A wound is a break in the skin or tissue caused by injury. Wound healing is the body's process of restoring injured tissue. It involves three phases - inflammatory, proliferative, and remodeling. In the inflammatory phase, blood vessels constrict then dilate to deliver immune cells and fibrin to the wound. In the proliferative phase, new tissue such as collagen is produced by fibroblasts. In remodeling, collagen matures and wound strength increases over months. Wounds heal through primary, secondary, or tertiary intention depending on wound management and tissue loss.

1. Wound /wound healing
Dr. Naila Yasmin PT

2. DEFINITION
• A wound is a break in the continuity of soft
tissues
• defined as a separation or discontinuity of
the skin, mucous membrane or tissue caused
by physical, chemical or biological insult

3. Wound healing
• Wound healing is a mechanism whereby the
body attempts to restore the integrity of the
injured part.

4.  Site of the wound
 Structures involved
 Mechanism of wounding
 Incision
 Crush
 Crush avulsion
 Contamination (foreign bodies/bacreria
Factors influencing healing of a
wound

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Other local factorsVascular insufficiency
(arterial or venous)
Loss of tissue
• Previous radiation
• Pressure
• Systemic factors
• Malnutrition or vitamin and mineral
deficiencies

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• Disease (e.g. diabetes mellitus)
• Medications (e.g. steroids)
• Immune deficiencies (e.g. chemotherapy,
acquired
• immunodeficiency syndrome (AIDS))

7. Normal wound healing
• 1 the inflammatory phase;
• 2 the proliferative phase;
• 3 the remodelling phase (maturing phase

8. classification
• Classification of wound closure and
healing
• Primary intention
• Secondary intention
• Tertiary intention

9. • Primary intention
Wound edges opposed
Normal healing
Minimal scar
• Secondary intention
– Wound left open

10. Heals by granulation, contraction and
epithelialisation
Increased inflammation and proliferation
Poor scar
• Tertiary intention (also called delayed
primary intention)
Wound initially left open
Edges later opposed when healing conditions
favourable

15. Managing the acute wound
• Cleansing
• Exploration and diagnosis
• Debridement
• Repair of structures
• Replacement of lost tissues where indicated

16. • Skin cover if required
• Skin closure without tension
• All of the above with careful tissue
handling and meticulous technique

17. Chronic wound
• Leg ulcer
• Pressure sore

18. Leg ulcer
• Venous disease leading to local venous
hypertension (e.g.
• varicose veins)
• Arterial disease, either large vessel
(atherosclerosis) or small
• vessel (diabetes)
• Arteritis associated with autoimmune
disease (rheumatoid

19. • Trauma – could be self-inflicted
• Chronic infection – tuberculosis/syphilis
• Neoplastic – squamous or basal cell
carcinoma, sarcoma

21. Pressure sore
• Ischium
• Greater trochanter
• Sacrum
• Heel
• Malleolus (lateral then medial)
• Occiput

23. Symptoms
• Local
• Remote

24. Local Symptoms
• Hemorrhage
• Pain
• Gaping of the edges of wound
• Phenomena of repair

25. Remote Symptoms
• Observed away from the wound
• Abscess formation in a dependent lymph node
• Paralysis or a loss of function in a dependent portion
• Neuritis extending along the course of the nerve involved
in the wound.

26. Management of wounds
• Contusions: are treated with cold and astringent
applications to minimize extravasation.
• Haematomas: when small get absorbed ,other wise they
may have to be opened and treated.
• Open wound: surgical or aseptic wound/ contaminated
and septic wound/ accidental traumatic wounds.

27. Surgical or aseptic wounds
• A surgical wound made with all aseptic precautions
in a non infected tissue is an aseptic wound.
• Surgeon should avoid drying of the tissue, excessive
trauma and haemorrhage – lower the wound
infection.
• Prophylaxis against tetanus
• Drainage should be provided if haemotoma or
seroma formation is expected.

28. • Suture should be supported up to healing time 8 -14
days
• Systemic use of specific antibiotics as a therapeutic
or prophylactic measure.
• Local application of Fly repellents – hot summer
months.
• The patient and the affected injured part should be
kept at rest

29. Contaminated and septic wounds
• A fresh wound gets contaminated when it is more
than 4 -5 hours old.
• Management is mainly directed towards overcoming
factors like.
– Type and number of invading micro organisms
– Type and location of the wound
– Poor blood flow at the wound site
– Effective ness of the treatment
– Presence of foreign material
• Dead tissue at the wound site.

30. General principle
• Control of haemorrhage: Bleeding is controlled and
ligating large vessels if any
➢ Wound and its periphery should be thoroughly cleaned with warm
normal saline, water, soap or 2% H2O2 5% dettol, 0.5% potassium
permanganate
➢ Clipping and shaving of large area around wound

31. Cleaning of wound/ irrigation of wound
• The wound and surrounding areas are irrigated with mild, non irritant,
antiseptic lotions:
1:1000 Per chloride of mercury lotion.
1:500 acriflavin lotion
1:40 Eusol lotion (Eupad is 1:40 bleaching powder + boric acid)
5 – 10 % hyper tonic salines.
• If wound is fresh suturing may be attempted
• Infected and deep penetrating wounds are not sutured
• Wounds that are not sutured should be irrigated daily or on alternate
days
• Wounds of feet: warm antisepic foot baths may be given with 10%
formalin

32. Wound debridement
• Debridement for removal of devitalized or necrosed
tissue is either done by excising the unhealthy tissue or
by use of topical mendicaments
➢ 2.5% sodium chloride solution.
➢ Magnesium sulphate and glycerin paste.

