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Wound2007

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Wound2007

  1. 1. Wound and Wound Healing
  2. 2. Repair Processes <ul><li>Coagulation </li></ul><ul><li>Inflammation </li></ul><ul><li>Epithelialization </li></ul><ul><li>Granulation </li></ul><ul><li>Fibroplasia </li></ul><ul><li>Contraction </li></ul>
  3. 3. Repair Processes <ul><li>Coagulation </li></ul><ul><ul><li>instantaneously following wound formation. </li></ul></ul><ul><ul><li>Coagulation and complement cascades are activated, and platelets create a hemostatic plug. </li></ul></ul><ul><ul><li>Release of various inflammatory mediators from activated platelets sets the stage for the steps that follow. </li></ul></ul><ul><ul><li>Impaired by anticoagulants, antiplatelet agents, and coagulation factor deficiency. </li></ul></ul>
  4. 4. Repair Processes <ul><li>Inflammation </li></ul><ul><ul><li>Vascular events </li></ul></ul><ul><ul><ul><li>Constrict, dilation, permeability </li></ul></ul></ul><ul><ul><li>Cellular events </li></ul></ul><ul><ul><ul><li>Migration of white cells, differentiation, proliferation, secretion, phagocytosis </li></ul></ul></ul><ul><ul><ul><li>PMNs, lymphocytes, monocytes, platelets, fibroblasts, mast cells, macrophages, endothelium </li></ul></ul></ul><ul><ul><li>Chemical events </li></ul></ul><ul><ul><ul><li>Collagen, Gf, complement, coagulation system, cytokines, chemokines </li></ul></ul></ul>
  5. 6. Repair Processes <ul><li>Granulation </li></ul><ul><ul><li>Inflammatory cells infiltration </li></ul></ul><ul><ul><li>Fibroplasia </li></ul></ul><ul><ul><li>Angiogenesis </li></ul></ul>
  6. 7. Repair Processes <ul><li>Fibroplasia </li></ul><ul><ul><li>Formation of the scar </li></ul></ul><ul><ul><li>Deposit of collagen </li></ul></ul><ul><ul><li>Reestablish the tissue integrity </li></ul></ul><ul><ul><li>Remodeling </li></ul></ul>
  7. 8. Repair Processes <ul><li>Epithelialization </li></ul><ul><ul><li>Migration of epithelial cells, proliferation of the basal cells </li></ul></ul><ul><li>Contraction </li></ul><ul><ul><li>Contraction of the wound </li></ul></ul><ul><ul><li>Contracture of the scar </li></ul></ul><ul><ul><li>Myofibroblast </li></ul></ul><ul><ul><li>Matrix components </li></ul></ul>
  8. 9. Growth Factors: Regulators of Repair <ul><li>Selectively chemoattract inflammatory cells </li></ul><ul><ul><li>PDGF, EGF, IGF, TGF- β , FGF </li></ul></ul><ul><li>Stimulate cellular proliferation </li></ul><ul><ul><li>b-FGF, PDGF, IGF-1 for fibroblast and endthelium </li></ul></ul><ul><ul><li>EGF, TGF- α for epithelium </li></ul></ul><ul><li>Stimulate the formation of collagen, fibronectin </li></ul>
  9. 10. Surgical wound classification <ul><li>Clean </li></ul><ul><li>Clean-contaminated </li></ul><ul><li>Contaminated </li></ul><ul><li>Dirty/infected </li></ul>
  10. 11. The Types of Healing <ul><li>Primary or first intention healing </li></ul><ul><ul><li>Clean, closed (maybe with sutures) wound </li></ul></ul><ul><li>Second intention healing </li></ul><ul><ul><li>wound edges are not apposed, gross tissue loss and infection </li></ul></ul><ul><li>Delayed primary or third intention healing </li></ul><ul><ul><li>an open wound is secondarily closed </li></ul></ul>
