Wound healing afmc
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1. The document discusses wound classification, the phases of wound healing, and factors that affect wound healing. 2. The four main phases of wound healing discussed are hemostasis, inflammation, proliferation, and remodeling. 3. Proper wound management aims to support the natural healing process and create optimal conditions for healing through actions like controlling infection, managing moisture balance, and promoting tissue growth.
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Wound healing afmc
- 1. WOUND HEALING DR VIPIN V NAIR
- 2. PREVIEW • Wound definition and classification • Principles of wound healing • Phases of wound healing • Factors affecting • Complications • Newer Horizons
- 3. Understanding how the body repairs damaged tissue and what factors influence the wound healing process helps us to aid better scarless wound healing
- 5. FUNCTION •Protection • Sensation • Temperature regulation • Metabolism - Vit D • Psychosocial communication
- 6. WOUND
- 7. ULCER • Break in continuity of covering epithelium- skin, mucous membrane. Molecular death of epithelium or its traumatic removal • Ulcer is a type of wound.
- 12. Rank and Wakefield classification Tidy Incised Clean Healthy tissue Seldom Tissue Loss Untidy Crush or avulsed Contaminated Devitalized tissue Often tissue loss
- 13. Untidy Tidy AIM
- 14. Based on Type
- 23. WOUND CLEAN DIRTY DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND CLEAN CONTAMINATED CONTAMINATED
- 24. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 25. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 26. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 27. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 28. Surgical wound
- 29. Wound healing
- 32. Phases of Wound healing
- 33. Classification of wound closure and healing
- 36. Phases of wound healing
- 38. •Limit blood loss •Debridement •Sealing the wound
- 40. • Vessel damage ---- bleeding---- platelet plug — fibrin frame work deposition Haemostasis (Activated by intrinsic & extrinsic pathways)
- 42. PMNs •Peak at 24-48 hrs •Phagocytosis of bacteria &tissue debris • Major source of cytokines
- 43. T lymphocytes •1 week •Bridges from inflammatory to proliferative phase
- 44. Macrophages •By 48-96 hrs upto complete healing •Phagocytosis • Activation and recruitment of other cells
- 47. Fibroblastic activity • Collagen • Proteoglycans • Glycosaminoglyc ans
- 48. Day 3 – week 3
- 49. Angiogenesis
- 50. Deposition of type III collagen in Random fashion
- 52. Maturation and Re-modelling Aim •Wound shrinkage •Strength •Scar contraction
- 53. •Maturation of collagen •Type I replacing Type III, ratio 4:1 Realignment of collagen fibers along the lines of tension
- 56. INFECTION
- 59. POOR BLOOD SUPPLY •Wound healing is a highly energy dependant process •Initial response neovascularization •Persistent ischemia results in apoptosis
- 61. WOUND TENSION
- 62. FOREIGN BODIES • Acts a physical barrier • Asylum for bacteria • Inability to contract • Prevent epithelization
- 64. POOR TECHNIQUE • Placement of Incision • Flap design • Proper extension to prevent retraction pressure • Careful haemostasis • Proper selection of suture materials • Proper suturing technique
- 66. NUTRITONAL DEFICIENCIES Vit A: involved in epithelisation and collagen production Vit C: production and modification of collagen Zinc: enzyme co-factor, role in cell proliferation Protein: impaired immune and inflammatory responce
- 67. HEALING SLOWS DOWN WITH AGING
- 69. STEROIDS • Lysosomal stabalization--- impaired phagocytosis • Impairment of chemotaxis of microphages • Fibroblast genome inhibition--- decreased collagen, decreased strength and increased dehiscence
- 70. SMOKING Vasoconstriction Which is not transient— 1 cigarette for 90 min 1 pack for whole day
- 71. Systemic factors
- 72. Abnormal Healing
- 73. Skin - mutilating or debilitating scars, burn contraction
- 74. GI tract - Strictures or Stenoses
- 76. Solid organs - Cirrhosis, Pulmonary fibrosis
- 78. History of wound healing
- 79. Some historical perspectives of wound management
- 81. THE CHANGING TRENDS..... A Paradigm Shift Active Passive
- 82. THE TWO MAIN AIMS • Taking care of the systemic deterrents • Provide and promote the loco regional factors
- 83. • THE SYSTEMIC • THE LOCAL –Promote the autolytic enviroment –Counteract Infection –Promote GFs
- 84. General principles of wound management Goal – To aid the natural body process. – Create optimal conditions for the patient to heal themselves painlessly and quickly. – To produce optimal functional and cosmetic end result. 84
- 85. Achieved by – Minimize infections and complications. – Provide and promote the loco- regional factors. – Promote the autolytic environment. – Promote granulation. – Preserve function.
- 86. •THE PATIENT •THE WOUND •THE PLAN
- 87. 1. THE PATIENT • The whole patient not just the hole.
- 90. 2. THE WOUND Initial assessment, monitoring the healing and elements of wound documentation
- 91. Meticulous examination of the wound • The depth and configuration of the wound. • The extent of nonviable tissue. • The presence of foreign bodies and other contaminants. • Neurovascular examination • Radiography detail
- 96. Visitrak Grid
- 100. Lab test
- 101. Nutritional status-Albumin, prealbumin and transferrin
- 102. Level of physiological inflammation-CRP,ESR
- 103. Degree of diabetes control-Plasma glucose, HbA1c
- 104. Hematology
- 105. Biochemistry
- 106. Others-tcPo2, Toe Pressure, ABPI
- 107. 3) THE PLAN-WCP A •Acute B •Chronic C •Problem
- 108. A)Management of acute wounds • Antibiotics • Primary, secondary and the delayed primary. • Sutures, staples ,tissue adhesives or adhesive tapes
- 109. B)Management of chronic wounds
- 110. WOUNDBED PREPARATION-WBP Debridement Exudate management Bacterial imbalance resolution Undermined epidermal margin
- 111. THE FRAMEWORK CALLED TIME • T tissue management • I inflammation & infection control • M moisture balance • E epithelial edge &extras!
