In the Name of Allah, the Most    Beneficent, the Most Merciful And whosoever fears Allah and keeps his duty to Him, He wi...
Assistant professor OMFSWounds, Wound Healing And Complications                   ELHAWARY
Wound Healing And Suture Materials    WOUND – WOUND HEALINGWounds, Wound Healing And Complications   ELHAWARY
Definition• Type of injury in which skin is torn, cut or  punctured (an open wound), or where blunt  force trauma causes a...
Wounds, Wound Healing And Complications   ELHAWARY
Classifications of wounds                                          wound         According to the                         ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to object causing wound                                           Incision                       ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to object causing wound                                           Incision                       ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to object causing wound                                           Incision                       ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to the exposure to the outer environment                                           Incision     h...
Classification according to the exposure to the outer environment                                           Incision      ...
Classification according to object causing wound                                           Incision                       ...
Classification According to level of risk of sepsisWounds, Wound Healing And Complications         ELHAWARY
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Classification According to level of risk of sepsis                                          •   No viscus entered        ...
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Classification According to level of risk of sepsis                        Clean wound                                    ...
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Classification According to level of risk of sepsis                        Clean wound                            Clean   ...
Wound Healing And Suturing    WOUND HEALINGWounds, Wound Healing And Complications   ELHAWARY
Definition•      The process by which the body is trying to achieve       anatomical integrity of the injured part and to ...
Definition•      The process by which the body is trying to achieve       anatomical integrity of the injured part and to ...
Definition•      The process by which the body is trying to achieve       anatomical integrity of the injured part and to ...
Classification of wound healingWounds, Wound Healing And Complications   ELHAWARY
Classification of wound healing • Primary Intention •   Occurs when:      – The edges are clean and held        together w...
Classification of wound healing • Primary Intention •   Occurs when:      – The edges are clean and held        together w...
Classification of wound healing                                          • Secondary Intention                            ...
Classification of wound healing                                          • Secondary Intention                            ...
Classification of wound healing                                          • Secondary Intention                            ...
Differences between primary and secondary healing Wounds, Wound Healing And Complications   ELHAWARY
Differences between primary and secondary healing            Feature                   Primary healing             Seconda...
Normal sequence of wound healingWounds, Wound Healing And Complications   ELHAWARY
Normal sequence of wound healingWounds, Wound Healing And Complications   ELHAWARY
Normal sequence of wound healing                       Phases of wound healing        Hemostasis   Days                   ...
Normal sequence of wound healing                       Phases of wound healing    Inflammation        Hemostasis   Days   ...
Normal sequence of wound healing                       Phases of wound healing                             Proliferation  ...
Normal sequence of wound healing                       Phases of wound healing                                    Maturati...
http://en.wikipedia.org/wiki/File:Wound_healing_phases.pngWounds, Wound Healing And Complications                         ...
Normal sequence of wound healing• Inflammatory phase• Proliferative Phase• Remodeling Phase Wounds, Wound Healing And Comp...
Normal sequence of wound healing                                      Starts 1st day lasts from 3-5 days• Proliferative Ph...
Normal sequence of wound healing• Inflammatory phase Starts 3rd day lasts for 3rd week                                    ...
Normal sequence of wound healing• Inflammatory phase Starts from weeks to years• Proliferative Phase • The fibroblasts sta...
Factors affecting healingWounds, Wound Healing And Complications      ELHAWARY
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound        • Infection – delay healing & change type of healing  ...
Factors affecting healing                              Wound        • Infection – delay healing & change type of healing  ...
Factors affecting healing                              Wound        • Infection – delay healing & change type of healing  ...
Factors affecting healing                              Wound        • Infection – delay healing & change type of healing  ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
http://www.beltina.org/health-dictionary/langers-lines-skin.htmlWounds, Wound Healing And Complications                   ...
http://hi.baidu.com/hilygogo/blog/item/35cbe8f0db3a7baba50f5271.htmlWounds, Wound Healing And Complications               ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Factors affecting healing                              Wound                              sepsis                          ...
Complications of wound healingWounds, Wound Healing And Complications   ELHAWARY
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                                      • Classification of wounds according to risk of       ...
Complications of wound healing                                      • Classification of wounds according to risk of       ...
Complications of wound healing                                      • Classification of wounds according to risk of       ...
Complications of wound healing                                      • Classification of wounds according to risk of       ...
Complications of wound healing                        Infection                      Dehiscencecomplications           Inc...
Complications of wound healing                        Infection                      Dehiscencecomplications           Inc...
Complications of wound healing                                       • Definition: Total breakdown of all the layers of th...
Complications of wound healing                        Infection                       Dehiscencecomplications          Inc...
