This document provides a summary of wounds and wound healing. It begins with definitions of wounds and various classification systems for wounds based on factors like cleanliness, thickness, involvement of structures, time elapsed, and surgical context. It then discusses the stages and phases of wound healing, including inflammation, proliferation, remodeling and epithelialization. Various factors that can affect wound healing are outlined. Finally, it covers wound management principles and common problems like infection, dehiscence, hypertrophic scarring and keloids.
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
NECROTISING FASCIITIS- the flesh eating infection
#surgicaleducator #necrotisingfasciitis #surgicaltutor #babysurgeon #usmle
· Dear Viewers
· Greetings from “Surgical Educator”
· Today in this episode I have discussed about Necrotising Fasciitis- the flesh eating infection
· It is common in immunocompromised patients even after trivial trauma.
· I have discussed about the overview,etiology,types,clinical features,complications and treatment of Necrotising Fasciitis
· I hope this video is interesting and also useful to all of you
· You can watch the video in the following links:
· surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Thank you for watching the video
Surgical hemostasis is one of the pillars of modern surgery. Adequate hemostasis in a surgical patient involves a detailed perioperative clinical evaluation and investigation, and various intra operative techniques and options. Ensuring adequate surgical hemostasis reduces morbidity and mortality by modulating the metabolic response to trauma, decreasing the incidence of post operative anemia, reduces rates of surgical site infection and ultimately improving wound healing
NECROTISING FASCIITIS- the flesh eating infection
#surgicaleducator #necrotisingfasciitis #surgicaltutor #babysurgeon #usmle
· Dear Viewers
· Greetings from “Surgical Educator”
· Today in this episode I have discussed about Necrotising Fasciitis- the flesh eating infection
· It is common in immunocompromised patients even after trivial trauma.
· I have discussed about the overview,etiology,types,clinical features,complications and treatment of Necrotising Fasciitis
· I hope this video is interesting and also useful to all of you
· You can watch the video in the following links:
· surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Thank you for watching the video
Surgical hemostasis is one of the pillars of modern surgery. Adequate hemostasis in a surgical patient involves a detailed perioperative clinical evaluation and investigation, and various intra operative techniques and options. Ensuring adequate surgical hemostasis reduces morbidity and mortality by modulating the metabolic response to trauma, decreasing the incidence of post operative anemia, reduces rates of surgical site infection and ultimately improving wound healing
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. WOUND : DEFINITION
• A wound is a break in the integrity of the skin or tissues often, which may be
associated with disruption of the structure and function
4. I. RANK AND WAKEFIELD CLASSIFICATION
• a. Tidy wounds
• ► They are wounds like surgical incisions and wounds caused by sharp objects.
• ► It is incised, clean, healthy wound , without any tissue loss.
• ► Usually primary suturing is done. Healing is by primary intention.
5.
6. b. Untidy wounds
They are due to:
- Crushing.
- Tearing.
- Avulsion.
- Devitalised injury.
- Vascular injury.
- Multiple irregular wounds.
- Burns.
7. • Fracture of the underlying bone may be present.
• Wound infection, delayed healing are common.
• Liberal excision of devitalised tissue and allowing to heal by secondary intention is
the management.
• Secondary suturing, skin graft or flap may be needed.
10. • ♦ Superficial wound : involving only epidermis and dermal papillae.
• ♦ Partial thickness wound with skin loss up to deep dermis with only deepest
part of the dermis, hair follicle shafts and sweat glands are left behind.
• ♦ Full thickness wound with loss of entire skin and subcutaneous tissue
causing spacing out of the skin edges.
11. • ♦ Deep wounds are the one extending deeper, across deep fascia into
muscles or deeper structures.
• ♦ Complicated wounds are one associated with injury to vessels or nerves.
• ♦ Penetrating wounds are one which penetrates into either natural cavities
or organs.
12. CLASSIFICATION BASED ON INVOLVEMENT OF
STRUCTURES
• ♦ Simple wounds are one involving only one organ or tissue.
• ♦ Combined wounds are one involving mixed tissues.
13. V. CLASSIFICATION BASED ON THE TIME ELAPSED
• ♦ Acute wound is up to 8 hours of trauma.
• ♦ Chronic wound is after 8 hours of trauma.
14. CLASSIFICATION OF SURGICAL WOUNDS
• a. Clean wound
• ► Herniorrhaphy.
• ► Excisions.
• ► Surgeries of the brain, joints, heart, transplant.
• ► Infective rate is less than 2%.
15.
16. • b. Clean contaminated wound
► Appendicectomy.
► Bowel surgeries.
► Gallbladder, biliary and pancreatic surgeries.
► Infective rate is 10%.
17.
18. • c. Contaminated wound
• ► Acute abdominal conditions.
• ► Open fresh accidental wounds.
• ► Infective rate is 15-30%.
25. PRIMARY HEALING (FIRST INTENTION)
• ♦ It occurs in a clean incised wound or surgical wound.
• Wound edges are approximated with sutures.
