Keloid scars are made up of dense collagen, loose fibrous tissue, and granulation tissue. Keloids appear a few days after surgery and grow beyond the limits of the original wound. They are best treated with intralesional injection of triamcinolone. Local recurrence is common after excision. Combination therapies using excision with steroid injection or radiation have fewer recurrences than excision alone. The best cure rate is achieved using intralesional steroid injection combined with surgery.
This document discusses the necessity of peri-implant keratinized mucosa and surgical techniques for creating it. There is debate around whether keratinized mucosa is necessary for implant health, but it may help with plaque control and prevent inflammation. Two common techniques for creating keratinized mucosa are apically repositioned flaps and free gingival grafts. Free gingival grafts have better predictability but the donor site healing is less comfortable for patients. Healing after free gingival graft placement takes around 12 weeks to be fully complete.
Enteric nerve regeneration for hirchsprung disease Munira Shahbuddin
The documents discuss regenerating the enteric nervous system for Hirschsprung's disease using tissue engineering approaches. Key points include:
- Hirschsprung's disease results from the absence of ganglion cells in parts of the colon, causing constipation. Current interventions include surgically removing or reconstructing parts of the intestine.
- Tissue engineering uses biomaterials and cells to try to regenerate the enteric nervous system. Studies have seeded collagen scaffolds with smooth muscle cells in animal models, finding the scaffolds degraded and some regeneration of epithelial and muscle layers, but lack of nerve formation.
- Improving this approach requires optimizing the scaffold material and pore structure, using additional cell types like gl
Periodontal wound healing involves four overlapping phases - exudative, resorptive, proliferative, and regenerative. The proliferative phase includes re-epithelialization, fibroplasia, granulation tissue formation, collagen deposition, angiogenesis, and wound contraction. Growth factors play an important role in regulating periodontal wound healing. Healing after periodontal procedures like scaling and root planing, curettage, ultrasonic curettage, and gingivectomy depends on the extent of tissue disruption and follows a timeline of inflammatory response, epithelial migration, granulation tissue formation, collagen deposition and remodeling.
Wound healing (2) /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Advanced reconstructive technologies for periodontal tissue repairLuis Kabrera
This document discusses advanced technologies for regenerating periodontal tissues. It begins by defining regenerative periodontal therapy and identifying common indications. It then reviews periodontal wound healing, noting it involves inflammation, granulation tissue formation, and remodeling. The focus is on comparing advanced regenerative concepts using growth factors and gene therapy to conventional techniques. While clinical success remains limited, research aims to simplify and enhance rebuilding of periodontal support through new barrier membranes, growth factors, and gene delivery approaches.
This document provides an overview of active wound coverings and bioengineered skin substitutes. It discusses the structure of skin and extracellular matrix. Various extracellular matrix materials are described that help change the wound environment and promote dermal regeneration. Synthetic bilayer skin substitutes and acellular skin replacements are also summarized. The document outlines properties of an ideal skin substitute and future developments, including delivery of growth factors and antimicrobials in extracellular matrix materials. Allogenic acellular dermal substitutes and living skin substitutes are also briefly mentioned.
Collagen changing the course of the future by Md.Iftekhar Mahmood & Muh. Amd...Iftekhar Mahmood
Collagen is one of the body’s important natural resources and a component of skin tissue and connective tissue. Its application as a wound dressing& surgical material is vastly promising.
The document provides an overview of wound classification and wound healing. It classifies wounds based on several factors such as cleanliness, thickness, involved structures, and time elapsed. There are different types of wound healing including primary intention, secondary intention, and tertiary intention. The stages of wound healing are inflammation, proliferation, remodeling. Factors affecting wound healing include infection, blood supply, nutrition, and underlying diseases. Wound management involves cleaning, debridement, closure techniques, and treatment of underlying injuries or issues. Complications of wound healing can include infection, dehiscence, hypertrophic scarring, and keloids.
This document discusses the necessity of peri-implant keratinized mucosa and surgical techniques for creating it. There is debate around whether keratinized mucosa is necessary for implant health, but it may help with plaque control and prevent inflammation. Two common techniques for creating keratinized mucosa are apically repositioned flaps and free gingival grafts. Free gingival grafts have better predictability but the donor site healing is less comfortable for patients. Healing after free gingival graft placement takes around 12 weeks to be fully complete.
Enteric nerve regeneration for hirchsprung disease Munira Shahbuddin
The documents discuss regenerating the enteric nervous system for Hirschsprung's disease using tissue engineering approaches. Key points include:
- Hirschsprung's disease results from the absence of ganglion cells in parts of the colon, causing constipation. Current interventions include surgically removing or reconstructing parts of the intestine.
- Tissue engineering uses biomaterials and cells to try to regenerate the enteric nervous system. Studies have seeded collagen scaffolds with smooth muscle cells in animal models, finding the scaffolds degraded and some regeneration of epithelial and muscle layers, but lack of nerve formation.
- Improving this approach requires optimizing the scaffold material and pore structure, using additional cell types like gl
Periodontal wound healing involves four overlapping phases - exudative, resorptive, proliferative, and regenerative. The proliferative phase includes re-epithelialization, fibroplasia, granulation tissue formation, collagen deposition, angiogenesis, and wound contraction. Growth factors play an important role in regulating periodontal wound healing. Healing after periodontal procedures like scaling and root planing, curettage, ultrasonic curettage, and gingivectomy depends on the extent of tissue disruption and follows a timeline of inflammatory response, epithelial migration, granulation tissue formation, collagen deposition and remodeling.
Wound healing (2) /orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Advanced reconstructive technologies for periodontal tissue repairLuis Kabrera
This document discusses advanced technologies for regenerating periodontal tissues. It begins by defining regenerative periodontal therapy and identifying common indications. It then reviews periodontal wound healing, noting it involves inflammation, granulation tissue formation, and remodeling. The focus is on comparing advanced regenerative concepts using growth factors and gene therapy to conventional techniques. While clinical success remains limited, research aims to simplify and enhance rebuilding of periodontal support through new barrier membranes, growth factors, and gene delivery approaches.
