This document discusses wound healing and wound care. It covers the basic principles of wound healing including regeneration and repair. It describes the different types of tissues based on their regenerative capacity (labile, stable, permanent) and how each type heals. Factors that can influence and delay wound healing are discussed. The document also covers chronic wounds, excessive scarring, wound dressings and their purposes in wound management and care.
Definition
Wound healing
Chronic Ulcers
Causes for Non-healing Ulcers
Management of Chronic Ulcers
Role of Antibiotics /Antiseptics
Wound dressings
Ideal wound dressing
Types of Wound Dressings
When to change dressings
Things to avoid in chronic wounds
This topic is mainly for MBBS Studnts. It is under the General Principles of Surgery. Students shoud know the phases of wound healing so as to treat them appropriately and select the correct method of dressing material....
Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue. In undamaged skin, the epidermis and dermis form a protective barrier against the external environment
Definition
Wound healing
Chronic Ulcers
Causes for Non-healing Ulcers
Management of Chronic Ulcers
Role of Antibiotics /Antiseptics
Wound dressings
Ideal wound dressing
Types of Wound Dressings
When to change dressings
Things to avoid in chronic wounds
This topic is mainly for MBBS Studnts. It is under the General Principles of Surgery. Students shoud know the phases of wound healing so as to treat them appropriately and select the correct method of dressing material....
Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue. In undamaged skin, the epidermis and dermis form a protective barrier against the external environment
Introduction
Definition
Healing of skin wounds
Healing in bone
Healing of nervous tissue
Factors influencing healing
Complications of wound healing
Conclusion
References
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
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.
- 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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
wound healing and wound care.pptx
1. Wound healing and wound care
Dr Thana Ram Patel
Assistant Professor
Department of General Surgery
Dr SN medical college jodhpur
2. Wound Healing
• BASIC PRINCIPLES
• A. Healing is initiated when inflammation
begins.
• B. Occurs via a combination of regeneration
and repair
3. regeneration
• A. Replacement of damaged tissue with native
tissue; dependent on regenerative capacity of
tissue
• B. Tissues are divided into three types based
on regenerative capacity: labile, stable, and
permanent.
4. Labile tissues
• Labile tissues possess stem cells that
continuously cycle to regenerate the tissue.
• 1. Small and large bowel (stem cells in
mucosal crypts, Fig. 2.5)
• 2. Skin (stem cells in basal layer in epidermis,
Fig. 2.6)
• 3. Bone marrow (hematopoietic stem cells)
5. Stable tissues
• Stable tissues are comprised of cells that are
quiescent (G0) , but can reenter the cell cycle
to regenerate tissue when necessary.
• 1. Classic example is regeneration of liver by
compensatory hyperplasia after partial
resection. Each hepatocyte produces
additional cells and then reenters quiescence.
• stable cells (e.g., fibroblasts, smooth muscle
cells) can replicate.
7. Repair (fibrosis/ scar)
• A. Replacement of damaged tissue with fibrous scar
• B. Occurs when regenerative stem cells are lost (e.g., deep skin cut) or when a
tissue lacks regenerative capacity (e.g., healing after a myocardial infarction, Fig.
2.7)
• C. Granulation tissue formation is the initial phase of repair (Fig. 2.8).
• 1. Consists of fibroblasts (deposit type III collagen), capillaries (provide nutrients),
and myofibroblasts (contract wound)
• D. Eventually results in scar formation, in which type III collagen is replaced with
type I collagen
• 1. Type III collagen is pliable and present in granulation tissue, embryonic tissue,
• uterus, and keloids.
• 2. Type I collagen has high tensile strength and is present in skin, bone, tendons,
• and most organs.
• 3. Collagenase removes type III collagen and requires zinc as a cofactor.
8. • The main components of connective tissue
repair are
• angiogenesis,
• migration and proliferation of fibroblasts,
• collagen synthesis, and
• connective tissue remodeling.
13. Mechanism of tissue generation and
repair
• MECHANISMS OF TISSUE REGENERATION AND REPAIR
• A. Mediated by paracrine signaling via growth factors (e.g., macrophages secrete
• growth factors that target fibroblasts)
• B. Interaction of growth factors with receptors (e.g., epidermal growth factor with
• growth factor receptor) results in gene expression and cellular growth.
