This document provides tips and instructions for using a PowerPoint presentation on wound healing. It discusses: - Freely editing, modifying, and using the slides. - Many slides are blank except for the title to facilitate active learning sessions where students provide information before each slide is shown. - The presentation covers definitions of wounds, classifications of wounds and surgical wounds, phases of healing, factors affecting healing, and wound management. - It encourages interactive learning by showing blank slides first to elicit student responses before presenting each topic. This is recommended for both individual study and classroom learning.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Definition of wound.

3. Definition of wound.
• An injury or damage to tissues caused
by physical means with disruption of
normal continuity .

4. Types of wounds

5. Types of wounds
i. Incised wound
ii. Lacerated wound
iii. Bruising and contusion
iv. Haematoma
v. Puncture wound
vi. Abrasion
vii.Crush injury
viii.Injuries to bone and joint (maybe open or
closed)

6. Types of wounds
ix.Injuries to nerve (either clean cut or crush)
x. Injuries to arteries and veins
xi. Penetrating wounds
xii. Degloving injury.

7. Classification of surgical
wounds

8. Classification of surgical
wounds
a) Clean wound
b) Clean contaminated wound
c) Contaminated wound
d) Dirty infected wound

9. Healing

10. Healing
I Treat God Cures
• The ability to heal is inbuilt in our
physiology . We only help body to heal
itself and remove any obstacles in the
path of healing.
• There are no healing medicines / घाव
सूखनेकी दवा

11. TYPES OF WOUND HEALING

12. TYPES OF WOUND HEALING
• Healing by first (Primary) intention -wounds with
opposed edges.
• Healing by second intention wounds with separated
edges
• By Third intention (tertiary intention)-delayed
primary
Wound initially left open
Edges later opposed when healing conditions
favourable
• Partial thickness wounds –Abrasions- heal by
epithelisation.

13. Healing by first intention (wounds with
opposed edges)

14. Healing by first intention (wounds with
opposed edges)
Healing of wound with following characteristics:
• Clean and uninfected
• Surgically incised
• Without much loss of cells and tissue
• Edges of wound are approximated by surgical
sutures.
• Wounds with opposed edges
• Primary union

15. • The incision causes
 death of a limited number of epithelial cells and
connective tissue cells
 disruption of epithelial basal membrane continuity
• The narrow incisional space immediately fills with
clotted blood containing fibrin and blood cells;
dehydration of the surface clot forms the well known
scab that covers the wound.

16. Healing by second intention

17. Healing by second intention
• Wounds with separated edges
• Secondary union
• When there is more extensive loss of cells and tissue
• Regeneration of parenchymal cells cannot
completely reconstitute the original architecture.
• Abundant granulation tissue grows in from the
margin to complete the repair.

18. Secondary healing VS primary healing

19. Secondary healing VS primary healing
• Inflammatory reaction is more intense
• Much larger amounts of granulation tissue
are formed
• Wound contraction occurs in large surface
wounds
• Substantial scar formation and thinning of
the epidermis occurs

20. Difference between 1˚ & 2˚ union of
wound

21. Difference between 1˚ & 2˚ union of
wound
FEATURES PRIMARY SECONDARY
CLEANLINESS CLEAN NOT CLEAN
INFECTION NOT INFECTED INFECTED
MARGINS SURGICALLY CLEAN IRREGULAR
SUTURES USED NOT USED
HEALING SMALL GRANULATION
TISSUE
LARGE GRANULATION
TISSUE
OUT COME LINEAR SCAR IRREGULAR WOUND
COMPLICATION NOT FREQUENT FREQUENT

22. Phases of Healing

23. Phases of Healing
I. Inflammatory (Reactive)
- Haemostasis > Inflammation
II.Proliferative (Regenerative/Reparative)
Epithelial migration proliferation
Maturation
III.Maturational (Remodeling)
Contraction scarring Remodeling

24. Phases of Healing
• The inflammatory phase occurs
immediately following the injury and lasts
approximately 6 days.
• The fibroblastic (Proliferative) phase
occurs at the termination of the
inflammatory phase and can last up to 4
weeks.
• Scar maturation begins at the fourth week
and can last for years.

25. Wound Contraction

26. Wound Contraction
• Contraction of a wound across a joint can
cause contracture.
• Can be limited by skin grafts, full better
than split thickness.
• The earlier the graft the less contraction.
• Splints temporarily slow contraction.