This document provides an overview of active wound coverings and bioengineered skin substitutes. It discusses the structure of skin and extracellular matrix. Various extracellular matrix materials are described that help change the wound environment and promote dermal regeneration. Synthetic bilayer skin substitutes and acellular skin replacements are also summarized. The document outlines properties of an ideal skin substitute and future developments, including delivery of growth factors and antimicrobials in extracellular matrix materials. Allogenic acellular dermal substitutes and living skin substitutes are also briefly mentioned.
Collagen changing the course of the future by Md.Iftekhar Mahmood & Muh. Amd...Iftekhar Mahmood
Collagen is one of the body’s important natural resources and a component of skin tissue and connective tissue. Its application as a wound dressing& surgical material is vastly promising.
The document provides an overview of wound classification and wound healing. It classifies wounds based on several factors such as cleanliness, thickness, involved structures, and time elapsed. There are different types of wound healing including primary intention, secondary intention, and tertiary intention. The stages of wound healing are inflammation, proliferation, remodeling. Factors affecting wound healing include infection, blood supply, nutrition, and underlying diseases. Wound management involves cleaning, debridement, closure techniques, and treatment of underlying injuries or issues. Complications of wound healing can include infection, dehiscence, hypertrophic scarring, and keloids.
The document discusses wound classification and the normal process of wound healing. It defines wounds and classifies them into four categories (clean, clean-contaminated, contaminated, dirty/infected) based on the CDC's adaptation of the American College of Surgeons' wound classification schema. It then describes the four phases of normal acute wound healing: hemostasis, inflammation, proliferation, and remodeling. Hemostasis involves platelet aggregation and fibrin clot formation to stop bleeding. Inflammation brings neutrophils and macrophages to remove debris. Proliferation involves new tissue formation. Remodeling shapes the new tissue.
The document discusses wound healing and provides details on the various phases of healing. It describes the healing process, which involves regeneration or repair through scar formation depending on the tissue type. The main phases of healing are the inflammatory phase, proliferative phase, and remodeling phase. The inflammatory phase lasts 3-5 days and involves coagulation and an immune response. The proliferative phase lasts up to 3 weeks and includes granulation tissue formation, re-epithelialization, and collagen deposition. The remodeling phase can last years and involves matrix remodeling and strengthening of the scar tissue. Complications can arise if this delicate process is disrupted.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
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.
This document discusses skin substitutes, which are materials that can aid in wound closure and replace skin functions temporarily or permanently. It defines various types of skin substitutes and outlines their classification. It describes both temporary skin substitutes like porcine xenografts, human allografts, and synthetic options. It also discusses permanent skin substitutes that contain dermal and epidermal components, such as Integra, Apligraf, and cultured epithelial autografts. The document concludes that skin substitutes are important in plastic surgery and wound management but are limited by high costs and availability.
This document provides an overview of wound healing, including definitions, classifications of wounds, and the phases of healing. It discusses the healing process for soft tissues as well as specialized healing for nerves and bone. The four main phases of wound healing are bleeding, inflammation, proliferation, and remodeling. Factors that can affect healing and potential complications are also mentioned.
EWMA 2014 - EP432 CAUSES OF HYPERTROPHIC SCARS IN CHILDREN WITH EFFECTS OF BU...EWMA
Hypertrophic scars in children with burns can be caused by excessive activity of lymphocytes, macrophages and mast cells in the scar tissue within the first 6 months after wound healing. This leads to overproduction of cytokines that disrupt normal cell apoptosis and prolonged fibroblast activity. Between 5-12 months, excessive collagen synthesis narrows blood vessels in the scar, impairing circulation. The most important period for preventing hypertrophic scarring is the first 6 months, when conservative treatments like compression and anti-inflammatory drugs can influence scar development.
Wound healing involves three phases: inflammatory, proliferative, and maturational. Primary healing occurs when wound edges are in direct contact while secondary healing involves granulation tissue formation. Many factors can affect wound healing including infection, nutrition, steroids, ischemia, and diabetes. Growth factors are important for different stages of healing. Stem cells can help regenerate damaged tissue. Aberrations like keloids and hypertrophic scarring exist. New treatments include skin substitutes, dressings, growth factors, and therapies like hyperbaric oxygen and offloading casts.
This document discusses various types of skin substitutes that can be used as temporary or permanent replacements for skin, including biological, synthetic, and bio-synthetic options. It provides details on human allograft skin, noting that it expresses class-2 antigens and is typically rejected within 2-3 weeks but rejection can be decreased through various treatments. The document also discusses the use of autografts with allografts and shows pictures demonstrating the application and results of using amnion grafts on wounds. It provides an overview of Integra, a bio-synthetic skin substitute, explaining its inner biodegradable membrane and outer silicone layer and how it integrates with the body over time.
Wound and bone healing involve regeneration and repair processes. Wound healing occurs in four stages - hemostasis, inflammation, proliferation, and remodeling. There are three types of wound healing - primary, secondary, and delayed primary. Primary healing involves clean surgical wounds closed with sutures. Secondary healing involves open wounds without sutures that heal from the bottom up. Bone fracture healing similarly occurs through stages of hematoma formation, inflammation and callus formation, consolidation, and remodeling either directly or indirectly through callus formation. Factors like age, bone type, fracture pattern, and immobilization can affect bone healing.
The document discusses wound care and laceration repair for nurse practitioners in emergency care. It outlines the phases of wound healing: inflammatory, proliferative, and remodeling. It describes categories of wound healing: primary intention, secondary intention, and delayed primary closure. It also discusses factors that affect wound healing using the mnemonic "DIDN'T HEAL" and advocates for systematic wound management to prevent infection.
Wounds can be classified in several ways, including by depth of tissue involvement. Superficial wounds only affect the epidermis, partial-thickness wounds also affect part of the dermis, and full-thickness wounds involve the epidermis and dermis with potential damage to underlying tissues. Wound healing involves inflammation, proliferation, and maturation phases. Factors like age, dehydration, infection, and poor circulation can affect wound healing. A thorough wound assessment should document characteristics of the wound bed, surrounding skin, and underlying factors.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
1. The document discusses gastrointestinal anastomosis healing, comparing compression anastomoses to sutured/stapled techniques.
