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Wound Healing

Department of Clinical Studies, Faculty


of Veterinary and Animals Sciences,
PMAS UAAR.

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 1
Morning, Section B.
Goals!
• To get General idea about
 Wound
 Wound Types
 Wound Healing (Major focus)
 Factors Affecting Healing
 Wound Management
 Wound Closure
 And why a surgeon must have the idea about
wound healing.
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Content
• General Definitions
• Introduction to Wound Healing
• Phases of Wound Healing
• Factors affecting Healing
• Wound Management
• Wound Closure
• Conclusion
• References.
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Anesthesiology). 15-ARID-4409 DVM, 6th, 3
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General Definitions
• Wounds are cuts, tears, burns, breaks, or other
damage to living tissue or Disruption of normal
anatomic continuity and metabolic functions of
body structures, including organs, tissues, and
cells.
• Clean or Aseptic wound which does not carry any
infection as surgical wounds or by sterilized
instrument
• Septic wound which is produced on roads and it
carry some infection or invasion of
microorganisms.
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Cont.
• Open wounds
 Incised wound caused by sharp sterile object like scalpel.
 Laceration are irregular tear like wounds caused by blunt
force.
 Abrasion wounds are superficial caused due to friction.
 Avulsion wound is in which a part of tissue is removed.
 Penetration wound caused by a knife like object.
 Gun shot Wound, also referred as through and through
wound, as there may be 2 wounds, one of entering and one
of exiting of bullet.
 Puncture Wound, wound caused by needle like substances.

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 8
Morning, Section B.
SURG-302 (General Veterinary Surgery and
Anesthesiology). 15-ARID-4409 DVM, 6th, 9
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Cont.
• Closed wounds
 Heamatoma are accumulated blood under skin due to damage to
blood vessels.
 Petechiae <3 mm
 Purpura > 3 <10 mm
 Ecchymosis> 10 mm

 Contusion is heamatoma caused by external trauma.


 Crush injury occurred under trauma force applied over longer
period of time.
 Thermal wounds
 Chemical Wounds
 Electrical wounds

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 10
Morning, Section B.
Introduction
• Wound Healing is the complex biological process through
which damaged organ or tissues regains its biological
integrity i-e maintains its structure and function.

• Integral cellular components of wound healing include;

 Platelets, neutrophils, monocytes, macrophages,


endothelial cells, fibroblasts, myofibroblasts, and
keratinocytes.

 In addition to these cellular components, important


cellular mediators include growth factors, cytokines, and
chemokines.
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Phases Of Wound Healing
• For our understanding, some divide this
process in 4 and some in 3 phases;
• A) Hemostasis
• B) Inflammation and Debridement
• C) Proliferation
• D) Maturation/ Remodeling

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If we put it simply!

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Anesthesiology). 15-ARID-4409 DVM, 6th, 14
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But it actually happens like this!
a) Hemostasis
• Disrupted vascular endothelial cell produce endothelin,
which (in combination with epinephrine, norepinephrine,
and prostaglandins) initiates contraction of smooth muscle
resulting in vasoconstriction.

• The coagulation cascade is initiated, and thrombin is


formed.

• Thrombin serves as a catalyst for fibrinogen conversion to


fibrin and contributes to platelet activation .

• Activated Platelets aggregate and adhere to exposed


collagen and degranulate (release GF).
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b) Inflammation
• Vasodilatation and increased vascular
permeability occur in response to the presence
of leukotrienes, prostaglandins, histamine, and
kinins.

• Which result in increased blood flow to the


wound bed and extravasation of fluid.

• Creating the classic signs of inflammation—heat,


redness, swelling and maybe loss of function.

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b) Debridement
• Neutrophils and macrophages, through
phagocytosis and their degradative enzymes,
breakdown and remove (“clean-up”) the cell
debris resulting from tissue injury.

• Macrophages secrete a variety of chemotactic


and growth factors that establish the
microenvironment for the proliferation
(granulation) phase.
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c) Proliferation(Granulation)
• Day 4 through day 12
• The proliferation phase can last up to 3 to 4 weeks or
longer depending on the size of the wound.

• This phase is characterized by the generation of new


endothelium (angiogenesis), epithelium
(epithelialization), and connective tissue stroma
(fibroplasia/desmoplasia) to restore normal structure
and function to the injured tissue.

• The healing of skin after third-degree burns or severe


ulcerations is an example of this process.
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d) The Remodeling (Maturation,
Contraction) phase
• This phase begins approximately 3 to 4 weeks after injury,
but only after the inflammation and proliferation phases
have been successfully completed.