Complications of wound healing                        Infection                       Dehiscencecomplications          Inc...
Complications of wound healing                                       • Definition: Breakdown of the deeper layers of a    ...
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                                       • Definition: Excess collagen scar tissue formation -...
Complications of wound healing                                       • Definition                        Infection      • ...
Complications of wound healing                                       • Definition                        Infection      • ...
Complications of wound healing                                       • Definition                        Infection      • ...
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                                       • Definition: Overhealing with excess collagen scar  ...
Complications of wound healing                                       • Definition                        Infection      • ...
Complications of wound healing                                       • Definition                        Infection      • ...
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                        Infection                       Dehiscencecomplications           In...
Complications of wound healing                                       • Wound Contractures can occur with any wounds       ...
Complications of wound healing                                       • Wound Contractures can occur with any wounds       ...
Complications of wound healing                                       • Wound Contractures can occur with any wounds       ...
http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications                                 ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications                                 ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications                                 ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications                                 ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications                                 ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications                                 ELHAWARY
Thank you           Dr. Hesham El-Hawary                       El-           Ass. Professor OMFS           Facebook:      ...
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Transcript of "Wounds, Wound Healing And Complications"

  1. 1. In the Name of Allah, the Most Beneficent, the Most Merciful And whosoever fears Allah and keeps his duty to Him, He will make a way for him to get out (from every difficulty). (2) And He will provide him from (sources) he never could imagine. And whosoever puts his trust in Allah, then He will suffice him. Verily, Allah will accomplish his purpose. Indeed Allah has set a measure for all things. (3) Surat Aţ-ŢalāqWounds, Wound Healing And Complications ELHAWARY
  2. 2. Assistant professor OMFSWounds, Wound Healing And Complications ELHAWARY
  3. 3. Wound Healing And Suture Materials WOUND – WOUND HEALINGWounds, Wound Healing And Complications ELHAWARY
  4. 4. Definition• Type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound)• In pathology: it specifically refers to a sharp injury which damages the dermis of the skinWounds, Wound Healing And Complications ELHAWARY
  5. 5. Wounds, Wound Healing And Complications ELHAWARY
  6. 6. Classifications of wounds wound According to the According to exposure to the level of risk of outer sepsis environementWounds, Wound Healing And Complications ELHAWARY
  7. 7. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  8. 8. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  9. 9. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  10. 10. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  11. 11. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  12. 12. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  13. 13. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma http://woundbegone.blogdrive.com/ Crush injuryWounds, Wound Healing And Complications ELHAWARY
  14. 14. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://en.wikipedia.org/wiki/File:Knee_puncture.JPGWounds, Wound Healing And Complications ELHAWARY
  15. 15. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush http://journal.nzma.org.nz/journal/120-1267/2867/ injuryWounds, Wound Healing And Complications ELHAWARY
  16. 16. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://www.podiatrytoday.com/article/6303Wounds, Wound Healing And Complications ELHAWARY
  17. 17. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  18. 18. Classification according to the exposure to the outer environment Incision http://en.wikipedia.org/wiki/File:Bruises.jpg Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injuryWounds, Wound Healing And Complications ELHAWARY
  19. 19. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush http://www.buzzle.com/articles/hematoma-treatment.html injuryWounds, Wound Healing And Complications ELHAWARY
  20. 20. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://www.smrteam.com/na1_crushinjury.htmWounds, Wound Healing And Complications ELHAWARY
  21. 21. Classification According to level of risk of sepsisWounds, Wound Healing And Complications ELHAWARY
  22. 22. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty woundsWounds, Wound Healing And Complications ELHAWARY
  23. 23. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty woundsWounds, Wound Healing And Complications ELHAWARY
  24. 24. Classification According to level of risk of sepsis • No viscus entered Clean wound • No septic area • No break in aseptic technique Clean • Such wounds should never become contaminated infected; infection rates less than 3% wounds wound Contaminated wounds Dirty woundsWounds, Wound Healing And Complications ELHAWARY
  25. 25. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty woundsWounds, Wound Healing And Complications ELHAWARY