2. It describes the three phases of acute wound healing - inflammation, proliferation, and remodeling - and how complications can arise if the phases are prolonged or abnormal.
3. Studies comparing the ColonRing compression device to circular staplers found the ColonRing anastomoses had higher burst pressures, less scarring and narrowing, and more stable tissue regeneration over time.
Chapter 19 Wound Management, Stoma And Incontinence Productsdunerafael
This document summarizes different types of wound dressings and products. It describes 6 types of wounds and discusses traditional dressings like absorbents, bandages, and elastic hosiery. It also covers modern wound management products like vapor-permeable films, foams, foam film dressings, and polysaccharide beads. These new products help manage exudate levels and promote wound healing through features like absorption and moisture regulation. The document provides details on specific products within each category.
This document provides information on wound healing and care. It begins with the anatomy and functions of healthy skin. The three layers of skin - epidermis, dermis and subcutaneous tissue - are described. The four phases of wound healing are explained: inflammatory, proliferative, maturation and remodeling. Types of wounds and factors influencing healing are defined. Proper wound observation, cleaning, dressing and drainage are outlined as important for promoting healing.
Wound healing is a complex process involving three overlapping phases: inflammation, proliferation, and remodeling. During the inflammatory phase, blood vessels are disrupted causing bleeding and a fibrin clot forms. Inflammatory cells are recruited to the wound to remove debris and prevent infection. In the proliferative phase, new tissue such as granulation tissue, blood vessels and epithelium form. Finally, in the remodeling phase, the wound undergoes scarring and strengthening as collagen is remodeled over several months. Factors like infection, smoking, and malnutrition can disturb the healing process, while proper wound care including debridement, dressings and management of bioburden can optimize healing.
Residual Deformity in oral and maxillofacial surgerydr.nikil נαιη
Dr. Nikil Jain discusses nasal deformities resulting from trauma and their surgical correction. Nasal fractures can cause deviations of the nasal bridge and septum. Repositioning requires an intranasal approach to mobilize the septal cartilage and reduce displaced bone through osteotomies and chondrotomies. The nasal skeleton must be precisely realigned and immobilized internally and externally until healing is complete to avoid relapse of the deformity.
This document provides an overview of wound healing. It defines wounds and classifies them based on several factors. The stages and phases of wound healing are described, including inflammation, proliferation, and maturation. During inflammation, a clot forms and neutrophils and macrophages work to clean the wound. Proliferation involves granulation tissue formation through fibroblasts and angiogenesis. Epithelialization then occurs to close the wound. Factors affecting healing and complications are also mentioned.
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.
The document discusses wound classification and the normal process of wound healing. It defines wounds and classifies them into four categories (clean, clean-contaminated, contaminated, dirty/infected) based on the CDC's adaptation of the American College of Surgeons' wound classification schema. It then describes the four phases of normal acute wound healing: hemostasis, inflammation, proliferation, and remodeling. Hemostasis involves platelet aggregation and fibrin clot formation to stop bleeding. Inflammation brings neutrophils and macrophages to remove debris. Proliferation involves new tissue formation. Remodeling shapes the new tissue.
The document discusses wound healing and provides details on the various phases of healing. It describes the healing process, which involves regeneration or repair through scar formation depending on the tissue type. The main phases of healing are the inflammatory phase, proliferative phase, and remodeling phase. The inflammatory phase lasts 3-5 days and involves coagulation and an immune response. The proliferative phase lasts up to 3 weeks and includes granulation tissue formation, re-epithelialization, and collagen deposition. The remodeling phase can last years and involves matrix remodeling and strengthening of the scar tissue. Complications can arise if this delicate process is disrupted.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
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.
This document discusses skin substitutes, which are materials that can aid in wound closure and replace skin functions temporarily or permanently. It defines various types of skin substitutes and outlines their classification. It describes both temporary skin substitutes like porcine xenografts, human allografts, and synthetic options. It also discusses permanent skin substitutes that contain dermal and epidermal components, such as Integra, Apligraf, and cultured epithelial autografts. The document concludes that skin substitutes are important in plastic surgery and wound management but are limited by high costs and availability.
This document provides an overview of wound healing, including definitions, classifications of wounds, and the phases of healing. It discusses the healing process for soft tissues as well as specialized healing for nerves and bone. The four main phases of wound healing are bleeding, inflammation, proliferation, and remodeling. Factors that can affect healing and potential complications are also mentioned.
EWMA 2014 - EP432 CAUSES OF HYPERTROPHIC SCARS IN CHILDREN WITH EFFECTS OF BU...EWMA
Hypertrophic scars in children with burns can be caused by excessive activity of lymphocytes, macrophages and mast cells in the scar tissue within the first 6 months after wound healing. This leads to overproduction of cytokines that disrupt normal cell apoptosis and prolonged fibroblast activity. Between 5-12 months, excessive collagen synthesis narrows blood vessels in the scar, impairing circulation. The most important period for preventing hypertrophic scarring is the first 6 months, when conservative treatments like compression and anti-inflammatory drugs can influence scar development.
Wound healing involves three phases: inflammatory, proliferative, and maturational. Primary healing occurs when wound edges are in direct contact while secondary healing involves granulation tissue formation. Many factors can affect wound healing including infection, nutrition, steroids, ischemia, and diabetes. Growth factors are important for different stages of healing. Stem cells can help regenerate damaged tissue. Aberrations like keloids and hypertrophic scarring exist. New treatments include skin substitutes, dressings, growth factors, and therapies like hyperbaric oxygen and offloading casts.
This document discusses various types of skin substitutes that can be used as temporary or permanent replacements for skin, including biological, synthetic, and bio-synthetic options. It provides details on human allograft skin, noting that it expresses class-2 antigens and is typically rejected within 2-3 weeks but rejection can be decreased through various treatments. The document also discusses the use of autografts with allografts and shows pictures demonstrating the application and results of using amnion grafts on wounds. It provides an overview of Integra, a bio-synthetic skin substitute, explaining its inner biodegradable membrane and outer silicone layer and how it integrates with the body over time.
