golebiewska, E. M., & Poole, A. W. (2015). Platelet secretion: From haemostasis to wound
healing and beyond. Blood reviews, 29(3), 153-162. Doi: 10.1016/j.blre.2014.10.003
Harper, D., Young, A., &McNaught, C. E. (2014). The physiology of wound healing. Surgery
(Oxford), 32(9), 445-450. Doi: 10.1016/j.mpsur.2014.06.010

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Krezalek, M. A., Hyoju, S., Zaborin, A., Okafor, E., Chandrasekar, L., Bindokas, V., ...& Boyle-
Vavra, S. (2018). Can methicillin-resistant Staphylococcus aureus silently travel from the
gut to the wound and cause postoperative infection? Modeling the “Trojan Horse
Hypothesis”. Annals of surgery, 267(4), 749-758. doi: 10.1097/SLA.0000000000002173
Lee, G., & Bishop, P. (2012). Microbiology and infection control for health professionals.
Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?
hl=en&lr=&id=qhTiBAAAQBAJ&oi=fnd&pg=PP1&dq=microbiology+and+infection+c
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a&sig=RawVyNsKPSO_Q5MGLvvqtHYtSvc#v=onepage&q=microbiology%20and
%20infection%20control%20for%20health%20professionals%20Lee&f=false
Marieb, E. N., & Hoehn, K. (2016). Human anatomy & physiology: Harlow: Pearson Education
Limited, 2016.
Nissen, J. L., Skov, R., Knudsen, J. D., Østergaard, C., Schønheyder, H. C., Frimodt-Møller, N.,
& Benfield, T. (2013). Effectiveness of penicillin, dicloxacillin and cefuroxime for
penicillin-susceptible Staphylococcus aureus bacteraemia: a retrospective, propensity-
score-adjusted case–control and cohort analysis. Journal of Antimicrobial
Chemotherapy, 68(8), 1894-1900. Doi: 10.1093/jac/dkt108
Serra, R., Grande, R., Butrico, L., Rossi, A., Settimio, U. F., Caroleo, B., ...& de Franciscis, S.
(2015). Chronic wound infections: the role of Pseudomonas aeruginosa and
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Theoret, C. (2016). Physiology of wound healing. Equine wound management, 1-13. Doi:
10.1002/9781118999219.ch1
Wroblewski, B. M., Siney, P. D., & Fleming, P. A. (2016). Deep Infection. In Charnley Low-
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