This document provides an overview of wound healing and classification. It discusses the phases of wound healing including hemostasis and inflammation, proliferative phase, and maturation and remodeling. Factors affecting wound healing and healing in specific tissues like bone, cartilage, and nerves are also reviewed. Chronic wounds like ischemic, venous stasis, diabetic and pressure ulcers are described. Excess healing processes such as hypertrophic scarring, keloids, and contractures are also summarized.
Wound Management Presentation by Rebira.pptxRebiraWorkineh
This document outlines a presentation on wound management given by Rebira W., a student in the Adult Health Nursing postgraduate program. The objectives of the presentation are to describe the structures and functions of skin, understand the impact of wounds on quality of life, identify different types of wounds and factors affecting wound healing, and know how to manage both acute and chronic wounds. The presentation covers topics such as the anatomy of skin and its layers, types of wounds classified by origin, the phases of wound healing, and managing specific wound types like pressure sores and diabetic foot ulcers.
This document discusses the classification of soft tissue injuries associated with fractures. It describes several classification systems, including Tscherne, Gustilo-Anderson, and AO, that grade soft tissue injuries based on factors like wound size, contamination, and bone and muscle involvement. Proper classification of soft tissue injuries is important for determining fracture management and predicting healing to help standardize treatment protocols.
The document discusses wounds and the wound healing process. It defines a wound as a break in the skin or tissue integrity caused by injury. Wounds are classified based on various factors like cleanliness, depth, and type. The healing process involves three phases - inflammatory, proliferative, and remodeling. The inflammatory phase prepares the wound for healing. In proliferation, new tissue is formed through granulation. Remodeling provides increased strength over months. Healing occurs through regeneration or repair, with the former restoring original tissue and the latter resulting in scar tissue. Growth factors play important roles in the complex cellular cascade of wound healing.
This document provides an overview of wound healing, including definitions of wounds, the wound healing process, and chronic wounds. It discusses the three main phases of wound healing: inflammatory, proliferative, and remodeling. Key points include that acute wounds normally heal in an orderly process, while chronic wounds fail to progress and are associated with underlying conditions. The document also covers wound classification, growth factors involved in healing, cell types proliferating during each phase, and factors that can impair the wound healing process.
This document outlines the process of wound healing, including:
1. Wound healing involves overlapping phases of hemostasis and inflammation, proliferation, and maturation and remodeling. Key cell types and growth factors involved are described for each phase.
2. Specific tissues like skin, bone, cartilage and nerve heal through similar phases but with some tissue-specific differences. Fetal wounds heal without scarring due to different growth factor profiles and matrix composition compared to adults.
3. Factors that can affect normal wound healing include local issues like ischemia, infection, or movement as well as systemic factors like age, nutrition, disease states, and medications. Abnormal healing can result in chronic wounds or excessive scarring.
Management of ulcers,physical therapy interventions, characteristics, how to asses different ulcer,examination, prognosis, evidence based medicine, drug therapy and other therapies
This document discusses wound healing, tissue repair, and scar formation. It begins with definitions of wounds and wound healing. Wounds are classified based on exposure to the external environment and thickness. The stages of wound healing are described as inflammatory, proliferative, and remodeling phases. Types of wound healing include primary intention, secondary intention, and tertiary intention. Factors affecting wound healing and complications are outlined. Specialized healing in nerves and bone is also reviewed.
This document discusses different types of soft tissue injuries and classifications systems used to categorize them. It describes closed wounds like contusions and hematomas versus open wounds. Classification systems like Gustilo and Tscherne grade soft tissue damage and help determine appropriate treatment and prognosis. The goal is to effectively communicate injury severity and anticipate complications to improve patient outcomes.
Wound Management Presentation by Rebira.pptxRebiraWorkineh
This document outlines a presentation on wound management given by Rebira W., a student in the Adult Health Nursing postgraduate program. The objectives of the presentation are to describe the structures and functions of skin, understand the impact of wounds on quality of life, identify different types of wounds and factors affecting wound healing, and know how to manage both acute and chronic wounds. The presentation covers topics such as the anatomy of skin and its layers, types of wounds classified by origin, the phases of wound healing, and managing specific wound types like pressure sores and diabetic foot ulcers.
This document discusses the classification of soft tissue injuries associated with fractures. It describes several classification systems, including Tscherne, Gustilo-Anderson, and AO, that grade soft tissue injuries based on factors like wound size, contamination, and bone and muscle involvement. Proper classification of soft tissue injuries is important for determining fracture management and predicting healing to help standardize treatment protocols.
The document discusses wounds and the wound healing process. It defines a wound as a break in the skin or tissue integrity caused by injury. Wounds are classified based on various factors like cleanliness, depth, and type. The healing process involves three phases - inflammatory, proliferative, and remodeling. The inflammatory phase prepares the wound for healing. In proliferation, new tissue is formed through granulation. Remodeling provides increased strength over months. Healing occurs through regeneration or repair, with the former restoring original tissue and the latter resulting in scar tissue. Growth factors play important roles in the complex cellular cascade of wound healing.
This document provides an overview of wound healing, including definitions of wounds, the wound healing process, and chronic wounds. It discusses the three main phases of wound healing: inflammatory, proliferative, and remodeling. Key points include that acute wounds normally heal in an orderly process, while chronic wounds fail to progress and are associated with underlying conditions. The document also covers wound classification, growth factors involved in healing, cell types proliferating during each phase, and factors that can impair the wound healing process.
This document outlines the process of wound healing, including:
1. Wound healing involves overlapping phases of hemostasis and inflammation, proliferation, and maturation and remodeling. Key cell types and growth factors involved are described for each phase.
2. Specific tissues like skin, bone, cartilage and nerve heal through similar phases but with some tissue-specific differences. Fetal wounds heal without scarring due to different growth factor profiles and matrix composition compared to adults.
3. Factors that can affect normal wound healing include local issues like ischemia, infection, or movement as well as systemic factors like age, nutrition, disease states, and medications. Abnormal healing can result in chronic wounds or excessive scarring.
