wound healing

WOUND HEALING

D.Ahmed Mahamed Hussein General Surgeon Azadi Hospital

The wound managemanet

Temporary wound management (first aid)clean, hemostasis, coveringFinal primary wound managementclean, anaesthesis, excision, suturesALWAYS: thoracic cavity, abdominal wall or dura mater injuryNEVER: war injury, inflammation, contamination, foreign body, special jobs, bite, shot, deep punctured woundPrimary delayed suture (3-8 days)clean, wash – saline, coverexcision of wound edges, sutures *

The wound managemanet

* Early secondary wound closure (2 weeks)after inflammation, necrosis – proliferationanesthesia, refresh wound edges, suturing and drainingLate secondary wound closure (4-6 weeks)anesthesis, scar excision, suturing, draininggreater defect – plastic surgery

The wound healing

Process of wound healing 1) Hemostasis-inflammation. 2) Granulation-proliferation. 3) Remodelling.
* http://www.worldwidewounds.com/2004/august/Enoch/images/enochfig1.jpg

The main steps of the wound healing

1. Hemostasis-inflammation . vasoconstriction fibrin clot formation . proinflammatory cytokines and growth factors releasing . vasodilatation infiltration PMNs, macrophagescytokines releasing will lead to→ angiogensis→ fibroblast activation→ B- and T-cells activation→ keratinocytes activation→ wound contraction * 2. Granulation-proliferation .fibroblast migration .collagen deposition .angiogensis .granulation tissue formation .epithelisation .Contraction3. Remodelling .regression of many capillaries .physical contraction – myofibroblasts .collagen degeneration and synthetization new epithelium .tensile strength – max. 80%

Types of wound healing

Healing by primary intention


Healing by secondary intention

Healing by tertiary intention

*

Factors affecting wound healing

Local Ischemia Infection Foreign body Edema, elevated tissue pressure
Systemic Age and gender Sex hormones Stress Ischemia Diseases Obesity Medication Alcoholism and smoking Immunocompromised conditions Nutrition
* infection
ischemia
foreign bodies
edema/ elevated tissue pressure
IMPAIRED HEALING

Complications of wound healingI. Early complications

Seroma Hematoma Wound disruptin Superficial wound infection Deep wound infection Mixed wound infection
*

Complications of wound healingII. Late complications

Hyperthrophic scar Keloid formation Necrosis Inflammatory infiltration Abscesses Foreign body containing abscesses
*


Wound Healing
ANY ????
*