• C. Examples of mediators include
• 1. TGF-α - epithelial and fibroblast growth factor
• 2. TGF-β - important fibroblast growth factor; also inhibits inflammation
• 3. Platelet-derived growth factor - growth factor for endothelium, smooth muscle,
• and fibroblasts
• 4. Fibroblast growth factor - important for angiogenesis; also mediates skeletal
• development
• 5. Vascular endothelial growth factor (VEGF) - important for angiogenesis
14. repair
• Repair by connective tissue (fibrosis)
• 1. Repair by connective tissue occurs when injury is severe or persistent. Tissue in a third-degree
burn cannot be restored to normal, owing to loss of skin, basement membrane, and connective
tissue infrastructure.
• 2. Steps in normal connective tissue repair
• a. Repair requires neutrophil transmigration (see previous discussion) to liquefy injured tissue and
then macrophages to remove the debris.
• b. Repair requires formation of granulation tissue, the precursor of scar tissue . Granulation tissue
accumulates in the ECM and eventually produces dense fibrotic tissue (scar).
• c. Repair requires the initial production of type III collagen. Type III collagen has poor tensile
strength; hence, the wound can easily be reopened
• d. Dense scar tissue produced from granulation tissue contains type III collagen (weak collagen) that
must be remodeled.
• (1) Remodeling increases the tensile strength of scar tissue.
• (2) Metalloproteinases (collagenases containing zinc) replace type III collagen with type I collagen
(strong collagen), which increases the tensile strength of the wound to ≈70% to 80% of the original
after ≈3 months. Scar tissue after 3 months is primarily composed of acellular connective tissue
that is devoid of inflammatory cells and adnexal structures and is surfaced by an intact epidermis
15.
16. Factors influencing
• B. Delayed wound healing occurs in
• Extrinsic causes
• 1. Infection (most common cause; S aureus is
the most common offender)
• 2. foreign body
17.
18. • 3. Other causes include, ischemia, diabetes.
20. Nutritional deficiencies that impair
wound healing
• Nutritional deficiencies that impair wound healing
• a. Protein deficiency (e.g., malnutrition)
• b. Vitamin C deficiency - Vitamin C is an important cofactor in the hydroxylation of proline and
• lysine procollagen residues; hydroxylation is necessary for eventual collagen cross-linking.
• c. Trace metal deficiency
• (1) Copper deficiency leads to decreased cross-linking in collagen (also in elastic
• tissue). Copper is a cofactor for lysyl oxidase, which cross-links lysine and
• hydroxylysine to form stable collagen.
• (2) Zinc deficiency leads to defects in removal of type III collagen in wound remodeling.
• Type III collagen has decreased tensile strength, which impairs wound healing. Zinc is a cofactor for
collagenase, which replaces the type III collagen of granulation tissue with stronger type I collagen.
21. glucocorticoids
• a. Interfere with collagen formation and decrease tensile strength
• b. Clinically useful in preventing excessive scar formation
• (1) Dexamethasone is used along with antibiotics to prevent scar formation in
bacterial meningitis. Dexamethasone reduces the amount of cytokines (e.g., TNF-
α and IL-1 in the cerebrospinal fluid) and has been associated with decreased
inflammation, decreased cerebral edema, and lower rates of hearing loss.
• (2) Plastic surgeons inject high-potency steroids into wounds to prevent excessive
scar tissue formation.
• c. Other effects of glucocorticoids
• (1) Inhibit production of cytokines (including IL-1, IL-6, and TNF) and other
inflammatory mediators (e.g., histamine, prostaglandins)
• (2) Reduce vasodilation in response to inflammatory mediators, which reduces the
accumulation of cells and fluid in the interstitial space (reduces swelling).
• (3) Reduce the immune cell response by inducing apoptosis of lymphocytes.
22. Cutaneous wound
• NORMAL AND ABERRANT WOUND HEALING
• A. Cutaneous healing occurs via primary or
secondary intention.
• 1. Primary intention-Wound edges are brought
together (e.g., suturing of a surgical incision);
leads to minimal scar formation
• 2. Secondary intention-Edges are not
approximated. Granulation tissue fills the defect;
myofibroblasts then contract the wound, forming
a scar.
23.
24.
25.
26. Abnormal wound healing
• excessive formation of the repair components,
• deficient scar formation,
• formation of contractures.