Management of ulcers,physical therapy interventions, characteristics, how to asses different ulcer,examination, prognosis, evidence based medicine, drug therapy and other therapies
This document discusses wound healing, tissue repair, and scar formation. It begins with definitions of wounds and wound healing. Wounds are classified based on exposure to the external environment and thickness. The stages of wound healing are described as inflammatory, proliferative, and remodeling phases. Types of wound healing include primary intention, secondary intention, and tertiary intention. Factors affecting wound healing and complications are outlined. Specialized healing in nerves and bone is also reviewed.
This document discusses different types of soft tissue injuries and classifications systems used to categorize them. It describes closed wounds like contusions and hematomas versus open wounds. Classification systems like Gustilo and Tscherne grade soft tissue damage and help determine appropriate treatment and prognosis. The goal is to effectively communicate injury severity and anticipate complications to improve patient outcomes.
Skin integrity and wound care [autosaved] (2)Nelson Munthali
This document discusses skin integrity and wound care. It describes factors that affect skin health like age, illness, and activity level. Wounds are breaks in skin integrity and can be accidental or surgical. The stages of pressure ulcer development and types of wound healing are explained. Finally, it outlines the three phases of wound healing - defensive, reconstructive, and maturation - and factors that can influence the healing process like nutrition, circulation, and immune function.
1. The document discusses normal wound healing which occurs in three phases - inflammatory, proliferative, and remodeling. The inflammatory phase begins immediately after injury and lasts 2-3 days.
2. It also discusses abnormal wound healing such as delayed healing and discusses managing acute wounds which involves thorough debridement to remove all contaminated and devitalized tissue.
3. The document provides details on the classification of wounds as tidy or untidy and discusses various types of wounds like bites, puncture wounds, and degloving injuries as well as their management.
Low back pain remains the common reason to see the doctors in the clinics and in United states
it remains the second most common reason to see neurosurgeon or orthopedic doctor in their respective outpatient departments. However as the presentation is common so is the surgery for the
disease is common and as with all surgeries this also carries a small risk of complications. Bowel
perforation is a rare yet documented complication following a spinal surgery and in our case it was
diagnosed within 18 hours of the laminectomy which was performed via left sided anterolateral
approach
The document discusses the phases of wound healing:
1) Hemostasis and inflammation occurs within the first few days as the wound clots and immune cells clear debris.
2) Proliferation spans days 4-12 as new tissue is formed through fibroblast and endothelial cell proliferation and migration. Collagen and new blood vessels are deposited.
3) Maturation and remodeling can take months as the wound contracts and collagen is reorganized and remodeled, increasing strength of the healed tissue.
The document discusses wound healing and provides details about the different phases of wound healing: inflammatory, proliferative, and remodeling. It defines wounds and outlines factors that influence wound healing. The three main phases of wound healing - inflammatory, proliferative, and remodeling - are described in detail including the key cell types and processes involved in each phase such as hemostasis, granulation, angiogenesis, and epithelialization. Chronic wounds are defined as wounds that fail to progress through the normal healing stages and factors that can impair wound healing are also outlined.
This document discusses wound healing. It defines wounds and classifies them based on origin, contamination, and depth. The two main processes of healing are regeneration, which results in complete tissue restoration, and repair through granulation tissue formation and wound contraction. Wound healing can occur through primary intention, with wound edges approximated, or secondary intention, with the wound left open. Secondary healing involves granulation tissue filling the wound space and wound contraction. Factors like infection, nutrition, and immobilization can affect healing. Complications include infection, keloids, hypertrophic scars, and pigmentary changes.
This document provides an overview of wound classification and the wound healing process. It begins with the objectives and defines a wound. It then classifies wounds according to surface covering, depth of injury, cause, type of injury, and degree of contamination. The stages of wound healing are described as inflammatory, proliferative, and maturation phases. Key processes in the proliferative phase include granulation, wound contraction, and epithelialization which work to fill the wound with new tissue and close it.
The document discusses wound classification and healing. It classifies wounds as tidy or untidy based on the nature of injury. Wounds are also classified based on thickness, surgical category, and time elapsed since injury. The healing process involves inflammation, granulation tissue formation, epithelialization, and scar formation. Healing occurs through regeneration or repair. First intention healing involves wounds with apposed edges, while second intention involves wounds with separated edges. The inflammatory, proliferative, and maturation phases describe the soft tissue healing process.
The document discusses wound healing and regeneration. It describes the three phases of wound healing as the inflammatory phase, proliferative phase, and remodeling phase. The inflammatory phase involves hemostasis, inflammation, and vasodilation. The proliferative phase involves granulation, angiogenesis, contraction, and epithelialization. Finally, the remodeling phase can last up to two years as new collagen is formed and wound strength increases.
This document discusses wound healing and the healing process after tooth extraction. It defines a wound and classifies wounds based on origin, contamination, and depth. The two main processes of healing are regeneration and repair. Repair involves granulation tissue formation and wound contraction. There are two types of wound healing: primary intention and secondary intention. Healing after tooth extraction involves blood clot formation, fibroblast proliferation, angiogenesis, and bone remodeling over 4 weeks. Complications can include dry socket and fibrous union.
The document discusses wound healing and its three phases: inflammatory, proliferative, and remodeling. It defines wound healing and the two processes of tissue regeneration and scar formation. The inflammatory phase involves hemostasis, recruitment of inflammatory cells, and late events like lymphocyte and mast cell entry. The proliferative phase involves granulation tissue formation, angiogenesis, contraction, and epithelialization. Remodeling involves the formation of new collagen to increase tensile strength over months. Factors influencing healing and potential complications are also outlined.
Healing occurs through regeneration or repair and involves granulation tissue formation. Regeneration fully replaces damaged tissue, while repair uses scar tissue. Granulation tissue forms within 1-3 days from new blood vessels and fibroblasts, filling wounds within a week. Primary wound healing occurs with minimal tissue loss and a thin scar. Secondary healing involves more tissue loss and granulation, with a substantial scar and possible wound contraction. Factors like infection, foreign bodies, wound size/location, and nutrition influence healing. Complications include deficient or excessive scarring that cause issues like dehiscence, hernias, hypertrophic scarring, and contractures.
