1. The document describes the stages of wound healing: inflammation, proliferation/tissue repair, and remodeling. It discusses factors that influence healing like nutrition, infection, and mechanical stress. 2. Details are provided on wound types like pressure sores, diabetic ulcers, and burns. Abnormal wound healing conditions like hypertrophic scarring, keloids, and contractures are also summarized. 3. Treatment methods covered include wound debridement, dressings, scar management, splinting/positioning, skin grafting, and physiotherapy. The effects of UV rays on wound healing and microorganisms are also discussed.

1. Skin conditions
/wound healing
A.THANGAMANI RAMALINGAM
PT, MSc(PSY),PGDRM, ACspss, MIAP

2. Wound
Wound
• Tissue damage
• Disruption of normal
continuity of structures.
• Loss of integrity
Wound healing
• Restoration of
integrity

3. Wound healing/stages
• Tissue repair : substitution of viable
cells for dead cells
• Regeneration : new cells and normal
function
• Replacement : new cells and loss some
function or scar
• Healing
- Primary intension
- Secondary intention
Inflammation
• It includes vascular response, a
hemostatis response, a cellular response
and an immune response.
Tissue repair/proliferation
• Here the epithelial and connective
tissue proliferation occurs
• Myofibroblasts move towards the center
of the wound
• Regeneration of new blood vessels
• Collagen synthesis
3. Remodeling/maturation (wound
contraction)
- Scar maturation
- Collagen turn over occurs
-Organisation of the fibers

4. stage of matrix formation and remodeling
From 9 days
stage of granulation tissue formation
3 to 20 days
stage of inflammation
1 to 10 days

5. inflammation
• (1) Hemodynamic
changes
• (2) Increased
capillary
permeability
• (3) Leukocytic
exudation

6. • Classical signs of
inflammation(Cornelius
Celsius) are: heat, redness,
swelling, pain, and loss of
function
• Lewis Triple response:
Flush: seen as a dull red line due to
vasodilatation.
Flare: an irregular red zone due to the
surrounding arterioles affected by both
nervous and chemical mediators.
Wheal : A raised area of skin due to
odema ( fluid passing out of blood
vessels into extravascular space)

7. Proliferation phase
• Migration of fibroblast &
endothelial cell
• Producing collagen & extra
cellular matrix(Collagen
synthesis)
• Capillary growth&
revascularization(angiogene
sis)
• Replacement with
granulation tissue
(fibroblast, collagen,
capillary)

8. Remodeling phase
• Collagen synthesis
and increase tensile
strength
• Organisation
• Mature scar avascular,
acellular(Scar
maturation)

9. WOUND INFECTION/SEPSIS
• Colonization
• Invasive wound sepsis
• Sepsis
Prevention by aseptic measures
• Local anti microbial therapy/systemic antibiotics/wound
debridement
• Early excision of necrotic tissues and skin grafting
• Treat septicemia

10. WOUND HEALING
• Stage of inflammation
• Stage of proliferation/tissue
repair
• Remodeling
Factors that influence
healing
• Nutrition - vitamin C
• Metabolic status – diabetes
hinders
• Circulatory status
• Hormones –
steroids/glucocorticoids
inhibit
• Infection
• Mechanical stress
• Foreign bodies
• Size, locations and type of
the wound

11. WOUND DEBRIDEMENT
• Mechanical- wet/dry
• Hydrotherapy- immersion/spray
• Enzymatic-sutilains
• Surgical-sequencial/fascial excision & escharotomies
Proteolysis-fibrinolysis-collagenolysis

12. WOUND DRESSINGS
• Biological dressings/skin graft
• Synthetic dressings
• Topical antimicrobials

13. Abnormal wound healing
• Pressure sore
• Diabetic ulcer
• Venous ulcer
• Arterial ulcer

14. Pressure sore

15. Grades of pressure sore
• Involves epidermis & dermis
• Heat, swelling,induration,and redness
• May be blister formation
• 10 – 14 days to heal.
Grade 1
• Involves epidermis, dermis and subcutaneous fat
• Irregular ulcer
• Redness, heat & swelling
• 3 weeks to 3 months to heal
Grade 2
• It involves epidermis, dermis, subcutaneous fat and adipose tissue and muscle
• With infection
• Loss of fluid and protein
• Joint involvement with stiffness & effusion
• Surgery indicated for healing
• Local bone inflammation
• Necrotic tissues seen in the site.
Grade3
• Soft tissue necrosis down to the bone and joint structures
• Osteomyelitis, septic arthritis,subluxation/discolation can occur
• Life threatening
Grade4