• This phase includes remodeling of granulating(healing)


tissue by immature connective tissue and the conversion of
immature connective tissue to mature connective tissue
through extracellular collagen formation.

• Remodeling can last for 2 or more years. It essentially


provides the time some tissues and organs, such as bone,
need to return to the near-normal tensile strength required
for normal axial and appendicular skeletal function.
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Factors Affecting Healing

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Management of Wound
• Following are some rules for successful
surgical treatment of wounds
Thorough debridement
Meticulous Hemostasis
Elimination of dead space
Judicious Insertion of drains
Proper placement of sutures

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Anesthesiology). 15-ARID-4409 DVM, 6th, 27
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Anesthesiology). 15-ARID-4409 DVM, 6th, 28
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Cont.
• Large volume of clean non-sterile fluid (e.g. mains
water) is more valuable than small volume of
sterile physiological saline.
• Judicious use of 3% hydrogen peroxide, or 1%
chlorhexidine solution speeds removal of pus and
tissue debris.
• Single or interrupted mattress sutures of
sheathed polyamide polymer multifilamentous
material (e.g. Vetafil®, Supramid® [Braun]),
monofilament nylon or polypropylene.
SURG-302 (General Veterinary Surgery and
Anesthesiology). 15-ARID-4409 DVM, 6th, 29
Morning, Section B.
Cont.
• Drains-Sialastic, Penrose.
 Polypropylene, flexible and thin-walled with
multiple openings in deeper
• 3 layers of Bandages

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 30
Morning, Section B.
SURG-302 (General Veterinary Surgery and
Anesthesiology). 15-ARID-4409 DVM, 6th, 31
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Wound Closure
• Primary wound Closure or healing by primary
intention includes healing of clean wounds
without tissue loss, in this wound tissues are set
appositionally either with use of bandage or
suture.

• Secondary Wound Closure or healing by


Secondary intention includes filling with granular
tissue and skin continuity is established through
epithelization and contraction.
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Anesthesiology). 15-ARID-4409 DVM, 6th, 32
Morning, Section B.
Cont.
• Delayed Primary intention or Tertiary
Intention Healing includes initial healing by
secondary healing and then extra granular
tissue is excised and edge of wound are
sutured.

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 33
Morning, Section B.
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Anesthesiology). 15-ARID-4409 DVM, 6th, 34
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Conclusion
• The cornerstone of surgery is the restoration
of function and healing, so surgery should be
about that, plus a surgeon must understand
these events so he/she could manipulate the
factors affecting early wound healing to
reduce the physical trauma to the animal and
economical trauma to the owner.

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 35
Morning, Section B.
JAZAK ALLAH
• Questions?

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Anesthesiology). 15-ARID-4409 DVM, 6th, 36
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References
1) Karen M. Tobias & Spencer A. Johnsten(2012)
Veterinary Surgery: Small animal pp.125-135,
www.veterinarysurgerysmallanimal.com

2) Kirby, R., & wilkins, P. (2018). Wound


Management - Special Pet Topics - Veterinary
Manual. Retrieved from https://www.merckvetmanual.com/special-pet-
topics/emergencies/wound-management#v3231987

3) Zachary, J. F., & Gavin, M. M. (2012). Pathologic


Basis of Veterinay Disease(Fifth ed.). Penny
Rudolph.
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Cont.
• 4) Alison shepherd(June,2009). The Role of
The Surgical Technologist in Wound
Management, Pp (255-261),
https://r.search.yahoo.com/_ylt=A0geKWYtFgFbCMIA_vAPxQt.;_ylu=X3oDMTByOHZyb21tBG
NvbG8DYmYxBHBvcwMxBHZ0aWQDBHNlYwNzcg--
/RV=2/RE=1526826669/RO=10/RU=http%3a%2f%2fwww.ast.org%2fpdf%2f306.pdf/RK=2/RS
=bmtMOCX2HftVPnk7JaUu1KAWqjo-

• 5) Kumar, V., Abbas, A. K., Aster, J. C., &


Robbins, S. L. (2013). Robbins basic
pathology(9th ed.). Philadelphia, PA:
Elsevier/Saunders.
SURG-302 (General Veterinary Surgery and
Anesthesiology). 15-ARID-4409 DVM, 6th, 38
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Cont.
• 6) Turner, S. A., & McIlWraith, W. C.
(2007). Techniques in Large Animal
Surgery(Second ed.). Lippincott Williams and
Wilkins.

SURG-302 (General Veterinary Surgery and


Anesthesiology). 15-ARID-4409 DVM, 6th, 39
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