Wound and bone healing involve regeneration and repair processes. Wound healing occurs in four stages - hemostasis, inflammation, proliferation, and remodeling. There are three types of wound healing - primary, secondary, and delayed primary. Primary healing involves clean surgical wounds closed with sutures. Secondary healing involves open wounds without sutures that heal from the bottom up. Bone fracture healing similarly occurs through stages of hematoma formation, inflammation and callus formation, consolidation, and remodeling either directly or indirectly through callus formation. Factors like age, bone type, fracture pattern, and immobilization can affect bone healing.
The document discusses wound care and laceration repair for nurse practitioners in emergency care. It outlines the phases of wound healing: inflammatory, proliferative, and remodeling. It describes categories of wound healing: primary intention, secondary intention, and delayed primary closure. It also discusses factors that affect wound healing using the mnemonic "DIDN'T HEAL" and advocates for systematic wound management to prevent infection.
Wounds can be classified in several ways, including by depth of tissue involvement. Superficial wounds only affect the epidermis, partial-thickness wounds also affect part of the dermis, and full-thickness wounds involve the epidermis and dermis with potential damage to underlying tissues. Wound healing involves inflammation, proliferation, and maturation phases. Factors like age, dehydration, infection, and poor circulation can affect wound healing. A thorough wound assessment should document characteristics of the wound bed, surrounding skin, and underlying factors.
Dr. kushagra case study, supported by TRIAGE MEDITECH NPWT INDIASiddharth Mandal
This study compared the effectiveness of vacuum assisted wound therapy (VAC) to standard wound therapy for treating open musculoskeletal injuries. 30 patients were randomly assigned to receive either VAC or standard saline dressings after surgical debridement. Wound size reductions were measured after 8 days of treatment. VAC resulted in greater wound size reductions of over 5 mm compared to less than 5 mm for standard therapy. VAC facilitated more rapid formation of healthy granulation tissue, potentially shortening healing time and reducing needs for further soft tissue procedures. The study concluded that VAC therapy is effective for open musculoskeletal wounds and produces better outcomes than standard wound care.
1. The document discusses gastrointestinal anastomosis healing, comparing compression anastomoses to sutured/stapled techniques.
2. It describes the three phases of acute wound healing - inflammation, proliferation, and remodeling - and how complications can arise if the phases are prolonged or abnormal.
3. Studies comparing the ColonRing compression device to circular staplers found the ColonRing anastomoses had higher burst pressures, less scarring and narrowing, and more stable tissue regeneration over time.
Chapter 19 Wound Management, Stoma And Incontinence Productsdunerafael
This document summarizes different types of wound dressings and products. It describes 6 types of wounds and discusses traditional dressings like absorbents, bandages, and elastic hosiery. It also covers modern wound management products like vapor-permeable films, foams, foam film dressings, and polysaccharide beads. These new products help manage exudate levels and promote wound healing through features like absorption and moisture regulation. The document provides details on specific products within each category.
This document provides information on wound healing and care. It begins with the anatomy and functions of healthy skin. The three layers of skin - epidermis, dermis and subcutaneous tissue - are described. The four phases of wound healing are explained: inflammatory, proliferative, maturation and remodeling. Types of wounds and factors influencing healing are defined. Proper wound observation, cleaning, dressing and drainage are outlined as important for promoting healing.
Wound healing is a complex process involving three overlapping phases: inflammation, proliferation, and remodeling. During the inflammatory phase, blood vessels are disrupted causing bleeding and a fibrin clot forms. Inflammatory cells are recruited to the wound to remove debris and prevent infection. In the proliferative phase, new tissue such as granulation tissue, blood vessels and epithelium form. Finally, in the remodeling phase, the wound undergoes scarring and strengthening as collagen is remodeled over several months. Factors like infection, smoking, and malnutrition can disturb the healing process, while proper wound care including debridement, dressings and management of bioburden can optimize healing.
Residual Deformity in oral and maxillofacial surgerydr.nikil נαιη
Dr. Nikil Jain discusses nasal deformities resulting from trauma and their surgical correction. Nasal fractures can cause deviations of the nasal bridge and septum. Repositioning requires an intranasal approach to mobilize the septal cartilage and reduce displaced bone through osteotomies and chondrotomies. The nasal skeleton must be precisely realigned and immobilized internally and externally until healing is complete to avoid relapse of the deformity.
This document provides an overview of wound healing. It defines wounds and classifies them based on several factors. The stages and phases of wound healing are described, including inflammation, proliferation, and maturation. During inflammation, a clot forms and neutrophils and macrophages work to clean the wound. Proliferation involves granulation tissue formation through fibroblasts and angiogenesis. Epithelialization then occurs to close the wound. Factors affecting healing and complications are also mentioned.
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.
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 Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The document discusses wound healing and fracture healing. It defines wounds and their classification. The main stages of wound healing are inflammation, proliferation and maturation. Wounds can heal by primary or secondary intention. Fracture healing involves an initial inflammatory response, formation of a blood clot (hematoma) and callus, and later remodeling of the bone. Key cell types involved in healing include fibroblasts, endothelial cells and macrophages. Growth factors influence various phases of the healing process.
this a basic presentation which I got inspired to do after seeing some presentations made on slideshare. It basically covers types of wounds,wound healing process,factors affecting wound healing and wound care.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses wound healing and wound care. It covers the basic principles of wound healing including regeneration and repair. It describes the different types of tissues based on their regenerative capacity (labile, stable, permanent) and how each type heals. Factors that can influence and delay wound healing are discussed. The document also covers chronic wounds, excessive scarring, wound dressings and their purposes in wound management and care.
Dentist in pune.(BDS. MDS) - Dr. Amit T. Suryawanshi. Wound healing in Dentis...All Good Things
entist in pune. (BDS. MDS) - Dr. Amit T. Suryawanshi. Seminar- Wound healing in dentistry.
