Wound Healing Case Study

This case study involves a young woman named Mary who sustained a laceration wound over the lateral aspect of the left foot. Read on to know more about wound management, infection, treatment and wound healing process.

Running head: WOUND HEALING CASE STUDY
Wound healing case study
Name of the student:
Name of the university:
Author note:

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WOUND HEALING CASE STUDY
Table of Contents
Question 1:.................................................................................................................................2
Question 2:.................................................................................................................................3
2.1...........................................................................................................................................3
2.2...........................................................................................................................................4
Question 3:.................................................................................................................................4
3.1...........................................................................................................................................4
3.2...........................................................................................................................................5
3.3...........................................................................................................................................5
3.4...........................................................................................................................................5
Question 4:.................................................................................................................................5
References:.................................................................................................................................7

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WOUND HEALING CASE STUDY
Question 1:
Wound management is associated with a number of different factors, the wound
observations play a fundamental role in understanding the exact nature of the wound and how
it will proceed to heal. As discussed by Harper, Young & McNaught, (2014), the wound
observation provides key information regarding the clinical status of the wound. This allows
the health care professionals be able to understand the exact care need of the patient and then
provide intervention to accelerate healing process. This case study involved a young woman
named Mary who sustained a laceration wound over the lateral aspect of the left foot. The
case scenario also elaborates that Mary had sustained this particular wound while being in the
beach and she had also not washed the wound just used her handkerchief to bandage the
wound, which is undoubtedly not the aseptic wound cleaning technique which should have
employed in this case. The lack of following the aseptic wound cleaning can be considered
the most important contributing factor that led to the infection that the patient acquired days
later (Lee & Bishop, 2012).
Lacerations is an uneven or irregular wound judging by the texture, it is generally the
result of tearing of the skin with a sharp or blunt object with enough force to cause an impact
injury. In this case, the injury that the patient sustained had been from a broken glass bottle
which resulted in a 2 cm deep wound. The inflammatory response is the second line of
defences is the body and is a very common observation associated with wounds. A wound
being red and swollen generally indicates the onset of infection, the inflammation and
discolouration of the skin is the result of the rapid proliferation of the pathogen underneath
(Frykberg & Banks, 2015). The wound was also warm to touch, it has to be mentioned that
the skin near the wound might appear hot normally however of the skin is extremely hot and
is not slowing any signs of cooling down it might indicate the response of the innate
immunity of the body to the invading infection. Lastly, the wound observations also indicates

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WOUND HEALING CASE STUDY
that the wound also has steady purulent discharge. Purulent discharge often accompanies a
wound and is the typical white yellow exudate that is secreted from the site of inflammation
and the wound opening. It is also known as the liquor puris, a protein rich fluid containing
mainly the dead leukocytes, mainly neutrophils (Bykov et al., 2017). The presence of
purulent discharge generally indicates deteriorating infections, possibly of bacterial origin
(Craft & Gordon, 2015).
Question 2:
2.1.
Endogenous infection is caused generally by the pathogenic microbiota that inhabits
the body itself. These pathogenic organisms stay within the body system in a dormant form
until there is any imbalance in the haemodynamic stability of the body which provides an
opportunity. These opportunistic pathogen enter the body and reach the vulnerable tissue due
to the breakdown of the sterile barrier of the tissues. In this case, the patient had a laceration
on her leg which was not aseptically cleaned or protected. This provided ample chance for the
opportunistic microflora on the surface of the skin to invade the internal tissue from the
wound opening and colonize the surrounding tissue. The most common skin opportunistic
pathogens are the different species of Staphylococcus. However, judging the symptoms and
wound observation physiology the causal pathogen can be considered the MRSA or
methicillin resistant Staphylococcus aureus (Serra et al., 2015).
MRSA is a very common and lethal skin infection causing bacteria and the mode of
transmission for this bacteria is generally via direct skin to skin contact. Hence, the
contamination to a new host can be mediated via the hands of anyone that comes into the
contact with the wound of the patient (Kansal, Rahimy, Garg & Dollin, 2017).

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WOUND HEALING CASE STUDY
2.2.
Exogenous contamination on the other hand is caused by the microbiota that is
present in the environment. In case of wound infections, the causal organisms generally
contaminates the wound of the patient by faulty wound cleaning or covering the wound. As
Mary had used a handkerchief to bandage her wound, the chances of airborne and respiratory
tract microbes contaminating the wound is most likely. Streptococcus pyogenes is a common
bacteria that is found in the respiratory tract of the human and can cause wound infections via
air droplets. Hence, it can be a possible source of contamination for Mary as she had used the
handkerchief to bandage her wound (Desroche et al., 2018).
The mode of transmission for this particular bacteria is air-droplet mediated. Hence,
the health care staff addressing to her wounds and coming in contact with the oozes coming
out of the wound. The hands of the staff can be the best contamination source for the new
host. Using equipment and supplies that have not been properly sterilized after use can also
cause contamination to new host.
Question 3:
3.1
The first line of treatment for an infection is antibiotics to stop the spread and
proliferation of the pathogenic bacteria. In this case, the patient was provided the ceftriaxone
injection via intravenous route. It has to be mentioned that ceftriaxone belongs to the group of
cephalosporin antibiotics which have bactericidal activities. This particular antibiotic is most
effective in intravenous format and hence it has been given to the patient in the preliminary
stage of the infection to stop the infection. This particular antibiotic also has a considerably
high plasma half-life and is considered to be work efficiently against a broad range of