  11. 13. Clinical Factors That Affect Wound Healing <ul><li>Nutrition </li></ul><ul><ul><li>Albumin </li></ul></ul><ul><ul><li>Vitamin C </li></ul></ul><ul><ul><li>Vitamin A </li></ul></ul><ul><ul><li>Vitamin Bs </li></ul></ul><ul><ul><li>Divalent cations </li></ul></ul><ul><ul><ul><li>Zinc, Copper </li></ul></ul></ul>
  12. 14. Clinical Factors That Affect Wound Healing <ul><li>Infection </li></ul><ul><li>Oxygen, Anemia, and Perfusion </li></ul><ul><li>Mulnutrition </li></ul><ul><li>Chronic disease, Diabetes Mellitus and Obesity </li></ul><ul><li>Smoking, Corticosteroids, Chemo- Radio- Rx </li></ul><ul><li>Foreign bodies </li></ul>
  13. 15. Wound care <ul><li>Nonoperational treatment </li></ul><ul><ul><li>abrasion </li></ul></ul><ul><ul><li>superficial pricking wound </li></ul></ul><ul><ul><li>superficial incised wound (not deeper than subcutaneous tissue ) </li></ul></ul>
  14. 16. Nonoperational treatment <ul><ul><li>Remove foreign bodies, </li></ul></ul><ul><ul><li>Hematostatsis, </li></ul></ul><ul><ul><li>Clean the wound with saline gauze, </li></ul></ul><ul><ul><li>Disinfect the skin surrounding wound with 70% alcohol or iodophor Polyvinylpyrrolidone (Povidone, PVP) iodine, </li></ul></ul><ul><ul><li>Pack the wound with sterile dressing. </li></ul></ul>
  15. 17. Wound care <ul><li>Clean wounds are simply sutured. </li></ul><ul><li>Debridement is used for other open wounds. </li></ul>
  16. 18. Debridement <ul><ul><li>1. Clean all foreign material and loose debris by use of syringes, scrub brushes, and curets; avoid traumatic factors. </li></ul></ul><ul><ul><li>2. Accomplish hemostasis. </li></ul></ul><ul><ul><li>3. Irrigate with sterile solutions (saline, hydrogen peroxide, iodophor) to dilute bacteria remaining in the wound and to carry away microscopic debris. </li></ul></ul><ul><ul><li>4. Disinfect the skin surrounding wound, administer local anesthesia. </li></ul></ul>
  17. 20. Debridement <ul><ul><li>5. Excise with scalpel ragged wound edges, all dead or questionably viable tissue, and tissues that contain embedded foreign material. </li></ul></ul><ul><ul><li>6. Close with sutures for wound formed lease than 8 hours and remained clean. Disinfect sutured wound and cover with sterile dressings. </li></ul></ul><ul><ul><li>7. Leave the wound open if there is heavy contamination or wound formed more than 8 hours ago. Place saline gauze as drainage. Dress frequently with moist antibiotic dressings and carry out delayed closure 24~48 hours later if there is no infection. </li></ul></ul><ul><ul><li>8. For infected wounds, first debridement and drainage are carried out, then dress and await secondary healing. </li></ul></ul>
  18. 21. Trauma <ul><li>auto accidents, </li></ul><ul><li>falls, </li></ul><ul><li>industrial accidents, </li></ul><ul><li>burns, knifings, </li></ul><ul><li>shootings, </li></ul><ul><li>nuclear bomb </li></ul>
  19. 22. Etiology <ul><li>reasons of the injury </li></ul><ul><ul><li>mechanical factors, </li></ul></ul><ul><ul><li>chemical factors, </li></ul></ul><ul><ul><li>burn, </li></ul></ul><ul><ul><li>combined factors </li></ul></ul><ul><li>sorted by location of injury </li></ul><ul><ul><li>head, </li></ul></ul><ul><ul><li>chest, </li></ul></ul><ul><ul><li>abdomen, </li></ul></ul><ul><ul><li>face, </li></ul></ul><ul><ul><li>bone fracture </li></ul></ul><ul><ul><li>Multiple injury </li></ul></ul><ul><li>integrity of the skin </li></ul><ul><ul><li>open wound, </li></ul></ul><ul><ul><li>closed wound. </li></ul></ul><ul><li>in abdomen, chest, bone, and joint, open wound means the cavity or bone is exposed to the laceration. </li></ul>