This document discusses tissue repair and wound healing. It begins by defining key terms like repair, regeneration, and healing. It then describes the phases of wound healing as inflammation, granulation tissue formation, and remodeling. The two main types of wound healing are primary intention for clean surgical wounds and secondary intention for wounds with more tissue loss. The process of each is described, involving inflammation, new blood vessel formation, collagen deposition, and epithelialization. Factors that influence healing like nutrition, infection, and wound size are also outlined. Complications can include dehiscence, contractures, and excessive scar formation.
1. Wound healing occurs in 3 phases: inflammatory, proliferative, and remodeling. In the inflammatory phase, hemostasis and an inflammatory response begin the healing process. In the proliferative phase, new tissue such as granulation tissue and blood vessels form. In the remodeling phase, the wound gains strength through collagen deposition and remodeling.
2. Wounds can heal through primary intention with wound edges in direct apposition or secondary intention with gap formation. Primary intention involves direct regeneration while secondary intention uses granulation tissue.
3. Factors that can influence healing include nutrition, infection, wound size/location, and metabolic status. Complications include deficient healing, excessive scarring, and exaggerated wound contraction.
This document provides an overview of the three phases of wound healing: inflammatory, proliferative, and remodeling. It describes the key cellular and molecular processes that occur in each phase, including hemostasis, inflammation, granulation tissue formation, angiogenesis, epithelialization, and collagen deposition/remodeling. Complications of wound healing like deficient or excessive scarring, dehiscence, and exaggerated contraction are also summarized. The roles of various growth factors like PDGF, EGF, VEGF, and cytokines in stimulating and orchestrating wound repair are highlighted. Factors that can delay or impair healing, such as infection, poor nutrition, diabetes, and large wound size/location are also reviewed.
This document provides information on classifying and managing open fractures. It begins by noting that open fractures are usually caused by high-impact trauma and other life-threatening injuries should be ruled out first. It then discusses the Gustilo classification system for open fractures in three levels of severity from I to III. Type III is further divided into IIIA, IIIB and IIIC. Guidelines recommend aggressive debridement and irrigation, fracture stabilization, antibiotic treatment within 3 hours, and wound closure within 7 days to reduce infection risk. Various case examples are provided to illustrate different types of open fractures.
This document discusses wound healing. It begins by defining wounds and classifying them based on type, thickness, and surgical classification. The document then covers the four phases of wound healing: hemostatic, inflammatory, proliferative, and remodeling. Key cell types and processes in each phase are described. Factors that can affect wound healing like nutrition, infection, and comorbidities are also reviewed. The document concludes by discussing normal wound management and potential complications.
This document discusses pathophysiology of wound healing and factors affecting it. It begins with an introduction to wound classification and the normal phases of acute wound healing. It then discusses factors that can impair wound healing and cause chronic wounds, such as diabetes, peripheral artery disease, radiation therapy, malnutrition, and infection. Recent developments to expedite healing, such as negative pressure wound therapy, are also covered. NPWT applies subatmospheric pressure to a wound which increases blood flow and stimulates cellular processes to promote granulation tissue growth and accelerate wound closure.
This document provides an overview of acute abdomen, including causes, clinical evaluation, diagnosis, and management. Acute abdomen refers to new onset abdominal pain that requires determining if urgent intervention is needed, and can be caused by surgical, medical, or gynecological issues. A thorough history and physical exam are important for diagnosis, and may be supplemented by laboratory tests, imaging, or laparoscopy. Depending on the underlying cause, management can include surgery, antibiotics and supportive care, or discharge with conservative treatment and observation.
This document defines and classifies different types of joints in the body. It begins by explaining that a joint is the union between two or more bones that allows varying degrees of movement. There are three main classifications of joints: fibrous joints which have minimal movement; cartilaginous joints which allow slight movement; and synovial joints which allow the greatest range of movement. Within synovial joints, the document further distinguishes six types - gliding, hinge, pivot, condyloid, saddle, and ball-and-socket - based on their structure and the motions they permit. It concludes by defining common angular, circular, and special movements associated with different joints.
Skin integrity and wound care [autosaved] (2)Nelson Munthali
This document discusses skin integrity and wound care. It describes factors that affect skin health like age, illness, and activity level. Wounds are breaks in skin integrity and can be accidental or surgical. The stages of pressure ulcer development and types of wound healing are explained. Finally, it outlines the three phases of wound healing - defensive, reconstructive, and maturation - and factors that can influence the healing process like nutrition, circulation, and immune function.
1. The document discusses normal wound healing which occurs in three phases - inflammatory, proliferative, and remodeling. The inflammatory phase begins immediately after injury and lasts 2-3 days.
2. It also discusses abnormal wound healing such as delayed healing and discusses managing acute wounds which involves thorough debridement to remove all contaminated and devitalized tissue.
3. The document provides details on the classification of wounds as tidy or untidy and discusses various types of wounds like bites, puncture wounds, and degloving injuries as well as their management.
Low back pain remains the common reason to see the doctors in the clinics and in United states
it remains the second most common reason to see neurosurgeon or orthopedic doctor in their respective outpatient departments. However as the presentation is common so is the surgery for the
disease is common and as with all surgeries this also carries a small risk of complications. Bowel
perforation is a rare yet documented complication following a spinal surgery and in our case it was
diagnosed within 18 hours of the laminectomy which was performed via left sided anterolateral
approach
The document discusses the phases of wound healing:
1) Hemostasis and inflammation occurs within the first few days as the wound clots and immune cells clear debris.
2) Proliferation spans days 4-12 as new tissue is formed through fibroblast and endothelial cell proliferation and migration. Collagen and new blood vessels are deposited.
3) Maturation and remodeling can take months as the wound contracts and collagen is reorganized and remodeled, increasing strength of the healed tissue.
The document discusses wound healing and provides details about the different phases of wound healing: inflammatory, proliferative, and remodeling. It defines wounds and outlines factors that influence wound healing. The three main phases of wound healing - inflammatory, proliferative, and remodeling - are described in detail including the key cell types and processes involved in each phase such as hemostasis, granulation, angiogenesis, and epithelialization. Chronic wounds are defined as wounds that fail to progress through the normal healing stages and factors that can impair wound healing are also outlined.