16. Scar
• Abnormal healing
• Increase collagen synthesis and matrix than normal

17. Burn Scars - Keloid

18. Burn Scars - Hypertrophic

19. HYPERTROPHIC SCAR
• Stay within and confine
of origin wound
• Above skin level 4 mm
• 4 week & regression
• Pain , itching , burning
sensation
KELOID
• Extend from origin
wound
• Occur 3 mo-1 yr
• No regression
• Black people
• Earlobe, presternal,
deltoid

20. Burn Scars - Contracture

21. Burn Scars - Contracture

22. Skin Graft Scars

23. SCAR MANAGEMENT
• Pressure therapy
• Silicone gel sheet
• Intra lesional injection
• Split skin graft
• Laser therapy
• Cryotherapy
• Radi0 therapy
• Combination therapy
• Elevation
• Itching
• Redness

24. CONTRACTURE MANAGEMENT
Types
• Intrinsic
• extrinsic
• Splintig/positioning
• Skin grafting(early)
• Plastic surgery
• physiotherapy

25. UV rays in wound healing
• UV irradiation is
divided into four
distinct spectral areas,
including vacuum-UV
(100–200 nm), UVC
(200–280 nm), UVB
(280–315 nm), and
UVA (315–400 nm)

26. • Basic science advances
• UV irradiation causes both beneficial and damaging effects, which depend on wavelength, exposure dose, and UV sources.
• The UVA, UVB, and UVC spectral bands differ in their biological effects and in their depth of penetration through the skin
layers.
• Short-term UVB exposure induces the production of vitamin D in the skin. UVA has distinct effects on cell signaling.
Judicious UV exposure might be beneficial for wound healing and skin homeostasis.
• Exposure to solar UV radiation is a major risk in the occurrence of nonmelanoma skin cancer. High doses of either UVC,
UVB, or UVA radiation are harmful to all living organisms in the following order: UVC>UVB>UVA.
• The mechanism of UVC inactivation of microorganisms is to damage the genetic material in the nucleus of the cell or nucleic
acids in the microbial cell.
• Clinical science advances
• The potential of UVC irradiation as an alternative approach for prophylaxis and treatment of localized infectious diseases has
been reported, especially those caused by multidrug resistance pathogens.
• With appropriate doses, UVC can selectively inactivate microorganisms, while preserving viability of mammalian cells and
promote wound healing.
• UVB has been directly applied to wounded tissue to stimulate wound healing, and irradiation of blood to stimulate the immune
system.
• Relevance to clinical care
• As striking increase in the average age of the population and the incidence of diabetes continues to rise, new and more
efficient strategies to manage chronic wounds are needed. Light-based technology is a set of growing minimally invasive
modalities in wound care.
• UV phototherapy has been associated with both beneficial and deleterious effects to patients with localized and systemic skin
disorders.
• UVC is less damaging to human tissue than UVB, which is an accepted option for a large number of cutaneous disorders in
humans with excellent safety profile. UVC irradiation offers fast and cost-effective antimicrobial therapy compared to
commonly used antibiotics.
• Under excessive repeated UVC irradiation, resistance of microorganisms to UVC inactivation may develop.
• UV should be used in a manner such that the side effects would be minimized, while the wound-healing process is augmented.
PMC
full
text:
Adv Wound Care (New Rochelle). 2013 Oct; 2(8): 422–437.
doi: 10.1089/wound.2012.0366

28. UV rays in skin conditions
• UVC Protocol for Treatment of
Infected Wounds (Bactericidal
Effect)
• UVB Protocol for Inducing an
Inflammatory Reaction in Chronic
Wounds
• UVB Protocol for Stimulating
Growth of Granulation Tissue
• UVB Protocol to Promote
Breakdown and Elimination of
Necrotic Tissue
• WOUND HEALING:
Alternatives in
Management
Third Edition
• Luther C. Kloth, MS,
PT, CWS, FAPTA
Professor
Physical Therapy Department
Marquette University
Milwaukee, WI
• Joseph M. McCulloch,
PhD, PT, CWS
Executive Associate Dean and
Professor, Physical Therapy
School of Allied Health
Professions
Louisiana State University
Health Sciences Center
Shreveport, LA

29. Wound measurement
• Simple measurement
• Wound tracing
• Photography
• Stereophotogrammetry(
3 dimentional /volume)
• Computerised/digital
image analysis