• There is more epithelial regeneration than fibrosis.
• Wound heals rapidly with complete closure.
• Scar will be linear and smooth.
27. SECONDARY HEALING (SECOND INTENTION)
• ♦ It occurs in a wound with extensive soft tissue loss like in
• major trauma, burns and wound with sepsis.
• It heals slowly with fibrosis.
• It leads into a wide scar, often hypertrophied and contracted.
• It may lead into disability.
• Re-epithelialisation occurs from remaining dermal elements or wound
margins
29. HEALING BY THIRD INTENTION (TERTIARY WOUND HEALING
OR DELAYED PRIMARY CLOSURE)
• After wound debridement and control of local infection, wound is closed with
sutures or covered using skin graft.
• Primary contaminated or mixed tissue wounds heal by tertiary intention.
31. • ♦ Stage of inflammation.
• ♦ Stage of granulation tissue formation and organisation. Here due to
fibroblastic activity synthesisation of collagen and ground substance occurs.
• ♦ Stage of epithelialisation.
• ♦ Stage of scar formation and resorption.
• ♦ Stage of maturation.
33. INFLAMMATORY PHASE (LAG OR SUBSTRATE OR
EXUDATIVE PHASE)
• It begins immediately after wound healing. It lasts for 4-6 days.
• Features of inflammation are rubor, calor, tumour, dolor and loss of function.
• Macrophages secrete fibroblastic growth factor which enhances
angiogenesis.
34. CONTINUE
• ♦ Polymorphonuclear leukocytes (PMN leukocytes) appear after 48 hours
which secrete inflammatory mediators and bactericidal oxygen derived free
radicals.
• ♦ These cells also remove clots, foreign bodies and bacteria.
36. • Here haemostasis, coagulation and chemotaxis occurs.
• Coagulation begins in wound haematoma —> formation of platelet fibrin
thrombus —> release of cytokines, PDGF (platelet derived growth factor),
transforming growth factor p (TGF-P), platelet activating factor , fibrin ,
serotonin.
37. CONTINUE
• Chemotaxis causes neutrophil migration first, and then activation of
macrophages, lymphocytes , leading into phagocytosis, wound debridement,
matrix activation,angiogenesis.
38. • Chemotaxis factors are complement factors, interleukin- 1, TNF-alpha (tumour
necrosis factor-a) TGF-beta and platelet factor
• Activated macrophages produce free radicals and nitric oxide; release
cytokine to activate lymphocytes which release interferon and interleukin
(called as lymphokines). These actions are reduced in diabetes mellitus,
Cushing’s syndrome and immunosuppression increasing the rate of sepsis.
39. PROLIFERATIVE PHASE (COLLAGEN/FIBROBLASTIC
PHASE)
• ♦ It begins in 7 days and lasts for 6 weeks
• ♦ Collagen and glycosamines are produced by fibroblasts
• ♦ Hydroxyproline and hydroxylysine are synthesised by specific enzymes using
iron, alpha ketoglutarate and vitamin C.
• ♦ Tropocollagen is produced which aggregates to form collagen fibrils.
• ♦ 80-90% of their final strength (in postoperative wounds) is achieved in 30
days.
40. REMODELLING PHASE (MATURATION PHASE)
• ♦ It begins at 6 weeks and lasts for 2 years.
• ♦ There is maturation of collagen by cross-linking which is responsible for
tensile strength of the scar.
• ♦ Collagen production is not present after 42 days of wound healing.
41. • Initially fibrin, fibronectin, proteoglycan deposition occurs; later collagen
protein develops to form scar.
• Normal dermal skin contains 80% type I (20% type III) collagen; granulation
tissue contains mainly type III collagen; scar contains both type I and III
collagen equally
43. LOCAL FACTORS
• Infection
• Presence of necrotic tissue and foreign body ,
• Poor blood supply
• Venous or lymph stasis
• Tissue tension
• Haematoma
• Large defect or poor apposition
• Recurrent trauma
• X-ray irradiated area
44. • Site of wound, e.g. wound over the joints and back has poor healing
• Underlying diseases like osteomyelitis and malignancy
• Mechanism and type of wound — incised/lacerated/crush/ avulsion
• Tissue hypoxia locally reduces macrophage and fibroblast activity
46. • Jaundice
• Diabetes, metabolic diseases
• HIV and immunosuppressive diseases
• Steroids and cytotoxic drugs
• Neuropathies of different causes
47. MANAGEMENT OF WOUNDS
• a. Wound is inspected and classified as per the type of wounds.
• b. If it is in the vital area, then:
• ► The airway should be maintained.
• ► The bleeding, if present, should be controlled.
• ► Intravenous fluids are started.
• ► Oxygen, if required, may be given.
• ► Deeper communicating injuries and fractures, etc. should be looked for.
48. • c. If it is an incised wound then primary suturing is done after thorough
cleaning.
• d. If it is a lacerated wound then the wound is excised and primary suturing is
done.
