Wound healing

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Wound healing

  1. 1. WOUND HEALING MBBS, Resident Plastic surgery, HMC, Peshawar ansoor Khan M
  2. 2. Complex & dynamic process of restoring cellular structures & tissue layers
  3. 3. SCARING Full thickness wounds EPITHELIZATION Partial thickness wounds HEALING w o u n d h e a l i n g
  4. 4. Phases of wound healing
  5. 5. Inflammatory phase (day1-4)
  6. 6. Limit blood loss Debridement Sealing the wound
  7. 7. Inflammatory phase Haemostasis Inflammation
  8. 8. Vessel damage ---- bleeding---- platelet plug ---- thromboxane A2 --- Vascular contraction and coagulation pathway activation --- fibrin frame work deposition Haemostasis (Activated by intrinsic & extrinsic pathways)
  9. 9. Inflammation Serotonin/Histamine --- increased vascular permeability TGF– neutrophil chemotaxis, starts 6-8 hrs, max in 24 hrs Monocyte/ Macrophage– max 3-4 days Phagocytosis, cytokines (IL-1, TNF), mediators (TGF, PDGF, FGF) Activated by platelet secretary products (PDGF, TGF, FGF, Serotonin, Histamine)
  10. 10. Proliferative Phase (day 4-21)
  11. 11. Filling wound gap with granulation tissue
  12. 12. EVENTS Fibroplasia, angiogenesis, contraction, re-epithelization
  13. 13. FIBROPLASIA Chemotactic TGF, PDGF, EGF, IL-1 Fibroblasts peaks at 7 th day Collagen & Matrix deposition, Wound contraction 10-21 days
  14. 14. ANGIOGENESIS Hypoxia, lactic acidosis, and FGF-1 (most potent), heparin, TGF, prostaglandin Endothelial cells proliferation
  15. 15. EPITHELIALIZATION Basal layers thickens, elongates and cells detaches and migrates
  16. 16. Tailoring the way reality lives Phase (day 21-2years)
  17. 17. S hrinkage L oss of oedema S trength S care contraction
  18. 18. EVENTS Regression of vessels & granulation tissue Wound contraction Collagen remodelling (replacing collagen III with I) Maximum strength at the 12 week
  19. 19. WOUND CONTRACTION Begin in the proliferative phase (4-5 th day) Continues throughout the healing process Maximum 10-21 day Brings edges close at a rate of 0.6-0.75mm/day Depends on the laxity of the skin
  20. 20. LOCAL FACTORS Venn diagram
  21. 21. RISK FACTORS RISK FACTORS SYSTEMIC RISK FACTORS RISK FACTORS RISK FACTORS
  22. 22. ISCHEMIA Wound healing is a highly energy dependant process
  23. 23. Sugar is the main fuel for wound healing ISCHEMIA
  24. 24. So it take a rich blood supply to heal a wound ISCHEMIA
  25. 25. Initial response neo-vascularization Persistent ischemia results in apoptosis “ ”
  26. 26. INFECTION Collagenase production and destruction of collagen
  27. 27. FOREIGN BODIES Acts a physical barrier Asylum for bacteria Inability to contract Prevent epithelization
  28. 28. HYPOTHERMIA Vasoconstriction and decreased blood supply
  29. 29. PAIN Adrenaline surge causing vasoconstriction
  30. 30. Keep the wounds wet , warm and comfortable “ ”
  31. 31. SMOKING Vasoconstriction Which is not transient— 1 cigarette for 90 min 1 pack for whole day
  32. 32. SMOKING Carboxihemoglobin--- O2 carrying capacity. Subcutaneous PO2
  33. 33. 1 pack/ day--- 3 times increased chances of flap or graft loss 2 packs/day--- 6 times increased chances of loss of flaps and grafts SMOKING
  34. 35. STEROIDS Lysosomal stabalization--- impaired phagocytosis Impairment of chemotaxis of microphages Fibroblast genome inhibition--- decreased collagen, decreased strength and increased dehiscence
  35. 36. HEALING SLOWS DOWN WITH AGING
  36. 37. CUTIS LAXA SYNDROME
  37. 38. EHLER-DANLOS SYNDROME
  38. 39. OSTEOGENESIS IMPERFECTA
  39. 40. FETAL WOUND HEALING (SCARLESS) ADULT: collagen production, remodelling, scar formation FETAL: Altered growth substances (Tenascin etc), absence of inflammation, deposition of hyaluronic acid rich matrix and deposition of organized collagen leading to regeneration

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