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WOUND HEALING

Agung Adhitya Indra


2

Types of wound healing


Healing by
Primary
Intention:

Healing by
Secondary
Intention:

Healing by
Tertiary
Intention:

Diegelmann RF and Evans MC. 2004. Wound healing : an overview of acute, fibrotic and delayed healing. Front in Biosci. 9:283-9.
Harding, KG; Morris, G K patel. 2002. Science, medicine, and the future Healing chronic wounds. BMJ Vol 324
Wound Healing

Diegelmann RF and Evans MC. 2004. Wound healing : an overview of acute, fibrotic and delayed healing. Front in Biosci. 9:283-9.
Harding, KG; Morris, G K patel. 2002. Science, medicine, and the future Healing chronic wounds. BMJ Vol 324
4

The wound healing


• Hemostasis-inflammation
• Granulation-proliferation
• Remodelling

capillaries
fibroblasts
lymphocytes
macrophages
neutrophyl gr.
thrombocytes
0 1 2 3 4 5 6 7 8 9 10 11 10 13 14 15

Diegelmann RF and Evans MC. 2004. Wound healing : an overview of acute, fibrotic and delayed healing. Front in Biosci. 9:283-9.
Harding, KG; Morris, G K patel. 2002. Science, medicine, and the future Healing chronic wounds. BMJ Vol 324
The main steps of the wound healing

Hemoistasis and inflamation phase

Remodeling phase

Poliferation phase
Diegelmann RF and Evans MC. 2004. Wound healing : an overview of acute, fibrotic and delayed healing. Front in Biosci. 9:283-9.
5.Harding, KG; Morris, G K patel. 2002. Science, medicine, and the future Healing chronic wounds. BMJ Vol 324
6

The main steps of the wound healing


1. Hemostasis-inflammation 2. Granulation-proliferation
vasoconstriction fibroblast migration
fibrin clot formation collagen deposition
angiogensis
proinflammatory citokines and granulation tissue formation
growth factors releasing epithelisation
contraction
vasodilatation 3. Remodelling
regression of many capillaries
infiltration PMNs, macrophages
physical contraction – myofibroblasts
collagen degeneration and synthetisation
cytokines releasing new epithelium
→ angiogensis tensile strength – max. 80%
→ fibroblast activation
→ B- and T-cells activation
→ keratinocytes activation
→ wound contraction

Diegelmann RF and Evans MC. 2004. Wound healing : an overview of acute, fibrotic and delayed healing. Front in Biosci. 9:283-9.
5.Harding, KG; Morris, G K patel. 2002. Science, medicine, and the future Healing chronic wounds. BMJ Vol 324
Wound Healing

Beidas, Omar E. "General Surgery Suture Needles." General Surgery Suture Needles.
Ed. Vikram Kate. Medscape, 23 July 2013.
MEATOTOMY
Meatotomy

Meatotomy: Cutting and widening of


external meatus

Sriram Bhat M. 2007. SRB's Manual of Surgery. Jaypee Brothers Medical Publishers.
Meatotomy
Indication:
Meatal stenosis
Urethral stone

meatotomy was applied to


extract the spiked
impacted stone in the
fossa navicularis
B.A. Kamal, R.M. Anikwe, H. Darawani, M. Hashish And S.A. Taha. Urethral calculi: presentation and management. BJU International, 93,
549–552, doi:10.1111. 2004
Kotkar, Kunal, Ravi Thakkar, and MC Songra. “Giant Urethral Calculus.” Journal of Surgical Case Reports 2011.8 (2011): 9. PMC. Web. 13
Sept. 2018.
Lowsley OS Kirwin JJ. “Clinical Urology”3rd Edition. Vol. 1, Williams and Wilkins Company, Baltimore, 1956, pp. 317-319
Palmer, Jeffrey S. (2010), Pediatric Urology: A General Urologist's Guide, Springer, p. 132, ISBN 1-60327-419-7
Meatotomy

ventral approach  small degree of hypospadias, which


is preferable to a dorsal incision  significant bleeding
by cutting into the vascular glans penis.

Steven B. Brandes. Urethral Reconstructive Surgery (Current Clinical Urology) 2008th Edition. Humana Press.
Meatotomy

OR

Dorsal Meatotomy Ventral Meatotomy


Meatotomy

Kirk A. Keegan, David F. Penson. 2013. Vasculogenic Erectile Dysfunction. Vascular Medicine: A Companion to Braunwald's Heart
Disease. Chapter 28