This document discusses wound healing. It defines wounds and classifies them based on origin, contamination, and depth. The two main processes of healing are regeneration, which results in complete tissue restoration, and repair through granulation tissue formation and wound contraction. Wound healing can occur through primary intention, with wound edges approximated, or secondary intention, with the wound left open. Secondary healing involves granulation tissue filling the wound space and wound contraction. Factors like infection, nutrition, and immobilization can affect healing. Complications include infection, keloids, hypertrophic scars, and pigmentary changes.
This document provides an overview of wound classification and the wound healing process. It begins with the objectives and defines a wound. It then classifies wounds according to surface covering, depth of injury, cause, type of injury, and degree of contamination. The stages of wound healing are described as inflammatory, proliferative, and maturation phases. Key processes in the proliferative phase include granulation, wound contraction, and epithelialization which work to fill the wound with new tissue and close it.
The document discusses wound classification and healing. It classifies wounds as tidy or untidy based on the nature of injury. Wounds are also classified based on thickness, surgical category, and time elapsed since injury. The healing process involves inflammation, granulation tissue formation, epithelialization, and scar formation. Healing occurs through regeneration or repair. First intention healing involves wounds with apposed edges, while second intention involves wounds with separated edges. The inflammatory, proliferative, and maturation phases describe the soft tissue healing process.
The document discusses wound healing and regeneration. It describes the three phases of wound healing as the inflammatory phase, proliferative phase, and remodeling phase. The inflammatory phase involves hemostasis, inflammation, and vasodilation. The proliferative phase involves granulation, angiogenesis, contraction, and epithelialization. Finally, the remodeling phase can last up to two years as new collagen is formed and wound strength increases.
This document discusses wound healing and the healing process after tooth extraction. It defines a wound and classifies wounds based on origin, contamination, and depth. The two main processes of healing are regeneration and repair. Repair involves granulation tissue formation and wound contraction. There are two types of wound healing: primary intention and secondary intention. Healing after tooth extraction involves blood clot formation, fibroblast proliferation, angiogenesis, and bone remodeling over 4 weeks. Complications can include dry socket and fibrous union.
The document discusses wound healing and its three phases: inflammatory, proliferative, and remodeling. It defines wound healing and the two processes of tissue regeneration and scar formation. The inflammatory phase involves hemostasis, recruitment of inflammatory cells, and late events like lymphocyte and mast cell entry. The proliferative phase involves granulation tissue formation, angiogenesis, contraction, and epithelialization. Remodeling involves the formation of new collagen to increase tensile strength over months. Factors influencing healing and potential complications are also outlined.
Healing occurs through regeneration or repair and involves granulation tissue formation. Regeneration fully replaces damaged tissue, while repair uses scar tissue. Granulation tissue forms within 1-3 days from new blood vessels and fibroblasts, filling wounds within a week. Primary wound healing occurs with minimal tissue loss and a thin scar. Secondary healing involves more tissue loss and granulation, with a substantial scar and possible wound contraction. Factors like infection, foreign bodies, wound size/location, and nutrition influence healing. Complications include deficient or excessive scarring that cause issues like dehiscence, hernias, hypertrophic scarring, and contractures.
This document discusses tissue repair and wound healing. It begins by defining key terms like repair, regeneration, and healing. It then describes the phases of wound healing as inflammation, granulation tissue formation, and remodeling. The two main types of wound healing are primary intention for clean surgical wounds and secondary intention for wounds with more tissue loss. The process of each is described, involving inflammation, new blood vessel formation, collagen deposition, and epithelialization. Factors that influence healing like nutrition, infection, and wound size are also outlined. Complications can include dehiscence, contractures, and excessive scar formation.
1. Wound healing occurs in 3 phases: inflammatory, proliferative, and remodeling. In the inflammatory phase, hemostasis and an inflammatory response begin the healing process. In the proliferative phase, new tissue such as granulation tissue and blood vessels form. In the remodeling phase, the wound gains strength through collagen deposition and remodeling.
2. Wounds can heal through primary intention with wound edges in direct apposition or secondary intention with gap formation. Primary intention involves direct regeneration while secondary intention uses granulation tissue.
3. Factors that can influence healing include nutrition, infection, wound size/location, and metabolic status. Complications include deficient healing, excessive scarring, and exaggerated wound contraction.
This document provides an overview of the three phases of wound healing: inflammatory, proliferative, and remodeling. It describes the key cellular and molecular processes that occur in each phase, including hemostasis, inflammation, granulation tissue formation, angiogenesis, epithelialization, and collagen deposition/remodeling. Complications of wound healing like deficient or excessive scarring, dehiscence, and exaggerated contraction are also summarized. The roles of various growth factors like PDGF, EGF, VEGF, and cytokines in stimulating and orchestrating wound repair are highlighted. Factors that can delay or impair healing, such as infection, poor nutrition, diabetes, and large wound size/location are also reviewed.
This document provides information on classifying and managing open fractures. It begins by noting that open fractures are usually caused by high-impact trauma and other life-threatening injuries should be ruled out first. It then discusses the Gustilo classification system for open fractures in three levels of severity from I to III. Type III is further divided into IIIA, IIIB and IIIC. Guidelines recommend aggressive debridement and irrigation, fracture stabilization, antibiotic treatment within 3 hours, and wound closure within 7 days to reduce infection risk. Various case examples are provided to illustrate different types of open fractures.
This document discusses wound healing. It begins by defining wounds and classifying them based on type, thickness, and surgical classification. The document then covers the four phases of wound healing: hemostatic, inflammatory, proliferative, and remodeling. Key cell types and processes in each phase are described. Factors that can affect wound healing like nutrition, infection, and comorbidities are also reviewed. The document concludes by discussing normal wound management and potential complications.
This document discusses pathophysiology of wound healing and factors affecting it. It begins with an introduction to wound classification and the normal phases of acute wound healing. It then discusses factors that can impair wound healing and cause chronic wounds, such as diabetes, peripheral artery disease, radiation therapy, malnutrition, and infection. Recent developments to expedite healing, such as negative pressure wound therapy, are also covered. NPWT applies subatmospheric pressure to a wound which increases blood flow and stimulates cellular processes to promote granulation tissue growth and accelerate wound closure.