27. Disturbances in Wound
Healing

28. Disturbances in Wound
Healing
• Local Factors
• Systemic Factors

29. Local Factors

30. Local Factors
• Immobility- Pressure sore/bed
sore/decubitus ulcer
• Ischemia
• Venous congestion.
• Lymphedema
• Infection: impairs healing.
• Smoking: increased platelet adhesiveness,
decreased O2 carrying capacity of blood,
abnormal collagen.
• Radiation:

31. Wound Infection
A positive wound culture does not
confirm a wound infection.

32. Wound Infection: Systemic features

33. Wound Infection: Systemic features
• Tachycardia
• Malaise
• Fever
• Chills
• Leukocytosis
• elevated erythrocyte sedimentation rate

34. Wound Infection: Local features
• Foul-smelling drainage
• spontaneously bleeding wound bed
• flimsy friable tissue
• increased levels of wound exudates
• increasing pain
• surrounding -
– cellulitis
– Crepitus
– necrosis,
– Fasciitis
– regional lymphadenopathy

35. Wound Infection: Local features
Osteomyelitis
• Fevers, malaise, chronic fatigue, and limited range
of motion of the affected extremity,
• patients often present with only a nonhealing
wound or a chronic draining sinus tract overlying
a bone or joint.
• Probe to bone test.
• Plain radiographs, CT scans, radionuclide bone
scans, and MRI
• Osteomyelitis is treated with surgical curettage
and appropriate systemic antibiotics.

36. Systemic Factors

37. Systemic Factors
• Malnutrition
• Cancer
• Old Age
• Diabetes- impaired neutrophil chemotaxis,
phagocytosis.
• Steroids and immunosuppression suppresses
macrophage migration, fibroblast proliferation,
collagen accumulation, and angiogenesis.
Reversed by Vitamin A 25,000 IU per day.
• Superstitions

38. Abnormal Response to Injury

39. Abnormal Response to Injury
• Inadequate Regeneration
• Inadequate Scar Formation
• Excessive Regeneration
• Excessive Scar Formation

40. Keloids and Hypertrophic
Scars

41. Keloids and Hypertrophic
Scars
• Both from an overall increase in the
quantity of collagen synthesized.
• Recent evidence suggests that the
fibroblasts within keloids are different from
those within normal dermis in terms of their
responsiveness.
• No modality of treatment is predictably
effective for these lesions.

42. Drugs affecting wound healing

43. Drugs affecting wound healing
• Negative
– antibiotics,
– anticonvulsants
– Steroids
– nonsteroidal anti-inflammatory drugs.
• Beneficial
– ferrous sulphate,
– insulin,
– thyroid hormones,
– vitamins

44. Wound Management

45. Wound Management
• Systemic measures.
• Local measures

46. Wound Management
Local measures- “The golden hour”
• Haemostasis
• Anaesthesia
• Decontamination
• Repair and closure
• Delayed closure-
• Late presentation
• Heavy contamination
• Lot of dead and devitalized tissue.

47. Wound Management
• Local measures-
• Surgically debride nonvitalized tissue and
with appropriate irrigation
• Dressing changes require clean but not
necessarily sterile technique.
• Remove foreign bodies
• Pat the wound surface with soft moist
gauze; do not disrupt viable granulation
tissue.

48. Wound Management
Pressure sores
• Mobilise
• Appropriate turning and positioning
• Use of offloading support surface
• Appropriate wound care
• Appropriate management of incontinence
• Appropriate nutritional management

49. Wound Management
• Pressure sores
•

50. Wound Management
Venous Ulcers
• Appropriate wound care
• Compression dressings.

51. Wound Management
Diabetic foot ulcers
• Appropriate wound care
• Liberal debridement
• Maintain euglycemia with insulin.
• Antibiotics only if evidence of infection.
• Reperfusion.

52. Wound Management
Surgical Care
• Skin grafting
• Cadaveric allografting
• Application of bioengineered skin
substitutes
• Use of flap closures

53. Future and Controversies

54. Future and Controversies
• Human cell–conditioned media developed
in embryologiclike conditions
• transforming growth factor (TGF)–β3
• Hyperbaric oxygen has also been used to
promote healing.
• Agents such as platelet-rich plasma (PRP)
and erythropoietin (EPO
• Engineered tissue matrices
• Stem Cells

55. Take home messages
• Early closure of clean wounds.
• Delayed closure of dirty / infected wounds.
• Antibiotics are generally not indicated in
abrassions, contusions.
• For open wounds give three dosage of
antibiotic.
• Further antibiotics only if evidence of
infection.
• Spirit, Betadine,Savlon, Hydrogen peroxide
Sumag should not be applied on wounds.

57. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

58. Get this ppt in mobile

59. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
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• https://www.facebook.com/doctorpradeeppa
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