- 113. T-TISSUE MANAGEMENT • The wound continuum • Assessment for nonviable tissue. • Wound debridement is the principal intervention
- 118. Every rule has an exception..
- 119. Assess and Investigate • Five cardinal signs of infection:R.C.T.D.F • Decline in wound status • Silent infections- abscess • Biofilms • Three types of Investigations – Deep tissue biopsy – During surgery(Bowler et al 2001). – Wound Fluid Sampling Aspiration using aseptic technique from deep – Wound Swabs and cultures
- 120. I-INTERVENTION • Role of antibiotics - Topical vs Systemic • Debridement • Medicated dressings
- 121. M-MOIST WOUND HEALING • The Exudate continuum • Dressings and other wound care products
- 123. Debridement • Single most important wound care tool • Reduce bioburden and promote wound healing
- 124. Without debridement ,wound persistently exposed to cytotoxic stressors and competes with bacteria for O2 and nutrition.
- 130. NPWT Mechanisms • Reduction of edema • Removal of wound fluid rich in deleterious enzymes • Mechano-transduction – Increased growth factor release – Matrix production – Cellular proliferation. – Microstrain and macrostrain
- 131. Clinical benefits – Decrease wound size – Accelerated wound bed preparation – Accelerated wound healing – Improved graft take
- 132. Hyperbaric oxygen O2 as a drug and hyperbaric chamber as delivery system
- 133. Inhalation of 100% O2 ,Increase tissue Po2 10 times higher Delivered at 1.9 to 2.5 atm for session of 90- 120 mins. Once daily, 5 to 6 times a week Stimulate angiogenesis Enhance fibroblast and leukocyte function
- 134. Growth Factors
- 137. DRESSINGS • Dry dressings • Wet to dry dressings • Polyurethane film dressing - breathable and nonbreathable • Vasline tules • Antibiotic impregnated tules INACTIVE • Hydrogels –fibre and foams • Hydrocellular dressings • Foams • Alginates • Crystaline silver and slow iodine releasing materials ACTIVE
- 138. DRESSINGS PASSIVE • HYDROGELS –FIBRE AND FOAMS • HYDROCOLLOID • HYDROFIBRES • ALGINATES • SEMIPERMEABLE FILMS INTERACTIVE • HYDROCOLLOIDS • FOAMS • FILMS OCCLUSIVE
- 139. DRESSING CHOICE ADD OR MAINTAIN DAMP GAUZE GELS RETAIN TRANSPARENT FILMS NON ADHESIVE GAUZE ABSORB FILLER COVER
- 140. Surgical Dressings- 07 classes Films Composites Hydrogels Alginates Hydrocolloid Foams Absorptive dressings
- 141. Passive dressings
- 142. Film dressings
- 143. Composite dressings
- 145. Hydrogel dressings
- 146. Alginate dressings
- 147. Foam dressings
- 148. Absorptive dressings
- 153. E- EDGE , EPITHELIAL ADVANCEMENT,EXTRAS! •Signs of edge advancement •Cleansing Agents
- 155. Basic elements in a chronic wound care plan- Summary Cleanse Debris from the Wound Possible Debridement Manage Exudate Promote Granulation and Epithelialization When Appropriate Possibly Treat Infections Minimize Discomfort
- 156. Empower the patient and responsible family member Teach the correct way to dressing Irrigation Compression
- 157. Problem wounds
- 158. The Problem wound
- 159. Wounds in patient on steroids Prone to infections decreased rate of angiogenesis collagen deposition and cellular proliferation
- 160. • Vit A as useful adjunct • Dose-25,000 IU daily orally • 2 Lakh IU topically 3 times a day
- 161. Wounds in patient with irradiation Progressive endarteritis and microvascular damage Aggressive debridement results in large non healing ulcers hence should be conservative Often need flap cover
- 162. The pressure sore wound Often debilitated patients Pressure offloading Nutrition building Surgical debridement Often require flap cover Consider administration of growth hormones and anabolic steroids like oxandrolene Recurrence is a rule after successful treatment
- 163. Wounds in patient with Diabetes Functional microangiopathy and neuropathic derangements. Debridement Blood sugar control Pressure offloading Growth factors
- 164. New Horizon
- 165. Electrostimulation Electrical current applied to wounds – Increases migration of cells – 109% increase in collagen – 40% increase in tensile strength – 1 to 50 mA direct or pulsed based on wound
- 166. Hyperbaric Oxygen • Developed 1662 by Henshaw • Atmospheric pressure at sea level = 1 ATA = 1.5ml O2/dL • Normal Tissue O2 tension is 40-50 mmHg. • O2 tension < 40 mmHg = chronic wound
- 168. Honeysoft • Natural dressing • Honey-impregnated dressing Chronic unhealing wounds. • Impregnated into a compress of EVA (ethylenevinylacetate) mesh
- 169. "MAX8," • A novel hydrogel, to seal wounds and at the same time deliver an antibacterial punch.
- 171. Pressure garments
- 172. Silicon gel sheet
- 173. Other ointments
- 175. Stem cell therapy
- 177. Gene therapy
- 181. God heals and , the doctor takes the fees Benjamin Franklin Thanks