This document provides an overview of acute abdomen, including causes, clinical evaluation, diagnosis, and management. Acute abdomen refers to new onset abdominal pain that requires determining if urgent intervention is needed, and can be caused by surgical, medical, or gynecological issues. A thorough history and physical exam are important for diagnosis, and may be supplemented by laboratory tests, imaging, or laparoscopy. Depending on the underlying cause, management can include surgery, antibiotics and supportive care, or discharge with conservative treatment and observation.
This document defines and classifies different types of joints in the body. It begins by explaining that a joint is the union between two or more bones that allows varying degrees of movement. There are three main classifications of joints: fibrous joints which have minimal movement; cartilaginous joints which allow slight movement; and synovial joints which allow the greatest range of movement. Within synovial joints, the document further distinguishes six types - gliding, hinge, pivot, condyloid, saddle, and ball-and-socket - based on their structure and the motions they permit. It concludes by defining common angular, circular, and special movements associated with different joints.
This document provides an overview of vitamins and minerals. It discusses 13 known vitamins, classifying them as either fat-soluble or water-soluble. Key details are provided on the sources, functions, and deficiency symptoms of important vitamins like A, C, D, B1, B2, B3, B6, B12, and folate. Minerals are introduced as inorganic nutrients divided into macro and trace categories. Examples like calcium, copper, iron, magnesium, and zinc are described as important cations, while anions like chloride, fluoride, phosphate, and selenium are outlined along with their major functions in the body. The document serves as an introductory chapter on vitamins and minerals for pharmacy students.
This document provides an overview of obstructive jaundice. It begins with definitions and classifications of jaundice. The anatomy and physiology of bile flow is reviewed. The main causes of obstructive jaundice are then discussed in detail, including gallstones, tumors, strictures, cysts, and more. Clinical manifestations and evaluation methods such as history, exam, imaging and labs are outlined. Finally, management approaches like surgery and stenting are covered. The presentation aims to give attendees a comprehensive understanding of obstructive jaundice.
This document discusses the evaluation and management of abdominal trauma. It notes that physical exam can be unreliable, so diagnostic adjuncts like CT scans and laparoscopy are used. Penetrating trauma like gunshot wounds usually require exploration, while stab wounds may not penetrate the abdomen. Blunt trauma is initially evaluated by FAST exam. Unstable patients undergo further tests like DPL. Surgical exploration controls bleeding and repairs injuries, using damage control techniques if the patient's physiology is unstable.
Breast cancer is the most common cancer in women and risk factors include hormonal influences like early menarche, late menopause, and family history, as well as non-hormonal factors like radiation exposure, alcohol consumption, high fat diet, and obesity. The document discusses the epidemiology, risk factors, genetics, screening, diagnosis, staging, and histopathology of breast cancer. Treatment options aim to prevent or reduce the risk of developing invasive breast cancer through chemoprevention, risk-reducing surgery, intensive screening, and management of early-stage disease.
Gallstone disease is common, affecting 11-36% of people based on autopsy reports. Gallstones can be asymptomatic or cause biliary colic, acute cholecystitis, or other complications. The document discusses the epidemiology, types, natural history, complications, clinical features, diagnosis, and treatment of gallstone disease and acute cholecystitis. Laparoscopic cholecystectomy is the definitive treatment for symptomatic gallstones and acute cholecystitis to prevent future attacks or complications.
C1 Medical interviewing- history taking & PE.pptxmyLord3
This document outlines the schedule and instructors for a series of clinical medicine lectures and demonstration sessions. The lectures will cover topics such as the respiratory system, cardiovascular system, locomotor system, abdomen, nervous system, and lymphoglandular system. The dates, times, responsible departments, and assigned instructors are provided for each lecture and demonstration session. The document also includes schedules assigning groups of students to ward demonstrations for different weeks as well as information on the final exam date and group assignments.
Histamine and serotonin function as neurotransmitters and local hormones. Histamine is an important mediator of allergic and inflammatory reactions that is stored in mast cells and basophils and released through immunologic or chemical means. It exerts effects through four receptor subtypes. First and second generation antihistamines competitively block histamine H1 receptors, with second generation drugs having fewer side effects like sedation. H2 receptor antagonists suppress gastric acid secretion. Third and fourth generation histamine receptor ligands may treat psychiatric and inflammatory conditions.
The document provides guidance on performing a physical examination of the abdomen. It describes dividing the abdomen into sections for inspection and outlines key steps for abdominal examination including inspection, auscultation, percussion, and palpation. Specific techniques are provided for assessing organs like the liver, spleen, and kidneys through percussion and bimanual palpation.
This document provides guidance on performing a neurologic examination, including:
1. Assessing mental status, cranial nerves, motor function, reflexes, sensory system, cerebellar function, and meningeal signs in 3 pages of detailed instructions.
2. It outlines the specific tests, procedures, and grading scales for each component of the neurologic exam.
3. The neurologic exam assesses many areas of neurologic function through tests of mental status, cranial nerves, motor skills, reflexes, sensation, coordination, and signs of meningeal irritation.
The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys filter the blood to remove wastes and produce urine. The ureters carry urine from the kidneys to the urinary bladder, where it is stored until urination. The bladder expels urine through the urethra to be excreted from the body. The kidneys regulate fluid and electrolyte balance and blood pressure and produce hormones. Nephrons are the functional filtering units of the kidneys that form urine through filtration, reabsorption, and secretion.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
2. Contents
Classification of wounds
Wound healing
Phases of wound healing
Factors affecting wound healing
Healing in specific tissues
Chronic wounds
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2
3. CLASSIFICATION OF WOUNDS
Closed vs open
Based on:
The level of cleanliness
Degree of clinical risk of infection
Duration of healing
Clinical healing pattern and
The risk for tetanus
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4. CLOSED
Intact epithelial surface
Skin cover not
completely breeched
e.g. – contusion, bruise,
hematoma
OPEN
Complete break of the
epithelial surface
e.g. – abrasion ,
laceration, puncture,
degloved wound, bites
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5. Based on level of cleanliness
TIDY
Incised
Clean
No devitalized tissue
Tendon and
neurovascular injuries
Primary closure
UNTIDY
Crushed
Contaminated
Devitalized tissue
Tissue loss
Fractures are common
Secondary or tertiary
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6. Based on degree of clinical risk of
infection
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8. Based on duration of healing
Acute wounds
Heal in a predictable pattern and time frame
Mostly few complications
Chronic wounds
Failure to epithelialize and close in a reasonable
time, mostly >3mo
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10. WOUND HEALING
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Complex biologic
process of restoring
normal tissue
continuity
Repair or
reconstruction of a
defect in an organ or
tissue, commonly the
skin.
