general surgery wound healing management of acute wound

1. G E N E R A L S U R G E R Y
WOUND HEALING
Dr. Haydar Muneer Salih
B.D.S., F.I.B.M.S.

2. Define .. Wound healing
Wound healing is a mechanism whereby
the body attempts to restore the integrity
of the injured part

3. There are essentially two processes by which
wound healing occurs:
1. Regeneration 2. Scar formation

4. Factors influencing healing of a wound
Local factor
• Site of the wound
• Structures involved
• Mechanism of wounding
• Contamination (foreign bodies/bacteria)
• Loss of tissue
• Others:
• Vascular insufficiency (arterial or venous)
• Previous radiation

5. Factors influencing healing of a wound
Systemic factors
• Malnutrition or vitamin and mineral
deficiencies
• Disease (e.g. diabetes mellitus)
• Medications (e.g. steroids)
• Immune deficiencies [e.g. chemotherapy,
acquired
• immunodeficiency syndrome (AIDS)]
• Smoking

6. Normal wound healing
". . The injury alone
has in all cases a
tendency to produce
the disposition and
the means of a
cure.”
John Hunter (1728–1793)

7. Normal wound healing
1. Inflammatory phase
2. Proliferative phase
3. Remodeling phase

8. The inflammatory phase
• Begins immediately after wounding and lasts
2–3 days.
• Bleeding is followed by vasoconstriction and
thrombus formation to limit blood loss.
• Derived from circulating monocytes,
macrophages achieve significant numbers in
the wound
• Platelets and the local injured tissue release
vasoactive amines such as histamine, serotonin
and, which increase vascular permeability,
• Macrophages regulating fibroblast activity in
the proliferative phase of healing.

10. The proliferative phase
• Lasts from the third day to the third
week consisting mainly of fibroblast
activity with the production of collagen
and ground substance, and
• The growth of new blood vessels as
capillary loops (angioneogenesis)
• Collagen deposited in a random fashion
and consists of type III collagen.

12. The Remodeling phase
• characterized by maturation of collagen
(type I replacing type III until a ratio of
4:1 is achieved).
• There is a realignment of collagen fibers
along the lines of tension, decreased
wound vascularity and wound
contraction due to fibroblast and
myofibroblast activity

14. Differentiate
Wound Contraction Scar contracture

15. Classification of wound closure and healing

16. Classifications of wounds
Tidy
• Incised
• Clean
• Healthy tissue
• Seldom tissue loss
Untidy
• Crushed or avulsed
• Contaminated
• Devitalized tissues
• Often tissue loss

17. Classifications of wounds

18. MANAGING THE ACUTE WOUND
• Examination of wound and possible
damaged structure
• Bleeding control
• Analgesia and/or anesthesia
• Debridement is essential
• Irrigation
• Skin cover

19. Debridement

20. Irrigation

21. Skin cover (skin graft)

22. Skin cover (skin graft)

23. Skin cover (flap)

24. Some Specific wound
Bites
• Most bites involve either puncture wounds
or avulsions. Small animal bites are
common in children Ear, tip of nose and
lower lip injuries are most usually seen in
victims of human bites.
• Anaerobic and aerobic organism prophylaxis
is required as bite wounds typically have
high virulent bacterial counts

25. Bites

26. Some Specific wound
Degloving
• Degloving occurs when the skin and
subcutaneous fat are stripped by avulsion
from its underlying fascia, leaving
neurovascular structures, tendon or bone
exposed.
• An obvious example of an open degloving is
a ring avulsion injury with loss of finger skin

27. Degloving hand injury

29. There are essentially two processes by which
wound healing occurs:
1. Regeneration 2. Scar formation

31. Classifications of wounds
Tidy
• Incised
• Clean
• Healthy tissue
• Seldom tissue loss
Untidy
• Crushed or avulsed
• Contaminated
• Devitalized tissues
• Often tissue loss