Changes

on the circumstances, the species of bacteria will vary. For example Gram-negative

on the circumstances, the species of bacteria will vary. For example Gram-negative

species from faecal contamination will often infect a wound on

species from faecal contamination will often infect a wound on

the foot or distal limb. [[Staphylococcus spp.|Staphylococcal]] and [[Streptococci|Streptococcal]] infections are

the foot or distal limb. [[:Category:Staphylococcus species|Staphylococcal]] and [[:Category:Streptococcus species|Streptococcal]] infections are

common contaminants of skin wounds because they may be normal skin

common contaminants of skin wounds because they may be normal skin

commensals.

commensals.

remove/control and will inevitably have a harmful effect on healing.

remove/control and will inevitably have a harmful effect on healing.

Bacterial species (such as [[Pseudomonas aeruginosa and Burkholderia species|''Pseudomonas'']], [[Bacillus species|''Baccillus'']] or [[Proteus|''Proteus'']] as well as

Bacterial species (such as [[:Category:Pseudomonas and Burkholderia species|''Pseudomonas'']], [[Bacillus species|''Baccillus'']] or [[Proteus|''Proteus'']] as well as

some fungi) that produce collagenase (or other destructive) enzymes have

some fungi) that produce collagenase (or other destructive) enzymes have

a profound effect on healing by destruction of the collagen matrix, and so

a profound effect on healing by destruction of the collagen matrix, and so

the inflammatory response cannot effectively close the wound. Infection

the inflammatory response cannot effectively close the wound. Infection

with ''Staphylococcus aureus'' can cause pyogranuloma within the wound site.

with ''[[Staphylococcus aureus]]'' can cause pyogranuloma within the wound site.

Clinically this resembles both granulation tissue and [[Sarcoid - Donkey|sarcoid]].

Clinically this resembles both granulation tissue and [[Sarcoid - Donkey|sarcoid]].

* Excessive tension in the margins of the wound (often due to incorrect suturing techniques)

* Excessive tension in the margins of the wound (often due to incorrect suturing techniques)

* Accumulated exudate/dead space/pocketing

* Accumulated exudate/dead space/pocketing

* pH variations (usually alkaline). Ideally the pH of a wound should be around normal physiological pH or very slightly acidic (i.e. between pH 6.5 and 7.0). Alteration of the pH of a wound site is often a consequence of infection or wound dressings and solutions. A physiological state should be maintained as far as possible unless there are specific and defined reasons to alter this, for example, [[Pseudomonas aeruginosa and Burkholderia species|''Pseudomonas spp.'']] infection, where a more acidic environment will help control the bacterial replication.

* pH variations (usually alkaline). Ideally the pH of a wound should be around normal physiological pH or very slightly acidic (i.e. between pH 6.5 and 7.0). Alteration of the pH of a wound site is often a consequence of infection or wound dressings and solutions. A physiological state should be maintained as far as possible unless there are specific and defined reasons to alter this, for example, [[:Category:Pseudomonas and Burkholderia species|''Pseudomonas spp.'']] infection, where a more acidic environment will help control the bacterial replication.

* Poor surface oxygenation (this can be a result of dressings but more often is due to abnormal biofilms over the wound site that reduce surface gas exchange)

* Poor surface oxygenation (this can be a result of dressings but more often is due to abnormal biofilms over the wound site that reduce surface gas exchange)

* Low or high temperature

* Low or high temperature