Wound healing is a complex and dynamic process critical to restoring the integrity of the skin and underlying tissues after injury. 

Understanding the factors that influence wound healing is crucial for optimal patient care. This knowledge empowers pharmacists to provide targeted recommendations, identify potential complications, and optimise therapeutic outcomes. Here's a breakdown of key factors to consider: 

1.INTRINSIC FACTORS:

• Age: Wound healing slows with age due to decreased cellular turnover, impaired blood flow, and altered immune function.^1,2 
• Nutritional status: Deficiencies in protein, calories, vitamins (particularly C and A), and minerals can significantly hinder healing.^1,2,3 
• Comorbidities: Underlying conditions like diabetes, cardiovascular disease, and chronic infections impede wound closure.^1,2,4,5 
• Medications: Certain medications, such as corticosteroids and immunosuppressants, can slow healing.^1,2,6 

2.EXTRINSIC FACTORS:

• Wound type and severity: Complex wounds (e.g., diabetic foot ulcers, pressure injuries) present greater healing challenges.⁵ 
• Infection: Bacterial colonisation or full-blown infection delays healing and increases the risk of complications.^2,5,7 
• Blood supply: Poor perfusion due to peripheral vascular disease or venous insufficiency limits oxygen and nutrient delivery to the wound bed.^7,8 
• Moisture balance: Both excessively dry and overly moist wounds can impede healing.² 

3. IATROGENIC FACTORS:

• Suboptimal wound care: Improper cleaning, dressing selection, or bandaging techniques can negatively impact healing.² 
• Pressure on the wound: Constant pressure disrupts blood flow and hinders tissue granulation.⁷ 

OPTIMISING WOUND HEALING THROUGH PHARMACEUTICAL CARE: 

Pharmacists can play a vital role by: 

• Performing a comprehensive medication review: Identify medications that may be impairing healing and suggest alternatives if possible. 
• Recommending nutritional supplements: Address potential deficiencies in vitamins, minerals, and protein to support tissue repair. 
• Educating patients on proper wound care: Instruct on cleaning techniques, dressing changes, and signs of infection. 
• Collaborating with healthcare providers: Communicate concerns about delayed healing or potential medication interactions. 

By understanding these factors and taking an active role in wound care management, pharmacists can significantly contribute to improved patient outcomes and faster healing times. 

ADDITIONAL CONSIDERATIONS: 

• Smoking cessation: Smoking significantly reduces blood flow and impairs healing.7 Encourage smoking cessation for better wound outcomes.² 
• Pain management: Uncontrolled pain can hinder mobility and impede wound healing. Advise on appropriate pain management strategies. 
• Psychological Support: Chronic wounds can be emotionally stressful. Provide resources or referrals for psychological support if needed. 

Remember, effective wound care requires a multidisciplinary approach. Pharmacists, by virtue of their medication expertise and patient interaction, are well-positioned to optimise wound healing and improve patient well-being. 

REFERENCES 

1. Sgonc R, Gruber J. Age-Related Aspects of Cutaneous Wound Healing: A Mini-Review. Gerontology (2013) 59(2): 159-164. Available from: https://doi.org/10.1159/000342344  
2. Brown A. Diagnosing and managing wound infection. Wound Care. JCN (2022) 36(4): 34-40. Available from: https://www.researchgate.net/profile/Annemarie-Brown/publication/364606926_Diagnosing_and_managing_wound_infection/links/6352cf1712cbac6a3ee17431/Diagnosing-and-managing-wound-infection.pdf?origin=journalDetail&_tp=eyJwYWdlIjoiam91cm5hbERldGFpbCJ9 
3. MacKay D, Miller AL. Nutritional support for wound healing. Alternative Medicine Review (2003) 8(4): 359. Available from: https://openurl.ebsco.com/EPDB%3Agcd%3A9%3A21252633/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A106768203&crl=c 
4. Anderson K, Hamm RL. Factors That Impair Wound Healing, Journal of the American College of Clinical Wound Specialists. (2012) 4: 84-91. Available from: https://doi.org/10.1016/j.jccw.2014.03.001. 
5. Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Advances in Wound Care (2015) 4(9). Available from: https://www.liebertpub.com/doi/10.1089%2Fwound.2015.0635 
6. Singh S, Young A, McNaught C. The physiology of wound healing, Surgery (Oxford) (2017) 35(9): 473-477. ISSN 0263-9319. Available from: https://doi.org/10.1016/j.mpsur.2017.06.004 
7. Goktas S, Gezginci E. Wound Healing and Management: Current Approaches in Care. A Recent Studies in Health Sciences. St Kliment Ohridski University Press. (2019) 56: 581-596. Available from: https://d1wqtxts1xzle7.cloudfront.net/61874721/yabanci_kitap_bolumum20200123-96838-xdv30t-libre.pdf?1579803417=&response-content-disposition=inline%3B+filename%3DRecent_Studies_in_Health_Sciences.pdf&Expires=1719401108&Signature=fcWG8PZwrv3NAziynY5XvQdXTMW1qhBCzRHUT0voqmFV8N-w00URu3viZWzteR1gvkl8SZBET-lnuDKBRwaY9J7gRwtZ5W9dqfKeENrS0HVG7~-YwCaBHhCesNprvYp59X7caDBT30Md7wxyogYhdBb3UCTTA305dSabSzC3DfKeSdGHZW96M7YI5iw4fTz5Dpmd65y6LxifT-Yi0mw3dYPtGdbOS5Qe791ehetLLB8xhmXN0B5LxyoTWskLD-Gj0Vqc6AGEv1teEOxKLzZULWJbCJyUuS-3HNu9yS79v2aEPyzsYzVTOygGsBxpKhfCmM9wh6uS8ehBY2la594I8A__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA#page=592 
8. Woo KY, Brandys TM, Marin JA. Assessing chronic wound perfusion in the lower extremity: current and emerging approaches. Chronic Wound Care Management and Research. (2015) 2: 149-157. Available from: https://doi.org/10.2147/CWCMR.S60326