  20. 23. Response to Injury <ul><li>Local and systemical reaction </li></ul><ul><li>overlapping series of orchestrated events </li></ul><ul><li>Maintain life and limit the damage </li></ul><ul><li>restore the function and integrity of the structure </li></ul>
  21. 24. Local Response to Injury <ul><li>Exposure of collagen, bleeding, contaminant </li></ul><ul><li>Activating the complement cascade </li></ul><ul><ul><li>Amplify the injury signal </li></ul></ul><ul><ul><li>Chemoattract inflammatory cells </li></ul></ul><ul><li>Activating coagulation mechanisms </li></ul><ul><ul><li>Heamostasis </li></ul></ul><ul><ul><li>Thrombosis </li></ul></ul><ul><li>Local hypoxia and acidosis </li></ul>
  22. 25. Local Response to Injury <ul><li>Migration of inflammatory cells </li></ul><ul><ul><li>Defense & debride </li></ul></ul><ul><ul><li>PMNs and lymphocytes, </li></ul></ul><ul><ul><li>Monocytes, a few days later </li></ul></ul><ul><li>Fibroplasia </li></ul><ul><ul><li>Fibroblasts, collagen </li></ul></ul><ul><li>Revascularization </li></ul><ul><ul><li>Fibrinolysis </li></ul></ul><ul><ul><li>New capillaries </li></ul></ul>
  23. 26. Systemic Response to Injury <ul><li>Stress </li></ul><ul><li>Catabolism </li></ul><ul><li>Disorder of immune system </li></ul>
  24. 27. Systemic Response to Injury <ul><li>Deleterious if too strong </li></ul><ul><li>Acute inflammation--->wound healing, remodeling </li></ul>
  25. 28. Clinical manifestation <ul><li>Local Cardinal Signs </li></ul><ul><li>Redness </li></ul><ul><li>Swelling </li></ul><ul><li>Heat </li></ul><ul><li>Pain </li></ul><ul><li>Impaired function </li></ul>
  26. 29. Clinical manifestation <ul><li>Systemic Signs </li></ul><ul><li>Raised body temperature </li></ul><ul><li>Tachycardia </li></ul><ul><li>Thirsty and anuria </li></ul><ul><li>Leukocytosis </li></ul><ul><li>Hypotension </li></ul><ul><li>Increased Ree </li></ul><ul><li>Other </li></ul><ul><ul><li>malaise, anorexia, sleepiness, etc </li></ul></ul>
  27. 30. Clinical manifestation <ul><li>Complications </li></ul><ul><li>Sepsis </li></ul><ul><li>Shock </li></ul><ul><li>Fat embolism </li></ul><ul><li>Malfunction of coagulation system </li></ul><ul><li>Stress ulcer </li></ul><ul><li>Mods </li></ul>
  28. 31. Principles of treatment of Trauma—First aid <ul><li>Resuscitation </li></ul><ul><ul><li>Airway </li></ul></ul><ul><ul><li>Breathing and ventilation </li></ul></ul><ul><ul><li>Circulation maintain and hemostasis </li></ul></ul><ul><li>Pack the wounds </li></ul><ul><li>Fixation of fractures </li></ul><ul><li>Transport </li></ul>
  29. 32. Principles of treatment of Trauma <ul><li>Assess the entire patient </li></ul><ul><li>Characterize the wound </li></ul><ul><li>Ensure adequate ventilation & oxygenation </li></ul><ul><li>Resuscitation of shock </li></ul><ul><li>Pain management </li></ul><ul><li>Treat infection </li></ul><ul><li>Debride </li></ul><ul><li>Ensure adequate nutrition </li></ul>

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