Anda di halaman 1dari 14

WOUND HEALING

DR TILAK

WOUND HEALING
The word HEALING means replacement of destroyed tissue by living tissue. Two terms to be understood1. Regeneration means replacement of lost tissue by tissue similar in type. 2. Repair means replacement of lost tissue by granulation tissue, followed by fibrosis &scar tissue formation.

WOUND HEALING
Types of wound healing 1. Primary intention 2. Secondary intention

WOUND HEALING
PRIMARY HEALING Occurs in a clean incised wound such as a surgical incision wherein there is only a potential space between the edges. It produces a clean , neat, thin scar. SECONDARY HEALING Refers to a wound which is infected,discharging pus or wound with skin loss . Such wounds heal with an ugly scar.

COMPONENTS OF WOUND HEALING


1. Hemostasis This is the first step in the process of healing. Reflex vasospasm Clotting mechanism - Clotting factors - Platelets Platelets are critical in hemostasis &wound healing. They are the first cells to appear at the wound site &release certain substances termed as CYTOKINES.

Hemostasis [cont]
Cytokines in wound healing 1. TGF-B 2. PDG-F 3. EGF 4. B-FGF

WOUND HEALING
2.

INFLAMMATION Cellular events are dominant in this stage.

Order of arrival of cells at wound site Platelets Neutrophils Monocytes Lymphocytes

WOUND HEALING
TIME 30 SECS-2 MINS EVENTS Neutrophils adhere to vessel wall

3 hrs
10 hrs

RBCs & WBCs escape out of vessel, fibrin network over wound, lymphocytes are predominant
Wound collagen synthesis

24 hrs
3- 5 days

Fibroblasts migrate into site of wound, neutrophils are predominant


Granulation tissue forms &progressively increases

5 days
8 10 days >20 days

Collagen synthesis peaks, ground substance increases , monocytes are predominant


Wound contraction begins Scar formation

WOUND HEALING
3.

REPAIR Final stage in the healing process although it starts as early as 24 hrs after injury. Its components are-

Granulation tissue formation Collagen / matrix formation Remodelling / scar tissue formation

WOUND HEALING
STAGES OF SCAR FORMATION Scar is a metabolically active & dynamic tissue. STAGE-1[0-4 WKS] Soft , fine & weak scar. STAGE-2 [4 12 WKS] Red , hard &strong scar. STAGE-3 [12 40 WKS ] Soft , white &supple scar. Wound contraction is essential in scar formation. 2 theories to explain this-

STAGES OF SCAR FORMATION [cont]


1. CENTRAL GRANULATION TISSUE THEORY The forces of contraction are in the centre of the granulation tissue.
2. PICTURE FRAME THEORY The forces of contraction are at the wound margins.

FACTORS AFFECTING WOUND HEALING


General factors: 1.Age 2.Nutrition Protein def Vit c def Vit A def Zinc , calcium ,cu, manganese def 3.Hormones 4. Anemia 5. Uremia 6. Jaundice 7. Diabetes 8. Blood dyscrasias 9.Malignant diseases 10. Cytotoxic drugs

FACTORS AFFECTING WOUND HEALING [cont]


LOCAL FACTORS: Position of skin Tension Movement Foreign bodies Necrosis Uv rays

Blood supply Infection Exposure to ionizing radiation Adhesions to bony surfaces Lymph drainage Faulty technique of wound closure

COMPLICATIONS OF WOUND HEALING


1. 2. 3. 4. 5. 6. Infection Ugly scar Keloid & hypertropic scar Incisional hernia Pigmentation of skin Marjolins ulcer

Anda mungkin juga menyukai