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I Treat God Cures
• The ability to heal is inbuilt in our
physiology . We only help body to heal
itself and remove any obstacles in the
path of healing.
• There are no healing medicines / घाव
TYPES OF WOUND HEALING
• Healing by first (Primary) intention -wounds with
• Healing by second intention wounds with separated
• By Third intention (tertiary intention)-delayed
Wound initially left open
Edges later opposed when healing conditions
• Partial thickness wounds –Abrasions- heal by
Healing by first intention (wounds with
Healing of wound with following characteristics:
• Clean and uninfected
• Surgically incised
• Without much loss of cells and tissue
• Edges of wound are approximated by surgical
• Wounds with opposed edges
• Primary union
• The incision causes
death of a limited number of epithelial cells and
connective tissue cells
disruption of epithelial basal membrane continuity
• The narrow incisional space immediately fills with
clotted blood containing fibrin and blood cells;
dehydration of the surface clot forms the well known
scab that covers the wound.
Healing by second intention
• Wounds with separated edges
• Secondary union
• When there is more extensive loss of cells and tissue
• Regeneration of parenchymal cells cannot
completely reconstitute the original architecture.
• Abundant granulation tissue grows in from the
margin to complete the repair.
Secondary healing VS primary healing
• Inflammatory reaction is more intense
• Much larger amounts of granulation tissue
• Wound contraction occurs in large surface
• Substantial scar formation and thinning of
the epidermis occurs
Difference between 1˚ & 2˚ union of
FEATURES PRIMARY SECONDARY
CLEANLINESS CLEAN NOT CLEAN
INFECTION NOT INFECTED INFECTED
MARGINS SURGICALLY CLEAN IRREGULAR
SUTURES USED NOT USED
HEALING SMALL GRANULATION
OUT COME LINEAR SCAR IRREGULAR WOUND
COMPLICATION NOT FREQUENT FREQUENT
Phases of Healing
• The inflammatory phase occurs
immediately following the injury and lasts
approximately 6 days.
• The fibroblastic (Proliferative) phase
occurs at the termination of the
inflammatory phase and can last up to 4
• Scar maturation begins at the fourth week
and can last for years.
• Contraction of a wound across a joint can
• Can be limited by skin grafts, full better
than split thickness.
• The earlier the graft the less contraction.
• Splints temporarily slow contraction.
Wound Infection: Local features
• Foul-smelling drainage
• spontaneously bleeding wound bed
• flimsy friable tissue
• increased levels of wound exudates
• increasing pain
• surrounding -
– regional lymphadenopathy
Wound Infection: Local features
• Fevers, malaise, chronic fatigue, and limited range
of motion of the affected extremity,
• patients often present with only a nonhealing
wound or a chronic draining sinus tract overlying
a bone or joint.
• Probe to bone test.
• Plain radiographs, CT scans, radionuclide bone
scans, and MRI
• Osteomyelitis is treated with surgical curettage
and appropriate systemic antibiotics.
• Old Age
• Diabetes- impaired neutrophil chemotaxis,
• Steroids and immunosuppression suppresses
macrophage migration, fibroblast proliferation,
collagen accumulation, and angiogenesis.
Reversed by Vitamin A 25,000 IU per day.
Keloids and Hypertrophic
• Both from an overall increase in the
quantity of collagen synthesized.
• Recent evidence suggests that the
fibroblasts within keloids are different from
those within normal dermis in terms of their
• No modality of treatment is predictably
effective for these lesions.
Local measures- “The golden hour”
• Repair and closure
• Delayed closure-
• Late presentation
• Heavy contamination
• Lot of dead and devitalized tissue.
• Local measures-
• Surgically debride nonvitalized tissue and
with appropriate irrigation
• Dressing changes require clean but not
necessarily sterile technique.
• Remove foreign bodies
• Pat the wound surface with soft moist
gauze; do not disrupt viable granulation
• Appropriate turning and positioning
• Use of offloading support surface
• Appropriate wound care
• Appropriate management of incontinence
• Appropriate nutritional management
Future and Controversies
• Human cell–conditioned media developed
in embryologiclike conditions
• transforming growth factor (TGF)–β3
• Hyperbaric oxygen has also been used to
• Agents such as platelet-rich plasma (PRP)
and erythropoietin (EPO
• Engineered tissue matrices
• Stem Cells
Take home messages
• Early closure of clean wounds.
• Delayed closure of dirty / infected wounds.
• Antibiotics are generally not indicated in
• For open wounds give three dosage of
• Further antibiotics only if evidence of
• Spirit, Betadine,Savlon, Hydrogen peroxide
Sumag should not be applied on wounds.
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