Starts immediately
after being wounded.
12. Hemostasis and inflammation
Precedes and initiates inflammation
PMNs are the first infiltrating cells, peaking at 24 to
48 hours.
48-96hrs post wounding macrophages invade the
wound.
About 1wk post injury T-lymphocytes invade the
wound
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14. Proliferative phase
From 4th day to roughly 21st day of injury
Fibroblasts, epithelial and endothelial
cells are the important cells
Angiogenesis , granulation tissue formation ,
epithelialization and contraction occurs.
Balance b/n scar formation & tissue
regeneration
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15. EPITHELIALIZATION
proliferation and migration of epithelial
cells adjacent to the wound
Starts with in 1 day of injury.
Marginal and fixed basal cells migrate to
the surface of the wound and bridge the
defect which eventually keratinizes.
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16. Maturation and remodeling
Starts at the fibroblastic phase and continues
6-12 months post injury
Maximize the strength & structural
integrity
Re-organization of previously synthesized
collagen.
Finally forms mature, avascular and acellular
scar. 3/31/2023
wound healing
16
20. Healing in specific tissues
GI Tract
begins with reapposition of the bowel ends.
Some of the differences in healing are,
Mesothelial (serosal) and mucosal healing can occur
without scarring.
Significant decrease in marginal strength in the 1st week
Collagenase is expressed markedly in the colon
compared to the small bowel.
Failure of healing results in dehiscence, leaks, and fistulas.
Excessive healing results in stricture and stenosis of the
lumen. 3/31/2023
wound healing
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22. BONE
Inflammation
Hematoma
Liquefaction and degradation
Revascularization
Soft callus stage
Hard callus stage
Remodeling
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23. CARTILAGE
Healing response depends on the depth of
injury.
Superficial cartilage injuries are slow to
heal and result in persistent structural
defects.
Deep injuries involve underlying bone and
soft tissue resulting in structural and
functional integrity of the injured site.
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wound healing
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24. TENDON
Tendon vasculature has an effect on
healing.
Tenocytes are metabolically very active and
retain a large regenerative potential.
Restoration of mechanical integrity may
never be equal to that of the undamaged
tendon.
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25. NERVE
Three types of nerve injuries-
Neurapraxia
Axonotmesis
Neurotmesis
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26. Chronic wounds
Wounds that have not healed in 3 months.
Unresponsiveness to normal regulatory signals.
Fibroblasts from chronic wounds have decreased
proliferative potential.
Malignant transformation of chronic ulcers can occur
in any long-standing wound (Marjolin’s ulcer).
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27. Ischemic arterial ulcers
Due to lack of blood supply
painful at presentation.
Commonly present at the most distal
portions of the extremities.
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wound healing
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28. VENOUS STASIS ULCERS
Due to venous stasis and hydrostatic back
pressure.
Leads to Venous hypertension and
capillary damage
Fails to re-epithelialize despite the
presence of adequate granulation tissue.
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29. DIABETIC WOUNDS
2ry to neuropathy, foot deformity, and
ischemia.
Neuropathy is both sensory and motor
Sensory- unrecognized injury
Motor (Charcot’s foot)- collapse or dislocation
of the IP or MTP joints
Micro- and macrovascular circulatory
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30. Pressure ulcers
Localized area of tissue necrosis.
Accelerated in the presence of friction,
shear forces, and moisture.
Stages-
Non-blanching erythema
Partial thickness skin loss
Full thickness skin loss
Full thickness skin loss involving muscle and
bone 3/31/2023
wound healing
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32. Hypertrophic scars
Does not extend beyond the boundary
Across areas of tension and flexor surfaces,
which tend to be at right angles to joints or skin
creases.
Develop within 4 weeks after trauma.
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33. KELOIDS
• Extends beyond the boundaries of the original
incision or wound
• 3 months- years after initial insult.
• Higher incidence in the skin of earlobes, the
deltoid, presternal and upper back region.
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36. CONTRACTUES
Where scars cross
joints , a tight web
may form restricting
the range of
movement at the joint.
can cause
hyperextension or
hyperflexion deformity
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wound healing
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-healing occurs in closed wounds in which the edges are approximated, such as a clean skin incision closed with sutures.
-The incisional defect re-epithelializes rapidly, and matrix deposition seals the defect.
2. Second intention healing occurs when the wound edges are not apposed,
Granulation tissue fills the wound, and the wound contracts and re-epithelializes.
3. Delayed primary or third intention healing
-open wound is secondarily closed several days after injury eg.after removal of a ruptured appendix
Left open initially Edges approximated 4-6 days later….For contaminated wounds …skin Grafts and flaps may be reqiured
-Acute wounds transition through the stages of wound healing as a linear pathway, with clear start- and endpoints
-Chronic wounds are arrested in one of these stages, usually the inflammatory stage, and cannot progress further
-- The presence of necrotic tissue, foreign material and bacteria result in the abnormal production of metalloproteases which alter the balance of inflammation and impair the function of the cytokines
-Tetanus toxoid (0.5 mL intramuscularly) and tetanus immune globulin (250 units intramuscularly) should be given to patients with puncture wounds who have received less than three doses of tetanus toxoid or whose immunization status is uncertain.
