This document summarizes wound healing and its complications. It describes three types of wound healing: primary, secondary, and tertiary intention. The components and stages of wound healing are outlined. Factors that affect wound healing, such as age, nutrition, cortisone, and infection are discussed. Complications of wound healing include dehiscence, disfigurement, contracture, hypertrophic and keloid scarring, and infection. The document provides an overview of the wound healing process and potential problems that can arise.

1. Wound Healing
Prepared by: Dr. Dounia Maamar Kebbab

2. Types of wound healing :
 Healing by primary intention
 Healing by secondary intention
 Healing by tertiary intention

5. DEBRIDMENT.

6. Components of wound healing :
1. Wound contraction: the centripetal or concentric reduction in size of
an open wound, is essential to second-intention healing. Caused by
movement of fibroblasts in granulation tissue collagen and pulling forces
of granulation tissue myofibroblasts on the skin edges.
2. Granulation tissue formation: new connective tissue and
microscopic blood vessels that form on the surfaces of a wound during
the healing process. Granulation tissue typically grows from the base of a
wound and is able to fill wounds of almost any size.
3. Epithelialization: the process by which the skin and mucous
membranes replace superficial epithelial cells damaged or lost in a
wound.

7. Stages of wound healing :
1. Inflammatory phase
0 – 4 days
2. Proliferation phase
4 – 21 days
3. Remodeling phase
21 – 360 days

9. Wound strength :
Inflammatory + proliferative phase  little strength.
During remodeling:
6 weeks  50 % of the final strength.
6 - 12 months  maximum strength ( 75% of the preinjury).

10. Factors affecting wound healing :
General factors:
1.Age:  protein
2.Nutrition:
vit A deficiency ---->  epithelialization
Vit c deficiency ---->  protocollagen maturity
Protein deficiency ---->  collagen synthesis
3.Cortisone
4.Irradiation
5.Chronic disease

11. Local factors:
1.Poor vascularity
2.Tension
3.Foreign body + necrotic tissue
4.Infection
5.Immobilization
6.Adhesion to bone surface
Factors affecting wound healing :

12. Complications of wound healing :
1/Wound failure ----> dehiscence

13. 2/Stretching of the scar ----> disfigurement
Complications of wound healing:

14. 3/Contracture scar
Complications of wound healing

15. 4/Post-operative wound infection
Complications of wound healing

16. 5/Hypertrophic scar 6/Keloid scar
Red thickened
raised scar
Confined to wound edge Extends beyond the original
wound into normal tissue
Related to Wound tension
Prolonged inflammatory phase
Dark skin ++
Familial tendency
Occurs Sooner after injury Months after injury
Regression Spontaneous regression over years No regression
Common in Pre-sternal areas
Over shoulder
Ear lobules
Pre-sternal areas
Over shoulder
TTT Difficult, high rate of recurrence
1/ intra lesion steroid inj
2/ post-excision irradiation to 
recurrence

20. Complications of wound healing

21. General:
1. Shock.
2. Crush sd: traumatic rhabdomyolysis or Bywaters' syndrome major
shock and kidney failure after a crushing injury to skeletal muscle.
Local:
1. Infection ( pyogenetic + specific e.g: tetanus, gas
gangrene).
2. Injury of important structures, Vx, nerves, viscus.
3. Gangrene (infection + vascular).
4. Cpc of wound healing.
COMPLICATIONS OF WOUND: