Zahir T Fadel King Abdulaziz University Introduction Wound

Zahir T. Fadel King Abdulaziz University

Introduction Wound healing and care is important to understand because the incidence of poor wound healing, wound infection and excessive scarring is considered as a main cause of morbidity and mortality. Nowadays, a detailed knowledge of the basic mechanisms of healing and scarring allows surgeons to influence it, and prevent problems of incomplete or excessive repair.

Phases of Wound Healing The entire wound healing process is a complex series of events that begins at the moment of injury and can continue for months to years. This overview will help in identifying the various stages of wound healing.

I. Inflammatory Phase A) Immediate to 2 -5 days B) Hemostasis Vasoconstriction Platelet aggregation Thromboplastin makes clot C) Inflammation Vasodilation Phagocytosis

II. Proliferative Phase A) 2 days to 3 weeks B) Granulation - Fibroblasts lay bed of collagen - Fills defect and produces new capillaries C) Contraction - Wound edges pull together to reduce defect D) Epithelialization - Crosses moist surface - Cell travel about 3 cm from point of origin in all directions

III. Remodeling Phase A) 3 weeks to 2 years B) New collagen forms which increases tensile strength to wounds C) Scar tissue is only 80 percent as strong as original tissue

Wound Closure All wounds heal in one of three ways: First intention wound healing is the most desirable. Most surgical wounds heal by first intention if the wound is not contaminated, dead spaces are closed, tissue is handled gently, hemostasis is achieved, and the tissues are approximated accurately. secondary intention wound is allowed to heal by forming granulation tissue from the bottom of the wound outward. This type of healing takes much longer than healing by first intention. Secondary intention healing is used when tissue lost is more extensive, as in infection, inflammatory ulceration, abscess formation, or even large wounds.

Third intention When granulation tissue has developed along the edges of a wound the surgeon may use large retention type sutures to assist in healing. Third intention healing is used when there is gross infection, or after tissue has been lost due to traumatic injury or surgical debridement.

FACTORS AFFECTING Wound HEALING Malnutrition infection Anemia Hypoxia diabetes mellitus radiation injury drugs : corticosteroids , Dactinomycin, Fluorouracil, Methotrexate advanced age

Complications: Hypertrophic Scars During the active phase the scar may become firm to the touch and may rise from the surrounding unbroken skin, but remain within the boundaries of the original wound. This is what is called a hypertrophic scar.

Keloid Scars In some instances the scar tissue grows beyond the boundaries of the original injury or surgical incision. This is called a keloid scar. The keloid scar may slowly get bigger for many years and may never completely mature. In some instances, people are genetically prone to develop this type of scar. This type of scar does not improve with time

Wounds care and management: 1. Haemostasis Can be maintained either by applying firm pressure or using vasoconstrictors such as epinephrine. 2. Wound cleaning ( Irrigation) High pressure irrigation is more effective than lowpressure irrigation in reducing bacterial wound counts and wound infection rates. Most authorities recommend impact pressures generated by a 30 -60 cc syringe and a 18 -gauge needle. Normal saline is the most common choice of solution and should be used until the wound appears clean. Hydrogen peroxide and poviodine should NOT be used for irrigation.

3. Conservative debridement Devitalised pieces of skin and subcutaneous tissue are excised. Viable tissue should be conserved and this is especially important in the face and hands. 4. Wound Closure a. Suturing b. Staples 5. Wound dressings important to maintain sterility and absorb blood and serum

6. Optimal time for suture removal Location e. g. Face 3 - 5 days Scalp 7 days Chest and extremities 8 -10 days High tension (joints, hands) 10 -14 days Back 10 -14 days

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