-Patients sustaining wounds not classified as clean or minor should also undergo passive immunization with TIG
-Human TIG in high risk ( un-immunized )…..Commence active immunization ( T toxoid)
-Previously immunized- booster >10 years needs a booster dose
booster <10 years- no treatment in low
be divided into overlapping phases defined by characteristic cellular populations and biochemical activities
-Exposure of subendothelial collagen to platelets results in platelet aggregation, degranulation, and activation of the coagulation cascade
-the fibrin clot serves as scaffolding for the migration into the wound of inflammatory cells
-Increased vascular permeability, local prostaglandin release, and the presence of chemotactic substances all stimulate neutrophil migration
-primary role of neutrophils is phagocytosis of bacteria and tissue debris. are also a major source of cytokines early during inflammation, especially TNF-α3 which may have a significant influence on subsequent angiogenesis
--role of lymphocytes in wound healing is not fully defined. Depletion of most wound T lymphocytes decreases wound strength and collagen content
-selective depletion of the CD8+ suppressor subset of T lymphocytes enhances wound healing. However, depletion of the CD4+ helper subset has no effect
-Macrophages also play a significant role in regulating angiogenesis and matrix deposition and remodeling. oxygen radical and nitric oxide synthesis. Their most pivotal function is activation and recruitment of other cells via mediators
-The healing progression of chronic wounds usually becomes arrested in this inflammatory stage.
- The presence of necrotic tissue, foreign material and bacteria result in the abnormal production of metalloproteases which alter the balance of inflammation and impair the function of the cytokines
During this phase tissue continuity reestablished n Characterized by Epithelialization Fibroplasia & Vascularization
Endothelial cells also proliferate extensively participate in angiogenesis
-strongest chemotactic factor for fibroblasts is PDGF.-Fibroblasts are transformed from local mesenchymal cells, are usually present in the wound within 24 hrs,…10th day .
-They attach to the fibrin matrix of the clot, multiply, and produce glycoprotein and mucopolysaccharides, which make up ground substance.
-Fibroblasts isolated from wounds synthesize more collagen than nonwound fibroblasts, they proliferate less, and they actively carry out matrix contraction
-Fibroblasts synthesize collagen, the primary structural protein of the body ,production begins on the 2nd day, when it is secreted as an amorphous gel devoid of strength. Maximum collagen production does not begin until day five and continues for at least six weeks .The developing collagen matrix stimulates angiogenesis.
-fibroblasts produce myofibroblasts, are present in the wound by the fifth day and have characteristics of smooth muscle cells with the ability to contract .Pulling the edges of the wound together is dependent upon tissue mobility. Myofibroblastic cells are lost via apoptosis as repair resolves to form scar.
-In this phase the fibrin matrix is replaced by granulation tissue , which is composed of fibroblasts, macrophages and endothelial cells which form extracellular matrix and new blood vessels.
-Fixed basal cells in a zone near the cut edge undergo a series of rapid mitotic divisions, and these cells appear to migrate by moving over one another until the defect is covered
-Re-epithelialization is complete in less than 48 hours in the case of approximated incised wounds, but may take substantially longer in the case of larger wounds, where there is a significant epidermal/dermal defect
-The stimuli remain incompletely defined; however, it appears that it is mediated by a combination of a loss of contact inhibition; exposure to constituents of the extracellular matrix, particularly fibronectin; and cytokines
Involves a sequence of changes in wound keratinocytes—detachment, migration, proliferation, differentiation, and stratification.
Wound strength and mechanical integrity in the fresh wound are determined by both the quantity and quality of the newly deposited collagen
-Key elements of maturation include collagen cross-linking, collagen remodeling, wound contraction and repigmentation
--remodeling is characterized by the process of wound contraction by myofibroblasts and collagen remodeling i.e type ІІІ collagen initially laid down by fibroblast will be changed to type І collagen in few months.
-fibronectin and collagen type III constitute the early matrix scaffolding; glycosaminoglycans and proteoglycans represent the next significant matrix components; and collagen type I is the final matrix.
By several weeks post injury the amount of collagen in the wound reaches its plateau , but tensile strength continue increase for several month.
-the supply of cutaneous nerves and blood vessels decreases with age, and loss of collagen and ability to produce more collagen.
-Diabetes is associated with vasculopathy, neuropathy and immunopathy
-chemotherapy have effect on wound healing, through its effects on vascular endothelial growth factor (VEGF). VEGF is an important factor contributing to angiogenesis during the early stages of wound healing,
- Bacteria produce inflammatory mediators that inhibit the inflammatory phase of wound healing and prevent epithelialization
-steroid Healing especially when given in the first 3 days after wounding a deficiency in inflammatory cell function. Diminishing the supply of cytokines, Macrophage migration,….fibroblast proliferation, collagen accumulation, and angiogenesis
Reversed by -supplemental vitamin A 25,000 IU/day.OR Topical --
-Injuries to all parts of the GIT under go the same sequence of healing as cutaneous wounds
-submucosa is the layer that imparts the greatest tensile strength and greatest suture-holding capacity,
-serosal healing is essential for quickly achieving a watertight seal from the luminal side.
technical=handsutured vs. stapled, continuous vs. interrupted sutures, absorbable vs. nonabsorbable sutures, or single- vs. two-layer closure
--in the first week due to early and marked collagenolysis.
Collagenase activity occurs early in the healing process and during the first 3-5ds collagen break down far exceeds collagen synthesis.
-healing resemble those observed in dermal healing, but some d\c
•hematoma formation consists of an accumulation of blood at the fracture site, which also contains devitalized soft tissue, N dead bone,
-The next stage accomplishes the liquefaction and degradation of nonviable products at the fracture site. normal bone adjacent to the injury site can then undergo revascularization, with new blood vessels growing into the fracture site.
•3 to 4 days after injury, soft tissue forms a bridge between the fractured bone segments ,Clinically, soft callus formation phase is characterized by the end of pain and inflammatory signs N serves as an internal splint, preventing damage to the newly laid blood vessels and achieving a fibrocartilaginous union. formed externally along the bone shaft and internally within the marrow•
-hard callus stage consists of mineralization of the soft callus and conversion to bone. This may take up to 2 to 3 months and leads to complete bony union.
-remodeling phase. excessive callus is reabsorbed and the marrow cavity is recanalized.
. cartilage is very avascular and depends on diffusion for transmittal of nutrients across the matrix. hypervascular perichondrium contributes to the nutrition.
--in deep-exposure of bone n soft ts leads to the exposure of vascular channels of the surrounding damaged tissue that may help in the formation of granulation tissue. Hemorrhage allows for the initiation of the inflammatory response and the subsequent mediator activation of cellular function for repair.
