Wound healing.pptx

Professor en BRK Memorial Medical College Jagdalpur India
2 de Dec de 2022

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Wound healing.pptx

  1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  2. Definition of wound.
  3. Definition of wound. • An injury or damage to tissues caused by physical means with disruption of normal continuity .
  4. Types of wounds
  5. Types of wounds i. Incised wound ii. Lacerated wound iii. Bruising and contusion iv. Haematoma v. Puncture wound vi. Abrasion vii.Crush injury viii.Injuries to bone and joint (maybe open or closed)
  6. Types of wounds ix.Injuries to nerve (either clean cut or crush) x. Injuries to arteries and veins xi. Penetrating wounds xii. Degloving injury.
  7. Classification of surgical wounds
  8. Classification of surgical wounds a) Clean wound b) Clean contaminated wound c) Contaminated wound d) Dirty infected wound
  9. Healing
  10. Healing 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 सूखनेकी दवा
  12. TYPES OF WOUND HEALING • Healing by first (Primary) intention -wounds with opposed edges. • Healing by second intention wounds with separated edges • By Third intention (tertiary intention)-delayed primary Wound initially left open Edges later opposed when healing conditions favourable • Partial thickness wounds –Abrasions- heal by epithelisation.
  13. Healing by first intention (wounds with opposed edges)
  14. Healing by first intention (wounds with opposed edges) 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 sutures. • Wounds with opposed edges • Primary union
  15. • 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.
  16. Healing by second intention
  17. 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.
  18. Secondary healing VS primary healing
  19. Secondary healing VS primary healing • Inflammatory reaction is more intense • Much larger amounts of granulation tissue are formed • Wound contraction occurs in large surface wounds • Substantial scar formation and thinning of the epidermis occurs
  20. Difference between 1˚ & 2˚ union of wound
  22. Phases of Healing
  23. Phases of Healing I. Inflammatory (Reactive) - Haemostasis > Inflammation II.Proliferative (Regenerative/Reparative) Epithelial migration proliferation Maturation III.Maturational (Remodeling) Contraction scarring Remodeling
  24. 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 weeks. • Scar maturation begins at the fourth week and can last for years.
  25. Wound Contraction
  26. Wound Contraction • Contraction of a wound across a joint can cause contracture. • Can be limited by skin grafts, full better than split thickness. • The earlier the graft the less contraction. • Splints temporarily slow contraction.
  27. Disturbances in Wound Healing
  28. Disturbances in Wound Healing • Local Factors • Systemic Factors
  29. Local Factors
  30. Local Factors • Immobility- Pressure sore/bed sore/decubitus ulcer • Ischemia • Venous congestion. • Lymphedema • Infection: impairs healing. • Smoking: increased platelet adhesiveness, decreased O2 carrying capacity of blood, abnormal collagen. • Radiation:
  31. Wound Infection A positive wound culture does not confirm a wound infection.
  32. Wound Infection: Systemic features
  33. Wound Infection: Systemic features • Tachycardia • Malaise • Fever • Chills • Leukocytosis • elevated erythrocyte sedimentation rate
  34. Wound Infection: Local features • Foul-smelling drainage • spontaneously bleeding wound bed • flimsy friable tissue • increased levels of wound exudates • increasing pain • surrounding - – cellulitis – Crepitus – necrosis, – Fasciitis – regional lymphadenopathy
  35. Wound Infection: Local features Osteomyelitis • 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.
  36. Systemic Factors
  37. Systemic Factors • Malnutrition • Cancer • Old Age • Diabetes- impaired neutrophil chemotaxis, phagocytosis. • Steroids and immunosuppression suppresses macrophage migration, fibroblast proliferation, collagen accumulation, and angiogenesis. Reversed by Vitamin A 25,000 IU per day. • Superstitions
  38. Abnormal Response to Injury
  39. Abnormal Response to Injury • Inadequate Regeneration • Inadequate Scar Formation • Excessive Regeneration • Excessive Scar Formation
  40. Keloids and Hypertrophic Scars
  41. Keloids and Hypertrophic Scars • 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 responsiveness. • No modality of treatment is predictably effective for these lesions.
  42. Drugs affecting wound healing
  43. Drugs affecting wound healing • Negative – antibiotics, – anticonvulsants – Steroids – nonsteroidal anti-inflammatory drugs. • Beneficial – ferrous sulphate, – insulin, – thyroid hormones, – vitamins
  44. Wound Management
  45. Wound Management • Systemic measures. • Local measures
  46. Wound Management Local measures- “The golden hour” • Haemostasis • Anaesthesia • Decontamination • Repair and closure • Delayed closure- • Late presentation • Heavy contamination • Lot of dead and devitalized tissue.
  47. Wound Management • 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 tissue.
  48. Wound Management Pressure sores • Mobilise • Appropriate turning and positioning • Use of offloading support surface • Appropriate wound care • Appropriate management of incontinence • Appropriate nutritional management
  49. Wound Management • Pressure sores •
  50. Wound Management Venous Ulcers • Appropriate wound care • Compression dressings.
  51. Wound Management Diabetic foot ulcers • Appropriate wound care • Liberal debridement • Maintain euglycemia with insulin. • Antibiotics only if evidence of infection. • Reperfusion.
  52. Wound Management Surgical Care • Skin grafting • Cadaveric allografting • Application of bioengineered skin substitutes • Use of flap closures
  53. Future and Controversies
  54. Future and Controversies • Human cell–conditioned media developed in embryologiclike conditions • transforming growth factor (TGF)–β3 • Hyperbaric oxygen has also been used to promote healing. • Agents such as platelet-rich plasma (PRP) and erythropoietin (EPO • Engineered tissue matrices • Stem Cells
  55. Take home messages • Early closure of clean wounds. • Delayed closure of dirty / infected wounds. • Antibiotics are generally not indicated in abrassions, contusions. • For open wounds give three dosage of antibiotic. • Further antibiotics only if evidence of infection. • Spirit, Betadine,Savlon, Hydrogen peroxide Sumag should not be applied on wounds.
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