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WOUND HEALING CASE STUDY
microbes (Anand, Batra, Arora, Atwal & Dahiya, 2016). Hence, a stat dose of this medication
was administered.
3.2.
As the treatment proceeds for a wound infection patient, the intravenous antibiotic is
discontinued after the initial 24 hours and a course of oral antibiotics is administrated. In this
case, Mary was provided with oral cephalosporin. This is also a broad spectrum antibiotic
prescribed for skin and wound infections. The mechanism of action for this antibiotic is alike
penicillin group of antibiotics, stopping the cell wall formation of the bacteria, which is a
very effective bacteriostatic infection controlling technique (Dalen, Fry, Campbell, Eppler &
Zed, 2018). Hence, this was administered to Mary.
3.3.
The further investigative tests of the patient revealed the fact that she acquired
Staphylococcus aureus infection. However, staph infections are generally not treated with the
cephalosporin group of antibiotics as Staphylococci are penicillinase resistant. Hence, the
staph infections are generally treated with Penicillinase-resistant penicillins such as
dicloxacillin (Nissen et al., 2013). Hence, when it was discovered that Mary had S. aureus
infection, the prescription was changed and she was administered dicloxacillin.
3.4.
The side effects are nausea and diarrhoea (Bullock & Manias, 2013).
Question 4:
The wound healing is a complex procedure which progresses through 4 distinctive
phases, namely homeostasis, inflammation, proliferation, and remodelling (Theoret, 2016).
The first stage is the coagulation which begins with the platelets and the corpuscles rushing to
the area of wound and proceeding with the formation of the blood clot formation in order to

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WOUND HEALING CASE STUDY
cease bleeding. The next phase is the inflammation where the debris and damaged cells from
wound opening site is cleared and the nutrients are pooled in the wound area. The next stage
is contraction which leads to repair and restructuring of the wound tissues where the collagen
granules are deposited. The last stage is repair stage where the collagen granules are
realigned and remodelled closing up the broken tissues and completing the process (Theoret,
2016). The process of wound healing is further complicated when the wound becomes
infected by a pathogenic organism. Hence, the wound healing process is also complicated and
prolonged further by the infection, which is the case for Mary as well. In this case, the wound
had been in the inflammation phase, where vasodilation takes place to provide more blood
flow to the traumatized area (Marieb & Hoehn, 2016). In this case the intervention by the
antibiotic will kill the existing microbes and will eliminate the nutrient competition and let
the neutrophils, microphages and monocytes clean up the debris. On a more elaborative note,
dicloxacillin will inhibit the production of peptidoglycan chain and therefore stopping cell
wall synthesis completely, which in turn will act on stopping the proliferation of the bacteria
as well (Nissen et al, 2013). This will be followed by proliferation stage where the collagen
granules are deposited in the area and contraction of the wound. The last phase is the
remodelling of collagen deposited by the firbocytes and fibroblasts to close the wound
completely by which the healing will complete for Mary (Han & Ceilley, 2017).

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WOUND HEALING CASE STUDY
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. (2013). Fundamentals of pharmacology. Pearson Higher Education
AU. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=ODjiBAAAQBAJ&oi=fnd&pg=PP1&dq=fundamentals+of+pharmac
ology&ots=WJceQdAf4V&sig=QecvtlsCVwG_hZwQQE-
2mYrYXWQ#v=onepage&q=fundamentals%20of%20pharmacology&f=false
Bykov, I. M., Basov, A. A., Malyshko, V. V., Dzhimak, S. S., Fedosov, S. R., &
Moiseev, A. V. (2017). Dynamics of the pro-oxidant/antioxidant system
parameters in wound discharge and plasma in experimental purulent wound
during its technological liquid phase treatment. Bulletin of experimental biology
and medicine, 163(2), 268-271. Doi: 10.1007/s10517-017-3781-3
Craft, J. A., & Gordon, C. J. (2015). understanding pathophysiology. Retrieved from
https://www.researchgate.net/profile/Christopher_Gordon11/publication/
306017164_Understanding_Pathophysiology_2Ed/links/
57aad86708ae3765c3b6c045/Understanding-Pathophysiology-2Ed.pdf
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

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WOUND HEALING CASE STUDY
Frykberg, R. G., & Banks, J. (2015). Challenges in the treatment of chronic
wounds. Advances in wound care, 4(9), 560-582. Doi: 10.1089/wound.2015.0635
Han, G., & Ceilley, R. (2017). Chronic wound healing: a review of current management
and treatments. Advances in therapy, 34(3), 599-610. Doi: 10.1007/s12325-017-
0478-y
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
Kansal, V., Rahimy, E., Garg, S., & Dollin, M. (2017). Endogenous methicillin-resistant
Staphylococcus aureus endophthalmitis secondary to axillary phlegmon: a case
report. Canadian Journal of Ophthalmology, 52(3), e97-e99. Doi:
10.1016/j.jcjo.2016.11.016
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+infe
ction+control+for+health+professionals+Lee&ots=hxQ7f6LZ-
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

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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 Staphylococcus aureus. Expert review of anti-infective
therapy, 13(5), 605-613. Doi: 10.1586/14787210.2015.1023291
Theoret, C. (2016). Physiology of wound healing. Equine wound management, 1-13. Doi:
10.1002/9781118999219.ch1