  26. 26. Classification According to level of risk of sepsis Clean wound Clean • Operation enters a non-infected area but contaminated may encounter bacteria wounds • Careful control of the area should result wound in minimal spillage of organisms Contaminated • Examples of this include surgery on the wounds upper gastrointestinal tract, biliary tree or respiratory tract • Infection rates for this type of surgery Dirty wounds should be less than 10%Wounds, Wound Healing And Complications ELHAWARY
  27. 27. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty woundsWounds, Wound Healing And Complications ELHAWARY
  28. 28. Classification According to level of risk of sepsis Clean wound • Gross spillage of organisms, where there Clean is infection already present but without contaminated wounds pus formation wound • There is a major break in aseptic Contaminated technique wounds • There is an open wound that has been exposed for less than 4 h (e.g. following major trauma) Dirty wounds • In this type of wound, sepsis frequently exceeds 30%Wounds, Wound Healing And Complications ELHAWARY
  29. 29. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty woundsWounds, Wound Healing And Complications ELHAWARY
  30. 30. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds • This is an operation through an infected Dirty wounds area (e.g. perforated viscus, abscess or traumatic wound) that has been exposed for over 4 hWounds, Wound Healing And Complications ELHAWARY
  31. 31. Wound Healing And Suturing WOUND HEALINGWounds, Wound Healing And Complications ELHAWARY
  32. 32. Definition• The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function Wounds, Wound Healing And Complications ELHAWARY
  33. 33. Definition• The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function Wounds, Wound Healing And Complications ELHAWARY
  34. 34. Definition• The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function• As a secondary consideration, this should be combined with an attempt to produce as perfect a cosmetic result as possible Wounds, Wound Healing And Complications ELHAWARY
  35. 35. Classification of wound healingWounds, Wound Healing And Complications ELHAWARY
  36. 36. Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 monthWounds, Wound Healing And Complications ELHAWARY
  37. 37. Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 monthWounds, Wound Healing And Complications ELHAWARY
  38. 38. Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contractureWounds, Wound Healing And Complications ELHAWARY
  39. 39. Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contractureWounds, Wound Healing And Complications ELHAWARY
  40. 40. Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contractureWounds, Wound Healing And Complications ELHAWARY
  41. 41. Differences between primary and secondary healing Wounds, Wound Healing And Complications ELHAWARY
  42. 42. Differences between primary and secondary healing Feature Primary healing Secondary healingCleanness Clean UncleanInfection Generally uninfected May be infectedMargins Surgically clean IrregularHealing Scanty granulation tissue Granulation tissue fill the gapHealing period Short longHealing direction Direct healing From the bottom to the edgeOutcome Neat linear scar Contracted irregular wound Wounds, Wound Healing And Complications ELHAWARY
  43. 43. Normal sequence of wound healingWounds, Wound Healing And Complications ELHAWARY
  44. 44. Normal sequence of wound healingWounds, Wound Healing And Complications ELHAWARY
  45. 45. Normal sequence of wound healing Phases of wound healing Hemostasis Days Weeks MonthsWounds, Wound Healing And Complications ELHAWARY
  46. 46. Normal sequence of wound healing Phases of wound healing Inflammation Hemostasis Days Weeks MonthsWounds, Wound Healing And Complications ELHAWARY
  47. 47. Normal sequence of wound healing Phases of wound healing Proliferation Inflammation Hemostasis Days Weeks MonthsWounds, Wound Healing And Complications ELHAWARY
  48. 48. Normal sequence of wound healing Phases of wound healing Maturation & Remodeling Proliferation Inflammation Hemostasis Days Weeks MonthsWounds, Wound Healing And Complications ELHAWARY
  49. 49. http://en.wikipedia.org/wiki/File:Wound_healing_phases.pngWounds, Wound Healing And Complications ELHAWARY
  50. 50. Normal sequence of wound healing• Inflammatory phase• Proliferative Phase• Remodeling Phase Wounds, Wound Healing And Complications ELHAWARY
  51. 51. Normal sequence of wound healing Starts 1st day lasts from 3-5 days• Proliferative Phase • 1st vasoconstriction • 2nd blood clot formation• Remodeling Phase • 3rd platelets aggregation • 4th platelets degranulation • 5th vasodilatation • 6th chemotaxis • Leucocytes • Neutrophils • Macrophages Wounds, Wound Healing And Complications ELHAWARY
  52. 52. Normal sequence of wound healing• Inflammatory phase Starts 3rd day lasts for 3rd week • 1st Angiogenesis • 2nd fibroblasts migration• Remodeling Phase • 3rd formation of granulation tissue • 4th reepithelialization Wounds, Wound Healing And Complications ELHAWARY
  53. 53. Normal sequence of wound healing• Inflammatory phase Starts from weeks to years• Proliferative Phase • The fibroblasts start to disappear • Collagen type III is gradually replaced by stronger type I collagen • The tensile strength of the scar tissue gradually increase Wounds, Wound Healing And Complications ELHAWARY
  54. 54. Factors affecting healingWounds, Wound Healing And Complications ELHAWARY
