ppt

1. PRESENTED BY:
DR.PRAFULLA PATIL
WOUND

2. Definition:
 Wound is a discontinuity or break in the surface epithelium.
 A wound is simple when only skin is involved.
 It is complex when it involves underlying nerves, vessels and
tendons.

3. Types:
WOUND
OPEN
CONTUSION
ABRASION
HAEMATOMA
CLOSED
INCISED
LACERATED
PENETRATING
CRUSHED

4. TYPES:
WOUND
TIDY
UNTIDY

5. Types:
WOUND
ACUTE CHRONIC

6. HEALING OF WOUND:
 Healing by primary intention:occurs in clean incised
surgical wound.
 Healing by secondary intention: refers a wound which
is infected,discharging pus or wound with skin loss.

7. COMPONENTS OF WOUND
HEALING:
 INFLAMMATORY PHASE
 PROLIFERATIVE PHASE
 REMODELLING PHASE
 PHASE OF SCAR FORMATION

8. INFLAMMATORY PHASE
 Injury results in the release of inflammatory mediators
mainly histamines from platelets,mast cells and
graunlocytes.
 This results in increased capillary permiability.
 Later kinins and prostaglandins play a chemotactic role
for white cells and fibroblast.
 In 48 hours PMN leucocytes dominate.That leucocyte
play the role of scavengers by removing dead and
necrotic tissue.

9. PROLIFERATIVE PHASE:
 Between 3RD And 5TH Days,PMN leucocytes
 Monocytes increase (specialised scavenger)
 By 5th or 6 th day ,fibroblast appear,proliferate and give rise to
protocollagen which is converted in to collagen.
protocollagen
in presence of protocollagen hydroxylase,o2 ,ferrous
ion and ascorbic aacid.
collagen

10.  Epithelialisation : occurs mainly from the edges of the
wound by a process of cell migration and cell
umltiplication.
 This is mainly brought about by marginal basal cell.
 Thus within first 48 hour entire wound is reepithelised.

11. Remodelling phase:
 Starts after 4 days and completed within 14 days
 Brought about by specialised fibroblast they are called
myofibroblast because of their contractile nature.
 It is the natures way of reducing the size of defect,helping
in wound healing.
 Connective tissue formation:formation of granulation is the
most important process in wound healing.

12. Phase of scar formation:
 Following changes take place during scar formation:
 Collagen is increased
 Vascularity becomes less
 Epithelialisation continues
 Ingrowth of lymphatics and nerve fibres takes place
 Reodelling of collagen takes place with
cicatrisation,resulting in scar.

13. Complication of wound Healing:
 INFECTION
 UGLY SCAR
 KELOID
 INCISIONAL HERNIA
 PIGMENTATION
 MARJOLIN’S ULCER

14. General principles of management of open wounds:
WOUND
CLEANING AND
BANDAGE
SPLINT IF THERE IS
FRACTURE
SUTURING TRANSPORT
ACTIVE BLEEDING
STOP THE BLEEDING
IV
LINE,RESUSCITATION

15.  Admission and observation in hospital
 Monitoring of TPR ,BP
 Systemic antibiotic
 Injection TT
 Treatment in the form of cleaning ,dressing,or
suturing.
 Wound closure :by primary suturing and secondary
suturing

16. Factors affecting wound Healing:
 Age
 Vit c deficiency
 Diabetic patient
 Jaundiced and uraemic patients
 Cytotoxic drugs
 Generelised infection and local infection
 Corticosteroids
 Malnutrition
 Poor blood supply
 Hypoxia ,ionising radiation
 Faulty techniques of wound closure