D N EZRINAH BINTI D N ESHAM

121303632
BATCH 32, GROUP E1B
SDL 2: WOUND AND WOUND HEALING
16/2/16

WOUND AND WOUND HEALING
WOUND = break in the integrity of the skin or tissue and associated with
disruption of function and structure
WOUND HEALING = complex method to achieve anatomical and functional
integrity of the disrupted tissue

Pathophysiology:
o Involved several stages: stage of inflammation
Stage of granulation tissue formation
Stage of epithelialization
Stage of formation and resorption
Stage of maturation
1. Inflammatory phase:
 Begin immediately after wound healing.
 Last for 4-6 days.
 Rubor, color, dalor, tumour, and loss of functions presents.
 Haemostasis, coagulation and chemotaxis occurs.
 Haematoma formation by platelet → release of cytokines, platelet
factor, TNF-a, IL1 → chemotaxis of macrophage and neutrophils →
removal of clot, foreign body and bacteria.
2. Proliferative phase:
 Begins in day 7 and last for 6 weeks.
 Action of cytokines and released growth factor → angiogenesis and
fibroblast migration → production of collagen and glycosamine
 Proliferation of fibroblast and venular endothelial cell at wound
margin (angiogenesis and fibroplasia).
 Formation of granulation tissue which contain fibroblast,
neocapillaries, collagens, fibronectin, and hyaluronic acid.
3. Remodeling phase:
 Begin at 6 weeks and last for 2 years
 Maturation of collagen
 Formation of scar (made up from type 1 and type 3 collagen)
 Scar strength 3% in 1 week, 20% in 3 weeks, 80% in 12 weeks.

Tertiary wound healing (delayed primary closure)  Seen in contaminated or mixed wound. smoking Malnutrition: zinc. obesity. 3. and control of local infection. wound closed with suture or covered with skin graft. Factor influencing wound healing: Local Factor             Infection Presence of necrotic tissue or foreign bodies Poor blood supply Tissue tension Hematoma Large defect or poor application Recurrent trauma X ray irradiated area Site of wound Underlying disease Mechanism and type of wound Tissue hypoxia locally reduce cellular response and fibroblast activity General Factor            Age. smooth. 2. and supple.Type of wound healing: 1. Secondary healing (secondary intension)  Wound in excessive soft tissue loss  Heals slowly with fibrosis  Heals with wide scar. often hypertrophied and contracted. Primary healing (primary intention)  Occur in clean incised wound and surgical wound  Wound edges approximated with suture  Epithelial regeneration > fibrosis  Scar will be linear. manganese Vitamin deficiency: vitamin A and C Anaemia Malignancy Uraemia Jaundice DM HIV and immunocompromised disease Steroids and cytotoxic drug Neuropathies of different causes . copper.  After wound debridement.

then primary suturing is done after thorough cleaning. there will be oedema and tension in the wound. So after wound debridement or wound . then:      The airway should be maintained. if present. should be controlled.Type of wound:  Simple wound: only skin involved Complex wouds: vessels. Oxygen. d) If it is a lacerated wound. if required. etc. then the wound is excised and primary suturing is done. should be looked for. e) If it is a crushed or devitalized wound. tendons or bones are involved   Tidy wounds Untidy wounds Closed wound: contusion Abrasion Haematoma  Open wound: incised wound Lacerated wound Crush injuries Penetrating injuries     Clean wound Clean contaminated wound Contaminated wound Dirty wound   Wound management: a) Wound is inspected and classified as per the type of wounds. c) If it is an incised wound. nerves. Deeper communicating injuries and fractures. b) if it is in the vital area. may be given. Intravenous fluids are started. The bleeding.

or anti tetanus globulin (ATG) injection. Vessels are sutured with 6-zero polypropylene non absorbable suture material.  Done in infected wounds  After control of infection. h) Vascular or nerve injuries are dealt with accordingly. . i) Internal injuries (intracranial by craniotomy. intra-abdominal by laparotomy) has to be dealt with accordingly. Then delayed primary suturing is done. once healthy granulation tissue appears. the oedema is allowed to subside for 2-6 days.5 ml intramuscular to deltoid muscle). Fractured bone is also identified and properly dealt with. tetanus toxoid (0. # wound debridement:  wound toilet/wound incision  liberal excision of devitalized tissue at regular interval (48-72 hours) until healthy. Later. incised wounds # delayed primary suturing: suturing the wound in 48 hours to 10 days done in lacerated wound. g) In a wound with tension. vascular tidy wound is created. blood transfusion. Allow oedema to subside # secondary suturing:  Suturing the wound in 10-14 days or later. j) Antibiotics. If the wound is large a split skin graft (Thiersch graft) is used to cover the defect. fasciotomy is done so as to prevent the development of compartment syndrome.excision by excising all devitalised tissue. # primary suturing:  suturing the wound immediately within 6 hours  done in clean. If the nerves are having clean cut wounds it can be sutured primarily with polypropylene 6-zero or 7-zero suture material. f) If it is a deep devitalised wound. suturing is done # radical wound excision:  Pseudotumour approach  Excising entire devitalized tissue leaving tissue with visible bleeding from all layers. if the wound is small secondary suturing is done. after wound debride. intrathoracic by intercostal tube drainage.ment it is allowed to granulate completely. If there is difficulty in identifying the nerve ends or if there are crushed cut ends of nerves then marker stitches are placed using silk at the site and later secondary repair of the nerve is done. fluid and electrolyte balance.