This document discusses wound healing and provides information on various topics related to wound management. It begins with introducing wounds and the stages of wound healing. It then covers skin anatomy, functions of skin, and the different types of wounds. The document discusses wound healing through primary and secondary intention. It also addresses factors that can interfere with or impede wound healing such as infection, diabetes, obesity, and psychological stress. The document provides guidance on assessing wounds and managing acute wounds. It concludes by covering complications of wound healing.

1. WOUND HEALING
Dr Safika Zaman
Dept of ENT & HNS
RKMSP,VIMS

2. INTRODUCTION
• Wound: break in the integrity of the skin epithelium, often accompanied by
concurrent disruption of the underlying dermis.
• Whether small or large, acute or chronic, all wounds heal by a complex, dynamic,
highly orchestrated biological process.

3. CONT..
• A wound is ‘healed’ when:
• - connective tissue repair and complete re-epithelialization have occurred.
• - skin cover has been resorted with scar tissue without the necessity of drains or
dressings.

4. SKIN ANATOMY

5. FUNCTIONS OF SKIN

6. STAGES OF WOUND HEALING
Wound healing - A literature review*Ana Cristina de Oliveira
Gonzalez,1 Tila Fortuna Costa,2 Zilton de Araújo Andrade,1
and Alen Ribeiro Alves Peixoto Medrado2

9. RE-EPITHELIALIZATION
• Replication and movement of the epidermal cells from the wound edges in order to
reconstitute an organized, keratinized, stratified squamous epithelium.
• Initially, migration of epidermal cells creates a delicate covering over the raw area(epiboly).
• This process of migration is dependent on the oxygen tension present in the wound and is
most rapid in hyperbaric conditions.
• ‘Contact inhibition’ prevents movement when epithelial sheets meet.

12. Scott Brown`s text book of ENT – 8TH Edition

13. Scott Brown`s text book of ENT – 8TH Edition

14. TYPES OF WOUND

15. TYPES OF WOUND
https://epomedici
ne.com/medical-
students/wound-
its-types/

16. WOUND HEALING- PRIMARY INTENTION
 Closure of a wound within 12–24
hours of its formation.
 wounds are clean and well
perfused.
 Apposition of wound edges
reduces the distance for
epidermal proliferation.

17. PRINCIPLES OF WOUND SUTURING

18. WOUND HEALING – SECONDARY INTENTION
Healing by secondary intention usually occurs in large
wounds where it is not possible to appose the edges or in
wounds that are complicated by infection.
Sealing of the epithelium across the wound bed does not
occur rapidly.
Epithelial cells must grow both downwards and across the
wound bed, with granulation tissue filling the defect

19. THIRD INTENSION
Process mainly occurs in contaminated
wounds.
The wound edges are usually approximated
after
3–4 days.

20. BONE HEALING

21. TISSUE HEALING TIME

22. CHRONIC WOUND
If a wound does not follow the normal trajectory then it may become stuck in 1 of the
4 phases, becoming chronic.
“wound failed to proceed through an orderly and timely process to produce anatomic
and functional integrity, or proceeded through the repair process without establishing
a sustained anatomic and functional result.”

23. POOR HEALING OF WOUND

24. WOUND HEALING APPROACH
1. What are the causes of abnormal wound healing?
2. Which local and systemic factors impede wound healing?
3. How do we assess wounds?
4. How do we manage wounds?

25. ASSESSMENT OF A WOUND
• Size of the wound
• Location of the wound
• Wound edges
• Floor of the wound

26. WOUND INFECTION
• Pyrexia
• Pus
• Erythema (particularly when spreading)
• Malodour
• Wound dehiscence
• Poor healing
• Increased pain
• Sinus formation

27. BIOFILMS
• Collection of bacteria, fungi, and/or other microorganisms that can adapt,
communicate, and spread.
• Bacterial biofilms form when planktonik or free-floating bacteria attach to a suitable
surface and begin producing an extracellular polymeric substance (EPS) consisting of
sugars, proteins and nucleic acids.

29. FACTORS INTERFERE WOUND HEALING

30. EFFECT OF PSYCHOLOGICAL STRESS
ON WOUND HEALING
Factors Affecting Wound Healing
S. Guo and L.A. DiPietro*

31. EFFFECT OF DIABETES ON WOUND
HEALING
Factors Affecting Wound Healing
S. Guo and L.A. di pietro

32. OBESITY IN WOUND HEALING
Factors Affecting Wound Healing
S. Guo and L.A. DiPietro

33. FACTORS INFLUENCING HEALING OF
A SURGICAL WOUND
• Presence of an existing chronic infection
• Time interval between skin preparation and surgery.
• Nature of the invasive procedure – especially if involving the bowel
• Extent of tissue loss and/or trauma to tissues during surgery
• Poor application of the principles of asepsis at the time of wound dressing changes
• Presence of devitalized tissue within the wound – necrotic tissue or slough, if over
50%
• Nature and prolonged presence of exudate not managed by a closed drainage
system.

34. MANAGING ACUTE WOUND
Baily & Love short practice of surgery- 27th edition

35. WOUND DRESSING
• Produce rapid and cosmetically acceptable healing
• Reduce pain
• Remove odour
• Treat or prevent infection
• Cover a cosmetically unpleasant wound

36. APPROPRIATE DRESSING MATERIAL
• wound-related factors:
- size
- depth
-amount and characteristics of exudate
- necrotic/viable
- surrounding tissue appearance (pigmented, scarred or cellulitic)
• product factors
• patient factors.

37. Fonlinelibrary.wiley.com%2Fdoi%2Ffull%2F10.1002%2F

38. TIME CONCEPT FOR WOUND BED

40. BASIC WOUND DRESSING

42. EFFECT OF RADIATION TO TISSUE
• The acute effects are usually manifested in tissues which are rapidly proliferating
such as mucosa and epithelium and this leads to painful ulcers, mucositis and
desquamation.
• The chronic problems like tissue fibrosis and degeneration can manifest even years
after treatment.

43. RADIATION RELATED TISSUE INJURY
• Affected factors include - TGFβ,VEGF, TNF-α, and proinflammatory cytokines such as
interleukin-1 and interleukin-8.
• These cytokines are overexpressed after the radiation injury leading to uncontrolled
matrix accumulation and fibrosis.
• MMP-1 is decreased after radiation therapy, which may contribute to inadequate
soft tissue reconstitution
• Nitric oxide (NO) promotes wound healing by an induction of collagen deposition.
NO levels are decreased.

44. CURRENT EXPERIMENTAL STRATEGIES IN THE
TREATMENT OF IRRADIATED WOUNDS
Wound healing after radiation therapy: Review of the literature
Frank Haubner, Elisabeth Ohmann, Fabian Pohl, Jürgen Strutz & Holger G Gassner

45. COMPLICATION OF WOUND HEALING
• Infection,tissue necrosis and gangrene,
• Periwound dermatitis
• Periwound edema
• Osteomyelitis
• Hematomas
• Dehiscence
• Hypertrophic scar
• Keloid
• Wound contracture

46. NECROTISING INFECTIONS
Baily & Love short practice of surgery- 27th edition

48. Thank you