This document defines wounds and provides classifications of wounds. It describes the four main phases of wound healing - hemostatic, inflammatory, proliferative and remodeling. Factors that can affect wound healing like infection, diabetes and malnutrition are also discussed. The normal durations of each healing phase are provided. Management of wounds and potential complications are outlined.

2. Wounds
Healing

4. LEARNING OBJECTIVES
 Definition of wound.
 types of wounds.
 phases of wound healing.
 Healing in specific tissue.
 Factors affecting wound healing.
 Management of wound.
 Complications of wound.

5. DEFINITIONS OF WOUND
 A cut or break in the continuity of any tissue, caused
by injury or incision. bailliere (23rd Ed).
 A wound is a break in the integrity of skin or tissues
often which may be associated with disruption of
structure and function.
 (SRB 4th edition)
 It is circumscribed injury which is caused by external
force and it can involve any tissue and organ.

6. Classifications of wounds.
Rank and wakefield classification
 Tidy wounds.
 Untidy wounds.
Classification based on type wound
Clean incised wound.
Lacerated wound
Bruise and contusion
hematoma

7.  Puncture wound.
 Abrasion.
 Crush injury.
 Penetrating wound.
CLASSIFICATION BASED ONTHICKNESS OF WOUND
 Superficial wound.
 Partial thickness wound.
 Full thickness wound.
 Complicated wounds.

8. Classifications of wounds
 Clean wound.
 Clean contaminated wound.
 Contaminated wound.
 Dirty infected wound.

9. CLASSIFICATION ON BASIS OF DURATION
 Acute wounds heal in an orderly manner through the
four overlapping phases of healing.
 chronic wounds heal similarly but have prolonged
inflammatory, proliferative, or remodelling phases,
resulting in tissue fibrosis and in non-healing ulcers.

10. HEALING
 Healing is the body response to injury in an attempt to
restore normal structure and function.
 process of healing involves regeneration or repair.

11. PROCESS OF HEALING
 Regeneration
 When healing takes place by proliferation of
parenchymal cells and results in complete restoration
of original tissues.The goal all healings should be
regeneration.
 Repair. Healing in which normal tissue donot return
and healing occurs ny granulation tissue only.

12. TYPES OF HEALING
 Primary or First intention healing.
Wound edges are apposed to each other. e.g.
Surgical incised wounds.
 Secondary or second intention healing.
Wound edges are separated.
 tertiary or delayed primary healing.

14. PHASES OF WOUND HEALING

15. Hemostatic Phase
 Vasoconstriction.
 by contraction of vessels caused nerve and chemical
mediators.
 Platelets plug formation: alpha granules release fibrinogen,
fibronectin, thrombospondin, von Willebrand factor.
Clot formation : by fibrin plug using clotting factors.

17. INFLAMMATORY PHASE
 Neutrophils enter wound in 06 hr peaking in 24 to 48
hr and Key role of neutrophil is wound
decontamination by phagocytosis.their number drop
rapidly after third day.
 Macrophages reach at peak by 3-4th day and remain in
wound till healing.
 it can last up to 2 weeks in normal wounds.

18. Pro-inflammatory Cytokines
They are realesd by macrophages, platelets and
lymphocytes.
 IL- 1.
 IL2.
 IL6.
 IL8.
 IFN-γ.
 TNF alpha.

21. PROLIFERATIVE PHASE
 key cells of this phase are fibroblasts and endothelial
cells.they migrate wound on third day and peak on 7th
day.
 it is characterized by formation of granulation
tissue which is made of ECM and ground
substance endothelial cells, new capillaries which
is stimulated by cytokines..
 Endothelial cells. form capillaries which are more
leaky..

23. Epithelialization Phase
 First step toward epithelial phase is formation of
epithelial cells seal over surface of fibrin clot.
 Epithelial seal typically start after 21 to 28 hours of
injury.
 Epithelial cells stop growing after contact inhibition
with epithelial cells of opposite edge.

24. REMODELLING PHASE
 In this phase number of capillaries in granulation
tissue start to mature and reduce in number.
 There is also a decrease in the amount of
glycosaminoglycans and proteoglycans.
 The initial, disorganized scar tissue is slowly replaced
by organized ECM of normal skin.

25. REMODELLING PHASE

26. SCAR STRENGTH
3% in one eek
20% in 03 week.
80% in 12 week
.

27. HARD TISSUE HEALING
 Inflammatory and proliferative phases are same for
soft tissue wound healing.
 Maturation differs markly in hard tissues as compare
to soft tissue healing.
 In bone healing osteoclasts play role of macrophages

28. MANAGEMENT OFWOUND
Managing the acute wound
 Cleansing
 Exploration and diagnosis
 Debridement
 Repair of structures
 Replacement of lost tissues where indicated
 Skin cover if required
 Skin closure without tension
 All of the above with careful tissue handling and
meticulous

29. COMPLICATIONS OF WOUND
 INFECTION
 ULCERATION
 WOUND DEHISCENCE
 HEPERTROPHIC SCAR
 KELOID
 CONTRACTURES
 Pigmentation
 Marjolin ulcer
 Incisional hernias

30. FACTORS AFFECTING WOUND HEALING
LOCAL FACTORS
Site of the wound
● Structures involved
● Mechanism of wounding Incision Crush Crush avulsion
● Contamination (foreign bodies/bacteria)a
● Loss of tissue
● Other local factorsVascular insufficiency (arterial or
venous) Previous radiation Pressure
● Systemic factors Malnutrition or vitamin and mineral
deficiencies Disease (e.g. diabetes mellitus) Medications
(e.g. steroids) Immune deficiencies (e.g. chemotherapy,
acquired immunodeficiency syndrome [AIDS]) Smoking

31. General factors
 Age
 Obesity
 Smoking
 Malnutrition zinc, copper
 Vitamin deficiency vit A. vit C.
 ANEMIA
 JAUNDICE
 DIABETES MELLITUS
 Hiv AND IMMMUNOSUPRESSIVE DISEASES
 STEROIDAND CYTOTOXIC DRUGS,BISPHOSPHONATES,NSAID
 MALIGNANCY

32. Normal Duration of Healing

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