Email ID- amitsuryawanshi999@gmail.com
Contact -Ph no.-9405622455
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This document discusses the stages of skin graft take, including plasmatic imbibition, inosculation and capillary ingrowth, and revascularization. It describes graft fixation, contraction, reinnervation, pigmentation, and factors that can lead to graft failure. The stages of graft take typically involve serum imbibition for 24-48 hours, development of fine vasculature in a fibrin layer, and eventual blood flow as the graft becomes pink. Revascularization may occur through direct vessel anastomoses, new vascular channel formation, or a combination. Proper fixation and aftercare are important for successful graft take.
The document summarizes the structure and function of skin, the process of wound healing, and factors that can affect wound healing. It discusses the following key points:
- Skin is composed of several layers including the epidermis, dermis, and subcutaneous layer. Its structure varies depending on its location on the body.
- Wound healing involves regeneration of epithelial tissue and formation of connective scar tissue. It occurs through the phases of inflammation, proliferation, and remodeling.
- The three classifications of wound healing are primary intention, secondary intention, and delayed primary healing. Primary intention healing results in minimal scarring.
- The phases of wound healing involve coagulation, inflammation, proliferation, epithelialization
The document discusses wound healing and fibrosis. It describes that wound healing occurs in three phases: inflammation, proliferation, and maturation. It also discusses primary and secondary wound healing. Primary healing involves wounds with opposed edges that heal with a thin scar, while secondary healing involves wounds with tissue loss that heal with more scarring and contracture. The document also discusses factors that influence wound healing and complications that can arise. It provides details on cutaneous wound healing and fracture healing processes. Finally, it discusses fibrosis, describing that it is excessive collagen deposition in tissue during repair. It notes the role of macrophages and TGF-beta in promoting fibrosis.
Cartilage is derived (embryologically) from mesenchyme. . Chondroblasts produce the intercellular matrix as well as the collagen fibres. Chondroblasts that become imprisoned within this matrix become chondrocytes. The articular surface of most synovial joints are lined by hyaline cartilage
Tissue histopathology is important for estimating the age of injuries in forensic medicine. The presentation discusses the histological changes that occur over time in different tissues like skin, muscle, bone and brain around inflicted wounds. These vital reactions like hemorrhage, inflammatory cell infiltration and formation of granulation tissue can help determine if an injury was ante-mortem or post-mortem. The timing of cellular and biochemical changes in injured tissues can provide a window into how long ago an injury occurred. Understanding the histological healing processes in various tissues enables more accurate estimation of the age of wounds in medico-legal cases.
EWMA 2013 - Ep492 - From Secondary Intent to Accelerated Reconstruction – the...EWMA
This document summarizes a study evaluating a novel dermal scaffold called Smart Matrix (SM-SDR) for its potential to accelerate healing of chronic wounds. The SM-SDR is a cross-linked fibrin-alginate porous scaffold designed to promote neo-vascularization and reduce inflammation. In animal studies, the SM-SDR demonstrated rapid cellularization and vascularization within 7 days, with the wound site resembling surrounding skin within 21 days. Compared to controls, application of the SM-SDR in chronic wound models promoted wound healing to a more accelerated regenerating mode. The SM-SDR shows potential for single-stage full-thickness wound reconstruction and repair of other organs.
EWMA 2013 - Ep492 - From Secondary Intent to Accelerated Reconstruction – the...
Mosd
1. Keloid scars is made up of –
a) Dense collagen b) Loose fibrous tissue
c Granulamatous tissue d) Loose areolar tissue
What is true about keloids – (JIPMER 95)
a)It appears immediately after surgery
b)It appears a few days after surgery
c)It is limited in its distribution (grows beyond the limits of the original wound)
d) it is common in old people
Keloid is best treated by – (UPSC 95)
a)Intrakeloidal injection of triamcinolone
b)Wide excision and grafting
c)Wide excision and suturing
d)Deep X-ray therapy
The following statement about keloid is true- A) They do not extend in normal
skin (extreme overgrowth of scar tissue that grows beyond the limits of the original
wound)
b)Local recurrence is common after excision
c) They often undergo malignant change
d) They are more common in whites than in blacks
The best cure rate in keloids is achieved by –
a)Superficial X – ray therapy (UPSC 2001)
b)Intralesional injection of triamcinolone
c)Shaving
d)Excision and radiotherapy
Combination is always better.
Surgery:-Excision alone of keloids is subject to a high recurrence rate, ranging from
45 to 100%. There are fewer recurrences when surgical excision is combined with
other modalities such as intralesional corticosteroid injection, topical application of
silicone sheets, or the use of radiation or pressure
Radiation:-Poor results with 10 to 100% recurrence when used alone. It is more
effective when combined with surgical excision. Given the risks of
hyperpigmentation, pruritus, erythema, paresthesias, pain, and possible secondary
malignancies, radiation should be reserved for adults with scars resistant to other
modalities.
Combination therapies:- Intralesional corticosteroid injections decrease fibroblast
proliferation, collagen and glycosaminoglycan synthesis, the inflammatory process,
2. and TGF levels. When used alone, however, there is a variable rate of response
and recurrence, therefore steroids are recommended as first-line treatment for keloids
and second-line treatment for HTSs if topical therapies have failed. Intralesional
injections are more effective on younger scars. They may soften, flatten, and give
symptomatic relief to keloids, but they cannot make the lesions disappear nor can
they narrow wide HTSs. Success is enhanced when used in combination with surgical
excision. Serial injections every 2 to 3 weeks are required.
Sabiston:- Intralesional injection of steroids into a keloid scar can inactivate and
shrink the scar; such therapy is not indicated for hypertrophic scars.
Scars that are perpendicular to the underlying muscle fibers tend to be flatter and
narrower, with less collagen formation than when they are parallel to the underlying
muscle fibers. The position of an elective scar can be chosen in such a way to make a
narrower and less obvious scar in the distant future. As muscle fibers contract, the
wound edges become reapproximated if they are perpendicular to the underlying
muscle. If, however, the scar is parallel to the underlying muscle, contraction of that
muscle tends to cause gaping of the wound edges and leads to more tension and scar
formation.
