WOUND HEALING

DR. PRASAD DESHMUKH

Living tissues are best antiseptics and skin is the best dressing.
-Lister.

TYPES OF WOUND
Lacerated Incised Abrasion Puncture Degloving

 Definition:

Loss of continuity in skin or mucous membrane due to injury , bone and soft tissues may or may not be damaged.

Regeneration -- Form -- Function Scarring Laying down of collagen by Fibroblasts.

PHYSIOLOGY OF WOUND HEALING

Inflammation.

Epithelialisation.
Fibroplasia. Wound

contraction. Scar maturation.

INFLAMMATION

VASCULAR

CELLULAR

Transient vasoconstriction Persistent progressive vasodilatation

Neutrophilic infiltration Monocyte macrophage system

EPITHELIALISATION
Migration

and subsequent maturation of immature epithelial cells from basal layers. Epithelial cells move beneath the scab , sealing the wound.

FIBROPLASIA
Process

by which wounds regain strength. Fibroblasts proliferate and manufacture GP and MPS Ground substance formation CollagenTropocollagen synthesis by 4-5 days

WOUND CONTRACTION
Surgical

incision Avulsion injury Contraction Contracture

SCAR MATURATION
More

orderly arrangement of collagen fibres so as to give denser and stronger scar New scar softer and less bulky

HYPERTROPHIC SCAR

KELOID

-non familial -non racial -M=F -children -remain within wound -subsides with time -along flexor aspect

-may be familial -black > white -M < F -10-30 years -outgrows wound area -rarely subsides -along sternum, shoulder, face

SURGICAL WOUND HEALING

Primary

intention Secondary intention Tertiary intention(delayed primary closure)

PRIMARY INTENTION
Surgically

incised wound Reapproximated by layers Minimum scar formation Minimum time for healing

SECONDARY INTENTION
Contaminated

infected surgical

wounds Left open for formation of granulation tissue Allowed to heal spontaneously -Contraction -Granulation tissue formation

TERTIARY INTENTION
Delayed

primary closure For post op wound breakdown -grossly infected wounds

WOUND CLOSURE

INCIDENCE

0.5 5 % in Gen surg 0.1-0.7 % in Gynaecology -Elective surgeries -Healthy patients -Less chance of infections -Decreased rate of enterotomies

WOUND CLASSIFICATION (SURGICAL CLASSIFICATION)

CLEAN CLEAN CONTAMINATED CONTAMINATED SEPTIC / DIRTY

5% 10 % 20% >30%

CLASS I

CATEGORY Clean

DEFINATION

INFECTION RATE

Ideal operating <5% room conditions; elective Entry into GIT, GUT and RS Open fresh traumatic wounds; incisions wid acute non purulent inflammations >4 hrs traumatic; perforated viscera, devitalised tissue or FB 2-10% 15- 20 %

II III

Clean contaminated Contaminated

IV

Dirty / Septic

> 30 %

FACTORS AFFECTING WOUND HEALING

LOCAL-Infection -Blood supply -Foreign body -Movements -UV light SYSTEMIC-Age -Nutrition -Infection -Steroid therapy -Diabetes Mellitus -Haematological changes

COMPLETE WOUND DEHISCENCE

Separation

of skin and tissue layers posterior to skin upto the fascia With peritoneum Complete dehiscence With intestines protruding Evisceration

 PREDISPOSING
CLINICAL

FACTORS

FEATURES -usually on 5 -14 days -seepage of serosanguinous pink discharge from apparently intact wound -examine integrity of fascial closure -sensation of something tearing or popping out

TREATMENT
Replace

bowel with saline soaked

pads Abdominal binder CBC , Ser. Electrolytes ,C/S Broad spectrum antibiotics Under GA, debridement ,replace bowel ,warm saline wash, SmeadJones closure

REFERENCES
Te Lindes Operative Gynaecology Robbins Pathological basis of diseases Pyes Surgical Handicraft Schwartz Principles of Surgery Baily & Loves SPS Greenhills Surgical Gynaecology

A wise physician skilled our wounds to heal is more than armies for a common weal
-Homer

THANK YOU