27. • Excessive Scarring
• Excessive formation of the components of the repair process can
give rise to hypertrophic scars and keloids.
• The accumulation of excessive amounts of collagen may give rise to
a raised scar known as a hypertrophic scar. These often grow rapidly
and contain abundant myofibroblasts, but they tend to regress over
several months (Fig. 3.31A).
• If the scar tissue grows beyond the boundaries of the original
wound and does not regress, it is called a keloid (Fig. 3.31B, C).
• Keloid formation seems to be an individual predisposition, and for
unknown reasons it is somewhat more common in African
Americans.
• Hypertrophic scars generally develop after thermal or traumatic
injury that involves the deep layers of the dermis.
28.
29. Normal and aberrant wound healing
• C. Dehiscence is rupture of a wound; most commonly seen after
abdominal surgery
• D. Hypertrophic scar is excess production of scar tissue that is
localized to the wound (Fig. 2.9).
• E. Keloid is excess production of scar tissue that is out of proportion
to the wound (Fig.2.10).
• 1. Characterized by excess type III collagen
• 2. Genetic predisposition (more common in African Americans)
• 3. Classically affects earlobes, face, and upper extremities
30. Defects in healing – chronic wounds
• These are seen in numerous clinical situations, as a result of local and systemic
factors. The following are some common examples.
• • Venous leg ulcers (Fig. 3.30A) develop most often in elderly people as a result of
chronic venous hypertension, which may be caused by severe varicose veins or
congestive heart failure. Deposits of iron pigment (hemosiderin) are common,
resulting from red cell breakdown, and there may be accompanying chronic
inflammation. These ulcers fail to heal because of poor delivery of oxygen to the
site of the ulcer.
• • Arterial ulcers (Fig. 3.30B) develop in individuals with atherosclerosis of
peripheral arteries, especially associated with diabetes. The ischemia results in
atrophy and then necrosis of the skin and underlying tissues. These lesions can be
quite painful.
• • Diabetic ulcers (Fig. 3.30C) affect the lower extremities, particularly the feet.
There is tissue necrosis and failure to heal as a result of vascular disease causing
ischemia, neuropathy, systemic metabolic abnormalities, and secondary infections.
Histologically, these lesions are characterized by epithelial ulceration (Fig. 3.30E)
and extensive granulation tissue in the underlying dermis
31. • Pressure sores (Fig. 3.30D) are areas of skin ulceration
and necrosis of underlying tissues caused by prolonged
compression of tissues against a bone, e.g., in elderly
patients with numerous morbidities lying in bed
without moving. The lesions are caused by mechanical
pressure and local ischemia.
• When a surgical incision reopens internally or
externally it is called wound dehiscence. The risk
factors for such an occurrence are obesity,
malnutrition, infections, and vascular insufficiency. In
abdominal wounds it can be precipitated by vomiting
and coughing.
33. Wound care
• The aim of wound management is to prevent
the build-up of unwanted tissues types
(necrotic tissue , slough tissue) on the wound
bed, while encouraging the growth of
granulation and epithelial (healing) tissue in
order to repair the wound.
34.
35.
36.
37.
38. dressing
• Hydrating / moisturisinng dressings - Hydrocolloids –
these are hydrating products that can be used on dry
wounds with little or no moisture in order to raise the
exudate levels to a moist environment
• Absorbent dressings - Foams – these are absorbent
dressings intended to reduce exudate levels.
• Films – these products neither absorb moisture nor
hydrate wounds. Used on their own they can only be
used on vulnerable but unbroken skin (e.g. a Grade 1
pressure damage, areas vulnerable to friction, or on
healed wounds that require some protection for a
while).
39. Absorbent primary dressings
• Alginates – these are absorbent primary dressings
• Hydrofibre – this is an absorbent primary dressing
• absorbent primary dressings that require one of
the aforementioned insulating secondary
dressings applied over them. Failure to ‘insulate’
this type of dressing will cause it to dry and
adhere to the wound bed, thereby causing
trauma on removal. This type of dressing is
required for deeper wounds
40. • Non-adherent – these are dressings that don’t
insulate the wound, hydrate nor absorb
moisture and are commonly used for
superficial wounds under other dressing types
to prevent them from adhering to the wound.
Many wound experts consider these dressing
types have little usefulness in wound care and
are therefore most frequently used with
vacuum-assisted closure treatments (topical
negative pressure)