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Wounds
Primary closure of incised wounds must be done in –
a) 2 hrs b) 4 hrs
c) 6 hrs d) 12 hrs
e) 16 hrs
(Because of the fear of bacterial invasion, primary wound closure beyond 6 to 8 hours
after injury was historically proscribed. However, several scientific studies have since
shown that when blood supply to a wound is adequate and bacterial invasion is
absent, wounds can be safely closed at any time after proper débridement and
irrigation)
The tensile strength of wound reaches that of normal tissue by – (PGI 88)
) 6 weeks
c) 4 months
b) 2 months
d) 6 months
NEVER
In the healing of a clean wound the maximum immediate strength of the wound is
reached by –
a) 2 – 3 days b) 4 – 7 days
10 – 12 days d) 13 – 18 days
3. 21 days is ans
The tensile strength of the wound starts and increases after – (MAHE 05)
a)Immediate suture of the wound
b)3 to 4 days
c)7-10 days
d 6 months
see figure
When is the maximum collagen content of wound
tissue – (PGI 81, ROHTAK 87)
a)Between 3rd to 5th day
b)Between 6th to 17th day
C) Between 17th to 21st day d) None of the above
In a sutured surgical wound, the process of epithelialization is completed within –
(UPSC 07)
a) 24 hours b) 48 hours
c) 72 hours d) 96 hours
Ref schwartz Epithelialization:- While tissue integrity and strength are being re-
established, the external barrier must also be restored. This process is characterized
primarily by proliferation and migration of epithelial cells adjacent to the wound The
process begins within 1 day of injury and is seen as thickening of the epidermis at the
wound edge.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, in which there is a significant epidermal/dermal defect.
Sabiston : – Finally, adequate dressing of the closed wound isolates it from the
outside environment. Providing an appropriate dressing for 48 to 72 hours can
decrease wound contamination. However, dressings after this period increase the
subsequent bacterial count on adjacent skin by altering the microenvironment
underneath the dressing.
Following are required for wound healing except – a) Zinc
b) Copper c) Vitamin C d) Calcium
Copper is also a component of ferroprotein, a transport protein involved in the
basolateral transfer of iron during absorption from the enterocyte. As such, copper
plays a role in iron metabolism, melanin synthesis, energy production,
neurotransmitter synthesis, and CNS function; the synthesis and cross-linking of
elastin and collagen :- Harrison
Copper Deficiency:- Anemia, growth retardation, defective keratinization and
pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia,
mental deterioration.
Patient has lacerated untidy wound of the leg and attended the casualty after 2 ‘hours.
His wound (AIIMS 84)should be –
4. a) Sutured immediately b) Debrided and sutured immediately c) debrided and
sutured secondarily d) Cleaned and dressed
Wound healing is worst at –
(ALL INDIA 93) a) Sternum b) Anterior neck
c) Eyelid d) Lips
After closing deep tissues and replacing significant tissue deficits, skin edges should
be reapproximated for cosmesis and to aid in rapid wound healing. Skin edges may be
quickly reapproximated with stainless steel staples or nonabsorbable monofilament
sutures. Care must be taken to remove these from the wound before epithelialization
of the skin tracts where sutures or staples penetrate the dermal layer. Failure to
remove the sutures or staples by 7 to 10 days after repair will result in a cosmetically
inferior wound
(Anatomic areas where tension is excessive are avoided if possible. The shoulders,
back, and anterior chest are high tension and mobile areas where wide scarring
is difficult to avoid. Patients are also questioned as to propensity for development of
hypertrophic scars or keloid formation. Ears, anterior chest, and shoulders are areas
prone to these problematic scars)
Sabiston :-Wound strength increases rapidly within 1 to 6 weeks and then appears to
plateau up to 1 year after the injury .When compared with unwounded skin, tensile
strength is only 30% in the scar. An increase in breaking strength occurs after
approximately 21 days, mostly as a result of cross-linking.The rate of collagen
synthesis declines after 4 weeks and eventually balances the rate of collagen
destruction by collagenase (MMP-1). At this point the wound enters a phase of
collagen maturation.
Taylor:-The tensile strength of the young scar is only about 10% that of normal skin.
Scar strength increases to about 30–50% of normal skin by 4 weeks and to 80% after
several months.
Robbins:-We now turn to the questions of how long it takes for a skin wound to
achieve its maximal strength, and which substances contribute to this strength. When
sutures are removed, usually at the end of the first week, wound strength is
approximately 10% of the strength of unwounded skin, but it increases rapidly over
the next 4 weeks. This rate of increase then slows at approximately the third month
after the original incision and then reaches a plateau at about 70 to 80% of the tensile
strength of unwounded skin, which may persist for life.
Schwartz:-Wound strength and mechanical integrity in the fresh wound are
determined by both the quantity and quality of the newly deposited collagen. The
deposition of matrix at the wound site follows a characteristic pattern: 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 postinjury the amount of collagen in the wound
reaches a plateau, but the tensile strength continues to increase for several more
months.20 Fibril formation and fibril cross-linking result in decreased collagen
solubility, increased strength, and increased resistance to enzymatic degradation of the
5. collagen matrix. Scar remodeling continues for many (6 to 12) months postinjury,
gradually resulting in a mature, avascular, and acellular scar. The mechanical strength
of the scar never achieves that of the uninjured tissue.
Factors That Inhibit Wound Healing
Infection
Ischemia
Circulation
Respiration
Local tension
Diabetes mellitus
Ionizing radiation
6. Advanced age
Malnutrition
Vitamin deficiencies:- Vitamin C Vitamin A
Mineral deficiencies:-Zinc Iron
Exogenous drugs:-Doxorubicin (Adriamycin) Glucocorticosteroids
suture marks are to be avoided, skin sutures should be removed by - a) hours b) 1
week
2 weeks d) 3 weeks
Epidermal skin sutures function for fine alignment of skin edges. Interrupted sutures
are less constrictive than running sutures. The needle enters and exits the skin at 90
degrees in order to evert the skin edges. These skin sutures are removed as soon as
adequate intrinsic bonding strength is sufficient. Skin sutures left in place too long
result in an unsightly track pattern. On the other hand, sutures removed prematurely
risk wound dehiscence. Nonabsorbable sutures on the face are typically removed
after 5 days. Sutures in the hand, foot, or across areas that are acted on by
motion are left for 14 days or longer .Alternatively, by employing the running
intradermal suturing technique, the time constraints of suture removal may be
disregarded, and these sutures may be left in place for a longer time without risking a
track pattern scar. Finally, epidermal approximation can be achieved without suture
using a medical-grade cyanoacrylate adhesive such as Dermabond. Such adhesives
are applied across the coapted skin edges only and contribute no tensile strength. Tape
closure strips such as Steri-Strips can be applied at the completion of wound closure
to help splint the coapted skin edges.
