Wound healing basics for MBBS students

1. DrVIPINV NAIR
Associate Prof Surgery and Plastic Surgeon
AFMC Pune

23.  Tidy wounds: Primary repair of all
damaged structures
 Untidy wounds need Debridement
 Surgeon’s Aim: Convert untidy→Tidy
by:
 Removal of contaminants
 Removal of devitalised tissue

24.  ATLS protocol
 ABCD to be followed
 Evaluation/Cleansing/ Repair & Damage
Control
 Primary & Secondary Surveys
 Haemostasis + Pain Relief/Anaesthesia +
Tetanus prophylaxis

25.  T tissue management
 I inflammation & infection control
 M moisture balance
 E epithelial edge &extras!

26.  Assessment for non viable tissue.
 Wound debridement is the principle intervention

31. Types of debridement
WOUND
MECHANICAL
ENZYMATIC
CHEMICAL
BIOLOGICAL
AUTOLYTIC
SURGICAL/ SHARP

32. WOUND
MECHANICAL
ENZYMATIC
CHEMICAL
BIOLOGICAL
AUTOLYTIC
SURGICAL/ SHARP
Types of debridement

33. WOUND
MECHANICAL
ENZYMATIC
CHEMICAL
BIOLOGICAL
AUTOLYTIC
SURGICAL/ SHARP
Types of debridement

34. WOUND
MECHANICAL
ENZYMATIC
CHEMICAL
BIOLOGICAL
AUTOLYTIC
SURGICAL/ SHARP
Types of debridement

35. WOUND
MECHANICAL
ENZYMATIC
CHEMICAL
BIOLOGICAL
AUTOLYTIC
SURGICAL/ SHARP
Types of debridement

36. Wound
Contamination
Wound
Colonization
Critical
Colonization
Wound
Infection
Advance Wound
Infection

37.  Five cardinal signs of infection:
 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.

38.  Role of antibiotics
- Topical vs Systemic
 Debridement
 Medicated dressings

39. 39

40. REF: AMR Guidelines 2016 and ICMR 2021

43.  The Exudate continuum
 Dressings and other wound
care products

46. • Signs of edge
advancement
• Cleansing Agents

47. • Antiseptics
• Antibiotics
• Honey
• Saline 0.9%
• Tap water

49.  Cleanse Debris from theWound
 Possible Debridement
 Manage Exudate
 Promote Granulation and Epithelialization
WhenAppropriate
 PossiblyTreat Infections
 Minimize Discomfort

55.  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
current applied

57.  O2 as drug and chamber as delivery system
 Atmospheric pressure at sea level = 1 ATA =
1.5ml O2/dL
 NormalTissue O2 tension is 40-50 mmHg.
 O2 tension < 40 mmHg = chronic wound
Ref : SabistonTextbook of surgeryVol 1

62.  Avoid dirt/ particulate
contaminant
 Meticulous approximation of
edges
 Smallest suture chosen
 Germ free environment

64. Reversible
Hyperproliferative
Restricted to wound margin
Well organised collagen type III
3w-3months
Pressure therapy
>6months
Silicone therapy
Ongoing hypertrophy
InjTriamcinolone 10-
40mg/ml

65. Irreversible
Trunk, upper extremities and face
Not restricted to wound margin
Disorganised type I and type III collagen bundles
1st line
Silicone + Pressure+ Inj
Steroids
Bleomycin, 5-FU,
Verapamil
>12months
Surgical excision

67. 1) Local factors:
 Type ofWound (Incised, Crushed or Avulsed)
 Site of wound
 Size of wound
 Structure damaged
 Necrotic tissue and foreign body
 Poor blood supply
 Venous or lymph stasis
 Infection
 FaultyWound closure-Tissue tension
 Radiation exposure
 Recurrent trauma
 Large defect or poor apposition

68. 2) General factors
 Age
 Malnutrition, zinc, copper
 Vitamin deficiency (Vit C,Vit A)
 Malignancy
 Jaundice
 Uremia
 Diabetes
 HIV and immunosupressive
diseases
 Steroids and cytotoxic drugs
 Smoking