  55. 55. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  56. 56. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  57. 57. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  58. 58. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  59. 59. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound  Scrub the area with surgical antiseptic tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  60. 60. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound  Scrub the area with surgical antiseptic tension  Drape the body with sterile surgical drapes Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  61. 61. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  62. 62. Factors affecting healing Wound sepsis Blood • Areas of good blood supply heal better than areas supply of poor blood supply Local factors Wound • Proper surgical technique tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  63. 63. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  64. 64. Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  65. 65. Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous • Bridging a gap can be achieved by plastic surgeryFactors irradiation techniques rather than suturing under tension Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  66. 66. Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous • Bridging a gap can be achieved by plastic surgeryFactors irradiation techniques rather than suturing under tension Poor • Incision along lines of collagen bundles (Langer’s technique lines) Nutritional • Skin creases deficiencies • Transverse at the joints Systemic Systemic • Longitudinal on long parts (limbs) factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  67. 67. http://www.beltina.org/health-dictionary/langers-lines-skin.htmlWounds, Wound Healing And Complications ELHAWARY
  68. 68. http://hi.baidu.com/hilygogo/blog/item/35cbe8f0db3a7baba50f5271.htmlWounds, Wound Healing And Complications ELHAWARY
  69. 69. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  70. 70. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiationFactors • Predispose excess scar tissue formation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  71. 71. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiationFactors • Predispose excess scar tissue formation Poor • Types technique • Exogenous: enter at time of injury Nutritional • Endogenous: hair, fat, necrotic tissue, tooth deficiencies fragment Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  72. 72. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiationFactors • Predispose excess scar tissue formation Poor • Types technique • Exogenous: enter at time of injury Nutritional • Endogenous: hair, fat, necrotic tissue, tooth deficiencies fragment Systemic Systemic • Requires: proper cleaning and disinfection before factors diseases closure Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  73. 73. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  74. 74. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous irradiation • Radiation effectFactors • Hypovascularity Poor • Hypocellularity technique • Hypoxia Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  75. 75. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  76. 76. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor • Surgical technique affect the blood supply to area technique • Incision place: along lines of collagen bundles Nutritional (Langer’s lines) deficiencies • Flap design Systemic Systemic • Sharp clean cut factors diseases • Proper extension to prevent retraction Therapeutic pressure agents • Careful haemostasis • Proper suture material selection Age • Proper suturing techniqueWounds, Wound Healing And Complications ELHAWARY
  77. 77. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  78. 78. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor • Vitamins: A & C technique • vit. A: Involved in epithelialisation and Nutritional collagen production deficiencies • vit. C: Production and modification of collagen Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  79. 79. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor • Vitamins: A & C technique • Minerals: Zinc Nutritional • Acts as an enzyme cofactor deficiencies • Has a role in cell proliferation Systemic Systemic • It accelerates wound healing in experimental factors diseases models Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  80. 80. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor • Vitamins: A & C technique • Minerals: Zinc Nutritional • Protein: The main building block in wound healing deficiencies • A malnourished, hypoproteinaemic patient Systemic Systemic has impaired inflammatory and immune factors diseases responses, vital for normal wound healing Therapeutic and prevention of wound infection. agents • Protein amino acids are essential for collagen production which is itself a protein. AgeWounds, Wound Healing And Complications ELHAWARY
  81. 81. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  82. 82. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic • Several diseases are known to impair wound factors diseases healing via a number of mechanisms Therapeutic • Important examples include diabetes, uraemia and agents jaundice AgeWounds, Wound Healing And Complications ELHAWARY
  83. 83. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  84. 84. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique • Immunosuppressive drugs dampen the Nutritional inflammatory and immune responses, hence deficiencies impairing wound healing Systemic • Chemotherapeutic agents for malignancy Systemic factors diseases • Immunosuppressive and antiprostaglandin drugs used for inflammatory conditions such as Therapeutic agents rheumatoid disease; corticosteroid therapy N.B. Steroids have the additional effect of increasing Age the fragility of small blood vesselsWounds, Wound Healing And Complications ELHAWARY
  85. 85. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents AgeWounds, Wound Healing And Complications ELHAWARY
  86. 86. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies PreviousFactors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents • Prior to puberty, the rate of wound healing is Age increased compared to postpubertyWounds, Wound Healing And Complications ELHAWARY
  87. 87. Complications of wound healingWounds, Wound Healing And Complications ELHAWARY