Guidelines for Day of Suture Removal by Area
BODY REGION REMOVAL (DAYS)
Scalp 6-8
Ear 10-14
Eyelid 3-4
Eyebrow 3-5
Nose 3-5
Lip 3-4
Face (other) 3-4
Chest, abdomen 8-10
Back 12-14
Extremities 12-14
Hand 10-14
7. BODY REGION REMOVAL (DAYS)
Foot, sole 12-14
A patient with grossly contaminated wound presents 12 hours after an accident. His
wound should be managed by – (UPSC 96)
a)Thorough cleaning and primary repair
b)Thorough cleaning with debridement of all dead and devitalised tissue without
primary closure
c)Primary closure over a drain
d)Covering the defect with split skin graft after cleaning
Management of an open wound seen 12 hrs. after
the injury – (AIIMS 87)
a)Suturing
b)Debridement and suture
c)Secondary suturing
d)Heal by granulation
Delayed wound healing is seen in all except-(AP 96)
a) Malignancy b) Hypertension
c) Diabetes d) Infection
All of the following favour postoperative wound dehiscence except – (Karnat 05)
a)Malignancy
b)Vitamin B complex deficiency
c)Hypoproteinaemia
d)Jaundice
Fibroblast in healing wound derived from –
a) Local mesenchyme b) Epithelium (PGI 98)
c) Endothelial d) Vascular fibrosis
(Sabiston) Fibroplasia:- Fibroblasts are specialized cells that differentiate from resting
mesenchymal cells in connective tissue; they do not arrive in the wound cleft by
diapedesis from circulating cells. After injury, the normally quiescent and sparse
fibroblasts are chemoattracted to the inflammatory site, where they divide and
produce the components of the ECM.The primary function of fibroblasts is to
synthesize collagen, which they begin to produce during the cellular phase of
inflammation. The time required for undifferentiated mesenchymal cells to
differentiate into highly specialized fibroblasts accounts for the delay between injury
and the appearance of collagen in a healing wound. This period, generally 3 to 5 days,
depending on the type of tissue injured, is called the lag phase of wound healing.The
rate of collagen synthesis declines after 4 weeks and eventually balances the rate of
collagen destruction by collagenase (MMP-1). At this point the wound enters a phase
of collagen maturation. The maturation phase continues for months or even years.
Glycoprotein and mucopolysaccharide levels decrease during the maturation phase,
and new capillaries regress and disappear. These changes alter the appearance of the
wound and increase its strength.
8. Degloving injury is – (KERALA 2K)
a) Surgeon made wound b) Lacerated wound
c) Blunt injury d) Avulsion injury
e)Abrasive wound
Avulsion injuries are open injuries where there has been a severe degree of tissue
damage. Such injuries occur when hands or limbs are trapped in moving machinery,
such as in rollers, producing a degloving injury. Degloving is caused by shearing
forces that separate tissue planes, rupturing their vascular interconnections and
causing tissue ischaemia. This most frequently occurs between the subcutaneous fat
and deep fascia. Degloving injuries can be open or closed. Degloving can be localised
or circumferential. It can occur only in the single, subcutaneous plane, but where
present in multiple planes, such as between muscles and fascia and between muscles
and bone, is an indication of a severe high-energy injury with a limited potential for
primary healing. Similar injuries occur as a result of runover road traffic accident
injuries where friction from rubber tyres will avulse skin and subcutaneous tissue
from the underlying deep fascia (Fig. 3.11). The history should raise the examiner’s
suspicion and it is often possible to pinch the skin and lift it upwards revealing its
detachment from the normal anchorage. The danger of degloving or avulsion injuries
is that there is devascularisation of tissue and skin necrosis may become slowly
apparent in the following few days. Even tissue that initially demonstrates venous
bleeding may subsequently undergo necrosis if the circulation is insufficient.
Treatment of such injuries is to identify the area of devitalised skin and to remove the
skin, defat it and reapply it as a full-thickness skin graft. Avulsion injuries of hands or
feet may require immediate flap cover using a one-stage microvascular tissue transfer
of skin and/or muscle.
In treatment of hand injuries, the greatest priority is – (A1 96)
a)Repair of tendons
b)Restoration of skin cover
c)Repair of nerves
d) Repair of blood vessels
During the surgical procedure – (AIIMS 83)
a)Tendons should be repaired before nerves
b)Nerves should be repaired before tendons
c)Tendons should not be repaired at the same time
d)None is true
In hand injuries first to be repaired is – (A195)
a) Bone b) Tendon
c) Muscle d) Nerve
In the case of injuries, treatment is directed at the specific structures damaged:
skeletal, tendon, nerve, vessel, and integument. In emergency situations, the goals of
treatment are to maintain or restore distal circulation, obtain a healed wound, preserve
motion, and retain distal sensation. Stable skeletal architecture is established in the
primary phase of care because skeletal stability is essential for effective motion
and function of the extremity. This also results in reestablishing skeletal length,
straightening deformities, and correction of compression or kinking of nerves
9. and vessels. Arteries are also repaired in the acute phase of treatment to maintain
distal tissue viability. Additionally, extrinsic compression on arteries must be released
emergently such as in compartment pressure problems. In clean-cut injuries, tendons
can be repaired primarily. In situations in which there is a chance that tendon
adhesions may form, such as when there are associated fractures, it is nonetheless
better to repair tendons primarily with preservation of their length and if necessary at
a later date to perform tenolysis. However, when there are open and contaminated
wounds or a severe crushing injury, it is best to delay repair of both tendon and
nerve injuries
Prevention of wound infection done by –
a)Pre-op shaving (PGI 05)
b)Pre-op antibiotic therapy
c)Monofilament sutures
d)Wound apposition
SSIs are the most common nosocomial infection in our population and constitute 38%
of all infections in surgical patients. By definition, they can occur anytime from 0 to
30 days after the operation or up to 1 year after a procedure that has involved the
implantation of a foreign material (mesh, vascular graft, prosthetic joint, and so on).