- Gradually, hyaline cartilage is formed, which restores the structural and functional integrity of the injured site.
-Tendons and ligaments can be subjected to a variety of injuries, such as laceration, rupture, and contusion. Due to the mobility of the underlying bone or muscles, the damaged ends usually separate.
-Tendon and ligament healing progresses in a similar fashion as in other areas of the body. Matrix is characterized by accumulation of type I and III collagen along with increased water, DNA, and glycosaminoglycan content. As the collagen fibers are organized, transmission of forces across the damaged portion can occur.
-neurapraxia (focal demyelination), axonotmesis (interruption of axonal continuity but preservation of Schwann cell basal lamina), and neurotmesis (complete transection).
--Following (a) survival of axonal cell bodies; (b) regeneration of axons that grow across the transected nerve to reach the distal stump; and (c) migration and connection of the regenerating nerve ends to the appropriate nerve ends or organ targets.
- Phagocytes remove the degenerating axons and myelin sheath from the distal stump (Wallerian degeneration).
-Schwann cells ensheathe and help in remyelinating the regenerating axons.
- Functional units are formed when the regenerating axons connect with the appropriate end targets.
-Several factors play a role in nerve healing, such as growth factors, cell adhesion molecules, and nonneuronal cells and receptors.
-wounds that have failed to proceed through the orderly process that produces satisfactory anatomic and functional integrity or that have proceeded through the repair process without producing an adequate anatomic and functional result.
-Skin ulcers, usually occur in traumatized or vascular compromised soft tissue, are the major component of chronic wounds.
-Malignant wounds are differentiated clinically from nonmalignant wounds by the presence of overturned wound edges. suspected malignant
transformations, biopsy of the wound edges must be performed to rule out malignancy. Cancers arising de novo in chronic wounds include both squamous and basal cell carcinomas.
-associated with other symptoms of peripheral vascular disease, such as intermittent claudication, rest pain, night pain, and color or trophic changes.
-On examination, there may be diminished or absent pulses with decreased ankle-brachial index and poor formation of granulation tissue. signs of peripheral ischemia, such as dryness of skin, hair loss, scaling, and pallor.
-wound is shallow with smooth margins, and a pale base and surrounding skin may be present.
-prevention is extremely important in the approach. ??? FOR WHO AND HOW==READ IT
-are commonly painless. venous obstruction lead to abnormally directed flow from the deep to superficial venous systems via the perforating veins.
-The most common site of incompetent perforators is 5 to 10 cm above the medial malleolus
-.Congestion and pooling of blood in the superficial veins leads to venous hypertension, is associated with vessels that are abnormally permeable, leading to the accumulation of water, large proteins (including fibrinogen), and extravasated red blood cells into the interstitial space .
-The “white cell trap theory” postulates that the macromolecules are thought to trap growth factors and matrix material making them unavailable for tissue repair and the perivascular fibrin cuff may decrease the delivery of oxygen and nutrients leading to skin hypoxia and cell death resulting in the venous ulcer
lead to extravasation of hemoglobin causing pruritus and skin damage. Lipodermatosclerosis
-neutrophils adhere to the capillary endothelium and cause plugging with diminished dermal blood flow.
-Chronic venous ulcers usually are due to the incompetence of the deep venous system and most common being above the medial malleolus, over Cockett’s perforator.
-60% to 70% of diabetic ulcers are due to neuropathy, 15% to 20% are due to ischemia, and another 15% to 20% combination of both.
Tx= Achievement of adequate blood sugar levels. Eradication of the infectious source. débridement of all necrotic or infected tissue. orthotic shoes or casts. Topical PDGF and granulocyte-macrophage colony-stimulating factor. Prevention and specifically foot care. Skin allo grafts
-from ill-fitting shoes, foreign bodies, or other trauma.
and is 2ry to persistently high glucose levels.
-develops when soft tissue is compressed between a bony prominence and an external surface
-pressure causes capillary collapse and impedes the delivery of nutrients to body tissues
-Other contributory factors include immobility, altered activity levels, altered mental status, chronic conditions, and altered nutritional status
-tx= débridement of all necrotic tissue, maintenance of a favorable moist wound environment that will facilitate healing, relief of pressure, and addressing host issues such as nutritional, metabolic, and circulatory status.
-recurrence rates are extremely high, owing to the population at risk and the inability to fully address the causative mechanisms.
-Clinically, excess healing can be as significant as wound failure. It is likely that more operative interventions are required for correction of the morbidity associated with excessive healing than are required for wound failure.
-The clinical manifestations of exuberant healing are protean and differ in the skin (mutilating or debilitating scars, burn contractions), tendons (frozen repairs), the GI tract (strictures or stenoses), solid organs (cirrhosis, pulmonary fibrosis), or the peritoneal cavity (adhesive disease).
-risk of HTS increases if epithelialization takes longer than 21 days. Rarely elevated more than 4 mm above the skin.
-usually occur across areas of tension and flexor surfaces, which tend to be at right angles to joints or skin creases
BOTH- abundance of collagen and glycoprotein deposition.
-HTS-collagen bundles are flatter and more random, and the fibers are in a wavy pattern
-immune system appears to be involved in the formation of both HTSs and keloids
-benign fibrous growths present in scar tissue that form because of altered wound healing, with overproduction of extracellular matrix and dermal fibroblasts that have a high mitotic rate
Keloidal fibroblasts have normal proliferation parameters but synthesize collagen at a rate 20 times greater than that observed in normal dermal fibroblasts, and 3 times higher than fibroblasts derived from HTS
soft to rubbery or hard consistency. rarely extend into underlying subcutaneous tissues
-surgical intervention can lead to recurrence, often with a worse result
-collagen bundles are virtually nonexistent, and the fibers are connected haphazardly in loose sheets with a random orientation to the epithelium
-erexpression of growth factors, such as transforming growth factor-beta (TGF-beta), vascular endothelial growth factor (VEGF), and connective tissue growth factor (CTGF) appear to play a role in the formation of these lesions.TGF-beta is a regulator of fibroblast proliferation and collagen synthesis. In normal wound healing, transforming growth factor-beta (TGF-beta) activity diminishes upon the completion of wound repair, but in keloids TGF-beta is overproduced and poorly regulated