49. • e. If it is a crushed or devitalised wound there will be oedema and tension in
the wound. So after wound debridement or wound excision by excising all
devitalised tissue, the oedema is allowed to subside for 2-6 days. Then
delayed primary suturing is done.
50. • f. If it is a deep devitalised wound , after wound debridement it is allowed to
granulate completely. Later , if the wound is small secondary suturing is done.
If the wound is large a split skin graft (Thiersch graft) is used to cover the
defect.
• g. In a wound with tension, fasciotomy is done so as to prevent the
development of compartment syndrome
51. • h. Vascular or nerve injuries are dealt with accordingly.
• Vessels are sutured with 6-zero polypropylene nonabsorbable suture
material.
• If the nerves are having clean cut wounds it can be sutured primarily with
polypropylene 6-zero or 7-zero suture material.
52. • i. Internal injuries (intracranial by craniotomy, intrathoracic by intercostal tube
drainage, intra-abdominal by laparotomy) has to be dealt with accordingly.
• Fractured bone is also identified and properly dealt with.
53. • j . Antibiotics, fluid and electrolyte balance, blood transfusion, tetanus toxoid
(0.5 ml intramuscular to deltoid muscle), or antitetanus globulin (ATG)
injection.
54. PRINCIPLES OF WOUND SUTURING
• ❖ Primary suturing should not be done if there is oedema/
infection/devitalised tissues/haematoma
• ❖ Always associated injuries to deeper structures like vessels/ nerves or
tendons should be looked for before closure of the wound
• ❖ Wound should be widened by extending the incision whenever needed to
have proper evaluation of the deeper structures
55. • ❖ Proper cleaning, asepsis, wound excision/debridement
• ❖ Any foreign body in the wound should be removed
• ❖ Skin closure if it is possible without tension
• ❖ Skin cover by graft/flap — immediate or delayed
• ❖ Untidy wound should be made tidy and clean before suturing
56. • ❖ Proper aseptic precautions should be undertaken
• ❖ Antibiotics/analgesics are needed
• ❖ Sutured wound should be inspected in 48 hours
• ❖ Sutures are removed after 7 days
57. PROBLEMS WITH WOUND HEALING
• ♦ Wound infection is common in devitalized deep difficult wounds.
• Diabetes, immunosuppression, cytotoxic drugs, anaemia, malnutrition,
malignancy increases the chances of wound infection.
58. • ♦ Wound dehiscence is common in all above said adverse factors.
• Wound suddenly gives away with pain causing copious serosanguineous
discharge
• It needs emergency closure of the abdominal wound using specialized
sutures or retention sutures.
59. • ♦ Deeper wound will cause specified problems like paraesthesia, ischaemia,
paralysis, etc.
61. HYPERTROPHIC SCARS
• ♦ Occurs anywhere in the body.
• ♦ Not genetically predisposed. Not familial.
• ♦ Growth usually limits up to 6 months.
• ♦ It is limited to the scar tissue only. It will not extend to normal skin.
62. • ♦ It is pale brown in colour, not painful, nontender.
• ♦ Often self-limiting also. It responds very well for steroid injection.
• ♦ Recurrence is uncommon.
• ♦ It is common in wounds crossing tension lines, deep dermal burns, wounds
healed by secondary intention
63. • Complications :
• ♦ Often this scar breaks repeatedly and causes infection, pain.
• ♦ After repeated breakdown it may turn into Marjolin’s ulcer.
64. • Treatment :
• It is controlled by pressure garments or often revision excision of scar and
closure, if required with skin graft.
66. KELOIDS
♦ Keloid is common in blacks. Common in females.
♦ Genetically predisposed. Often familial. Very rare in Cauca-
sians.
♦ There is defect in maturation and stabilization of collagen
fibrils. Normal collagen bundles are absent
67. • Keloid continues to grow even after 6 months, may be for many years.
• It extends into adjacent normal skin.
• It is brownish black/ pinkish black (due to vascularity) in colour, painful,
tender and sometimes hyperaesthetic; spreads and causes itching.
• Keloid may be associated with Ehlers-Danlos syndrome or scleroderma.
68. • ♦ When keloid occurs following an unnoticed trauma without scar formation
is called as spontaneous keloid , commonly seen in Negroes.
• ♦ Some keloids occasionally become nonprogressive after initial growth.
• ♦ Pathologically keloid contains proliferating immature fibroblasts,
proliferating immature blood vessels and type III thick collagen stroma
69. • Treatment :
• a. Steroid injection — intrakeloidal triamcinolone , is injected at regular
intervals, may be once in 7-10 days, of 6-8 injections.
• b. Steroid injection — excision — steroid injection.
• c. Methotrexate and vitamin A therapy into the keloid.
70. • d. Silicone gel sheeting; topical retinoids.
• e. Laser therapy.
• f. Vitamin E/palm oil massage.
• g. Intralesional excision retaining the scar margin may prevent recurrence. It is
ideal and better than just excision.
• h. Excision and irradiation or irradiation alone.
• i. Excision and skin grafting may be done.