  88. 88. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  89. 89. Complications of wound healing • Classification of wounds according to risk of Infection sepsis Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  90. 90. Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating techniquecomplications Incisional • Prophylactic antibiotics Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  91. 91. Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating techniquecomplications Incisional • Prophylactic antibiotics Hernia • Treatment • Prophylactic antibiotics • Empirical antibiotic Hypertrophic • Therapeutic /specific antibiotics scaring • I&D • Antiseptic packs Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  92. 92. Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating techniquecomplications Incisional • Prophylactic antibiotics Hernia • Treatment • Prophylactic antibiotics • Empirical antibiotic Hypertrophic • Therapeutic /specific antibiotics scaring • I&D • Antiseptic packs Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  93. 93. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  94. 94. Complications of wound healing Infection Dehiscencecomplications Incisional © 2009 Nucleus Medical Art, Inc. Hernia Hypertrophic scaring Keloid scarring Contractures http://www.empowher.com/media/reference/wound-dehiscence Wounds, Wound Healing And Complications ELHAWARY
  95. 95. Complications of wound healing • Definition: Total breakdown of all the layers of the Infection surgical repair of a wound • Etiology / causes: • Suture breakage Dehiscence • Knot slippage • Cutting out of sutures • Excess tension on the suture linecomplications Incisional © 2009 Nucleus Medical Art, Inc. Hernia Hypertrophic scaring Keloid scarring Contractures http://www.empowher.com/media/reference/wound-dehiscence Wounds, Wound Healing And Complications ELHAWARY
  96. 96. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  97. 97. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional _hernia/info-incisional-hernia-gen-1.htm Wounds, Wound Healing And Complications ELHAWARY
  98. 98. Complications of wound healing • Definition: Breakdown of the deeper layers of a Infection wound in which the skin layer remains intact with protrusion of underlying structures through the deeper defect Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional _hernia/info-incisional-hernia-gen-1.htm Wounds, Wound Healing And Complications ELHAWARY
  99. 99. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  100. 100. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  101. 101. Complications of wound healing • Definition: Excess collagen scar tissue formation - Infection almost an over healing of a wound Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  102. 102. Complications of wound healing • Definition Infection • Clinical features: • It is non-progressive after 6 months • Does not extend beyond the edges of the Dehiscence wound. • It occurs most frequently around joints and where Langers lines of tension are crossed bycomplications Incisional the incision Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  103. 103. Complications of wound healing • Definition Infection • Clinical features: • Etiology: Poor skin suturing • The edges of the skin are overlapping instead Dehiscence of being accurately apposedcomplications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  104. 104. Complications of wound healing • Definition Infection • Clinical features • Treatment: • Difficult Dehiscence • Further surgery should not be attempted for at least 6 months • Excision of the scar and re-suturing often hascomplications Incisional disappointing results, resulting in the same over Hernia healing • Radiotherapy used to be used but has now been abandoned Hypertrophic • Some improvement can be achieved with local scaring injection of corticosteroids directly into the scar, a process that might need repeating several Keloid times scarring Contractures http://www.ehow.com/about_542243 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  105. 105. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  106. 106. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  107. 107. Complications of wound healing • Definition: Overhealing with excess collagen scar Infection formation due to abnormality in collagen metabolism Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  108. 108. Complications of wound healing • Definition Infection • Clinical features: • Excess scar tissue • Extends out beyond the wound edges Dehiscence • Continue to enlarge after 6 months • Prevalence is higher in • Patients with dark skincomplications Incisional • young patients Hernia • Burn wounds Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  109. 109. Complications of wound healing • Definition Infection • Clinical features • Treatment: • Excision generally results in a larger recurrence Dehiscence • Although excision followed by compression bandaging can have slightly better results • Corticosteroid injections give somecomplications Incisional improvement Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  110. 110. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  111. 111. Complications of wound healing Infection Dehiscencecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  112. 112. Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Infection • Burns Dehiscence • Incision crosses Langers linescomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  113. 113. Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement Dehiscence • It is therefore essential to avoid vertical incisions across a joint if possiblecomplications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  114. 114. Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement Dehiscence • Surgical treatment include • Skin grafting • local flapscomplications Incisional • wound Z-plasty Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  115. 115. http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications ELHAWARY
  116. 116. http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications ELHAWARY
  117. 117. http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications ELHAWARY
  118. 118. http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications ELHAWARY
  119. 119. http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications ELHAWARY
  120. 120. http://www.aafp.org/afp/2003/0601/p2329.htmlWounds, Wound Healing And Complications ELHAWARY
  121. 121. Thank you Dr. Hesham El-Hawary El- Ass. Professor OMFS Facebook: Facebook: Hesham El-Hawary El- Twitter: @elhawary_hesham Email: hesham@elhawarydentalclinc.com Website: www.elhawarydentalclinic.comWounds, Wound Healing And Complications ELHAWARY

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