Incisional infections are the most common; they account for 60% to 80% of all SSIs
and have a better prognosis than organ/space-related SSIs do, with the latter
accounting for 93% of SSI-related mortalities.
Preoperative shaving has been shown to increase the incidence of SSI after clean
procedures as well. This practice increases the infection rate about 100% as compared
with removing the hair by clippers at the time of the procedure or not removing it at
all, probably secondary to bacterial growth in microscopic cuts. Therefore, the
patient is not shaved before an operation. Extensive removal of hair is not
needed, and any hair removal that is done is performed by electric clippers with
disposable heads at the time of the procedure and in a manner that does not
traumatize the skin
1.Basic principles include size of the OR, air management (filtered flow, positive
pressure toward the outside, and air cycles per hour), equipment handling
(disinfection and cleansing), and traffic rules. All OR personnel wear clean scrubs,
caps, and masks, and traffic in and out of the OR is minimized.
2.The CDC recommends the use of chlorhexidine showers, and it is reasonable to
implement such a policy, particularly in patients who have been in the hospital for a
few days and in those in whom an SSI will cause significant morbidity (cardiac,
vascular, and prosthetic procedures). Skin preparation of the surgical site is done with
a germicidal antiseptic such as tincture of iodine, povidone-iodine, or chlorhexidine.
An alternative preparation is the use of antimicrobial incise drapes applied to the
entire operative area. Traditionally, the surgical team has scrubbed their hands and
forearms for at least 5 minutes the first time in the day and for 3 minutes every
consecutive time.
3.As many as 90% of an operative team puncture their gloves during a prolonged
operation. The risk increases with time, as does the risk for contamination of the
10. surgical site if the glove is not changed at the moment of puncture. The use of double
gloving is becoming a popular practice to avoid contamination of the wound, as well
as exposure to blood by the surgical team. Double gloving is recommended for all
surgical procedures.Instruments that will be in contact with the surgical site are
sterilized in standard fashion, and protocols for flash sterilization or emergency
sterilization, or both, must be well established to ensure the sterility of instruments
and implants.
Local Wound Related:-Intraoperative measures include appropriate handling of tissue
and assurance of satisfactory final vascular supply, but with adequate control of
bleeding to prevent hematomas/seromas. Complete débridement of necrotic tissue
plus removal of unnecessary foreign bodies is recommended, as well as avoiding the
placement of foreign bodies in clean-contaminated, contaminated, or dirty cases.
Monofilament sutures have proved in experimental studies to be associated with
a lower rate of SSI. Sutures are foreign bodies that are used only when required.
Suture closure of dead space has not been shown to prevent SSI. Large potential
dead spaces can be treated with the use of closed-suction systems for short periods,
but these systems provide a route for bacteria to reach the wounds and may cause SSI.
Open drainage systems (e.g., Penrose) increase rather than decrease infections in
surgical wounds and are avoided unless used to drain wounds that are already
infected.
In heavily contaminated wounds or wounds in which all the foreign bodies or
devitalized tissue cannot be satisfactorily removed, delayed primary closure
minimizes the development of serious infection in most instances. With this
technique, the subcutaneous tissue and skin are left open and dressed loosely with
gauze after fascial closure. The number of phagocytic cells at the wound edges
progressively increases to a peak about 5 days after the injury. Capillary budding is
intense at this time, and closure can usually be accomplished successfully even with
heavy bacterial contamination because phagocytic cells can be delivered to the site in
large numbers. Experiments have shown that the number of organisms required to
initiate an infection in a surgical incision progressively increases as the interval of
healing increases, up to the fifth postoperative day.
Finally, adequate dressing of the closed wound isolates it from the outside
environment. Providing an appropriate dressing for 48 to 72 hours can decrease
wound contamination. However, dressings after this period increase the subsequent
bacterial count on adjacent skin by altering the microenvironment underneath the
dressing.
Elective cholecystectomy is – (APPG 06)
a) Clean contaminated b) Clean
Dirty d) Contaminated
Which one of the following surgical procedures is considered to have a clean-
contaminated wound ?
a),Elective open cholecystectomy for cholelithiasis
b)Hemiorrhaphy with mesh repair
11. c)Lumpectomy with axillary node dissection
d)Appendectomy with walled off abscess
The accepted range of infection rates has been 1% to 5% for clean, 3% to 11% for
clean-contaminated, 10% to 17% for contaminated, and greater than 27% for dirty
wounds.
Table 14-2 – Surgical Wound Classification According to Degree of
Contamination
WOUND
CLASS DEFINITION
Clean An uninfected operative wound in which no inflammation is
encountered and the respiratory, alimentary, genital, or infected
urinary tract is not entered. Wounds are closed primarily and, if
necessary, drained with closed drainage. Surgical wounds after blunt
trauma should be included in this category if they meet the criteria
Clean- An operative wound in which the respiratory, alimentary, genital,
contaminated or urinary tract is entered under controlled conditions and
without unusual contamination
Contaminated Open, fresh, accidental wounds. In addition, operations with major
breaks in sterile technique or gross spillage from the
gastrointestinal tract and incisions in which acute, nonpurulent
inflammation is encountered are included in this category
Dirty Old traumatic wounds with retained devitalized tissue and those that
involve existing clinical infection or perforated viscera. This
definition suggests that the organisms causing postoperative infection
were present in the operative field before the operation
Staphylococcus aureus remains the most common pathogen in SSIs, followed by
coagulase-negative staphylococci, enterococci, and Escherichia coli. However, for
clean-contaminated and contaminated procedures, E. coli and other
Enterobacteriaceae are the most common cause of SSI.
The Vitamin which has inhibitory effect on wound healing is – (MAHE 05)
a) Vitamin-A b) Vitamin-E
c) Vitamin-C d) Vitamin B-complex