Wound healing

1. WOUND HEALING
PREPARED BY:
JISA SHEHZAAN ALTHAF

2. WOUND HEALING
DEFINITION
It is defined as the complex and dynamic process that results in
the restoration of anatomic continuity and function.
It requires adequate nutrition, blood flow and oxygen.

3. Wound healing is the final stage of inflammatory response. It
includes two major components:-
Regeneration (replacement of lost cells with same type of cells)
Repair( Lost cells are being replaced by connective tissue)

4. CLASSIFICATION
Primary Intention
Secondary Intention
Tertiary Intention

5. I. Primary Intention
It takes place when margins are approximated ( Eg: surgical
wound or incision).It has the following characteristics:
Clean & uninfected
Surgically incised

6. Cont...
Without much loss of cells & tissues
Edges of wound are approximated by surgical sutures
Wounds with opposed edges(opposite/very different)
Primary union( healing by first intension)
less scar is present

7. Cont..
Primary intention has got 3 phases:
I. Initial phase
II. Granulation phase
III. Maturation & scar contraction

8. Cont..
1) Initial Phase:-
 Lasts for 3-5 days
 Edges are aligned and sutured
 Incisional areas fills with blood and clot
 WBC migrate to that area
 Inflammatory response occurs
 The area of injury composed of fibrous clots, erythrocytes and
other debris.

9. Cont..
2)Granulation Phase:-
 It is the fibroblastic proliferative reconstructive phase.
 Lasts for 5 days - 3 weeks.
 Components of granulation tissue are fibroblast,
small capillaries, WBC and exudates.

10. Cont..
3)Maturation scar contraction:-
 It overlaps with granulation phase
 Begins 7 days after injury and continues months to years
 Collagen fibers are organized and re-modelling occurs

11. Cont...
 Fibroblast disappear as wound become stronger
 There will be active movement of myofilament(protein
filaments of muscles) that causes contraction of healing area,
edges close together and wound scar is formed.

12. II. Secondary Intention:-
 Wound that occurs from trauma, ulceration and infection in
a large exudate , wide irregular wound margin with
extensive tissue loss are certain wounds that heal through
secondary intention.

13. Cont..
 Closed deep layers & opened superficial layers
 Healing process include
; but it takes longer period.
Eg: pressure ulcer or abrasions.

14.  The characteristics are:
 Wound with separate edges
 Secondary union (along with granulating surface)
 More extensive loss of cells and tissue.
 Regeneration of parenchymal cells which cannot completely
constitute the original structure.

15. Cont...
 Abundant granulation tissue grows in from the margin to
complete the repair.
III.Tertiary Intention:-
 Healing occurs with delayed suturing of a wound in which 2
granular tissues are sutured together.

16. Cont...
 It occurs when the contaminated wound left open and
sutured after the infection being controlled.
 Because of the increased risk of infection, these wounds are
closed later when they get free of debris.

17. There are 4 stages of wound healing:
1. Hemostasis & coagulation
2. Inflammation
3. Proliferation & migration of dead tissues
4. Remodelling

18. • Hemostasis is the process of wound being closed by clotting.
• It starts when blood leaks out of the body.
• It is the stage of wound healing that happens very quickly.
• Steps:-

19. Cont...
Blood vessels constrict to blood flow
Platelets aggregate to the brocken area
of blood vessel
Coagulation occurs & platelets plug
with threads of fibin

20. Second stage of wound healing process
Begins right after injury when the injured blood vessels leak
causing localized swelling.
It controls bleeding & prevents infection.

21. During the inflammatory phase; damaged cells , pathogens
& bacteria are removed from the wound area.
This is a natural part of wound healing process & becomes
problematic only if prolonged or excessive.

22. This phase of wound healing is when the wound is rebuilt with new
tissue made up of collagen & extra cellular matrix.
It lasts from 3-7 weeks.
Its 3 process include : filling the wound, contraction of ound margins
& covering the wound.

23. Cont...
• Granulation tissue fills the wound bed with
connective tissue
• The new wblood vessels are formed.
• Wound margins contract & pull towards the centre of
wound
• Epithelial cells arise from the wound bed or margins
&
• begins to migrate across the wound bed

24. • New tissue slowly gains strength & flexibility.
• Collagen fibres recognize the tissue models & matures.
• Fibroblast continues to produce collagen & proteolichen.
• The maturation phase is when collagen is remodelled from
type III to type I and wound fully closes.

25. Factors Affecting Wound Healing
• Infection
• Edema
• Impaired circulation
• Impaired mobility
• Impaired nutrition

26. Cont...
• Impaired mobility
• Impaired nutrition
• Immunosupressed
• Drugs viz aspirin, heparin

27. i. Repair tissue in timel
ii. y manner
iii. Restore the function & anatomy of body part
iv. Prevent infection
v. Minimize pain,inflammation & edema
vi. The best aesthetic (beauty) outcome

28. COMPLICATIONS OF WOUND HEALING
 Hypertrophic scar & cheiloid formation
 Muscle contracture
 Excess granulation tissue
 Wound dehiscence
 Adhesion
 Wound infection

30. Collaborative Care:-
Drug Therapy
Anti-pyretics
(Acetaminophen)
NSAIDS (Salicylates,
Corticosteroids)
Nutritional Therapy
High proteins,
carbohydrates & vitamins
(Vit. A, B, C)
Moderate fat

31. NURSING MANAGEMENT
• Hyperthermia related to infection
• Risk for flid volume deficit
• Health promotion
• Rest & elevation of affected part
• Oxygenation

32. Cont...
• Infection prevention
• Fever management
• Negative pressure wound therapy
• Psychological support