33. Control of infection
• After irrigation and debridement wound
may cover with
➢ Moist antiseptic pad / antiseptic powder / ointment.
➢ Antiseptic powders, boric acid, eupad BIPP
➢ Ointments: Boric ointment, penicillin ointment,
streptomycin, chloromycin ointment, terramycin ointment.
➢ Application of very strong antiseptics should be avoided as
it will destroy granulation tissue.

34. Providing drainage
• If there is exudation and discharge the wound should not
be sutured.
• Deep wounds – fenestrated tube is advisable for drainage
• Deep wounds with narrow external opening – may be
enlarged for efficient drainage.
• Counter opening may be made in a dependent part seton
may be passed through it.

35. Immobilization of wounded area
• If proper immobilization is not provided healing is
delayed, formation of excessive granulation tissue
(Exubeenrt granulation / pround flush)
• Application of caustics – copper sulphate, potassium
permanganate

36. Accidental traumatic wounds
➢ Check hemorrhage
➢ Avoid development of shock
➢ Prophylaxis against tetanus
➢ Cleaning, excision, debridement
➢ Systemic antibiotic treatment

37. THANK YOU

38. DETAILS OF WOUND
HEALING

39. • A wound is defined as a separation or
discontinuity of the skin, mucous membrane
or tissue caused by physical, chemical or
biological insult.
• Wound healing is restoration of the tissue
continuity

40. • Wound healing, is the foundation of
surgery and complex process.
• Always associated with process of
inflammation.
• Inflammation is a local reaction of living
tissues to an injury of microcirculaion
and its associated tissues.

41. Wound Healing
• First intension
• Second intension
• Mixed intension
• Third intension
• Healing under scab

42. Healing by First intension
• Occurs in incised or surgical wounds, with
minimal tissue damage and bleeding
• Repair begins in 12 hours by proliferation
angioblast and fibroblast
• Healing is complited in about 14 days
• Scar formed is very little

43. • Wound should be clean and fresh
• Free form infection and bleeding
• Free from foreign bodies
• Edges should have good blood supply
• Edges should have proper alignment and
apposition

44. Healing by Sesond intension
• By replacement of tissue
• Wounds having extensive loss of tissue and
edges widely separated
• Granulating tissue consist of budding
capillaries and fibroblast, grows from edges
and bottom to fill up gap

45. • Granulating tissue is velvety in
appearance, soft, moist and pink in colour
• Granulation tissue is called so due to
granular appearance presented by budding
capillaries
• Healing takes 14-21 days, in large wound
with excessive loss of tissue it may take 42
days

46. Healing by Mixed intension
• Wound healing is partly by first intension
and partly by second intension
• Happens when sutured wound has partially
disrupted

47. Healing by Third intension
(Healing by secondary suture)
• Granulating tissue are united by sutures for
quicker healing

48. Healing under scab
• In superficial wounds like abrasions
• Exudate present in the wound dries and froms scab
• Granulation takes place under this scab
• When granulation is complete the scab
automatically separates and is cast off

49. Phases of wound healing
[A] Inflammatory phase: -
• Immediate response to injury is acute
inflammation
• Vasoconstriction of small vessels in the area
• Response last for 5-10 minutes and followed by
active vasodilation

50. • Vasodilatation causes accumulation of
exudate in the area
• Dilatation is due to release of histamine,
serotonin and bradykinin
• This causes swelling of vascular
endothelial cells, creating gap between
these cells

51. • Exudate provides fibrinogen and other clotting
elements, which form fribin clots
• These clots plugs the damaged lymphatics,
preventing further damage from injured area
• Inflammatory reaction is thus localized to a
specific area surrounding the injury
• Redness, swelling and heat are seen during
inflammatory reaction in the area

52. [B] Fibroblastic or Collagen phase: -
• Begins at about 5th day
• Fibroblast are actively engaged in
production of connective tissue matrix
• Fibrinogen in exudate is converted to fibrin
by enzymes from blood and tissue cells

53. • Fibrin is laid down in the wound and provides a
good frame work for repair besides haemostasis
• Collagen is synthesized by the fibroblasts
• Few collagen fibers are present at the beginning
but by 15th day wound gets good tensile strength
• Sutures are therefore removed about 2 weeks of
surgery

54. [C] Maturation phase: -
• It starts after collagen bed is laid
• Collagen fibers become thicker, denser
and number of fibroblast decreases
• Pale scar is formed, full maturation of
scar may take months or year

55. [D] Contraction phase: -
• It involves movement of existing tissue at the wound
edges resulting decrease in size of open wound
• Absence of attachment of the skin to the underlying
structures allow maximal contraction
• Contraction has been reported to be a cell mediated
phenomenon
• Contractions near joints may result in the formation of
tight band of scar tissue

56. Factors affecting wound healing
• LOCAL FACTORS: -
– Surgical technique
– Tissue vascularity
– Mechanical stress
– Movement
– Extent of wound surface
– Haemorrhages
– Foreign bodies
– Oedema and Dehydration
– Local irradiation
– Suture material and techniques
– Wound infection

57. • SYSTEMIC FACTORS: -
– Age
– Obesity
– Malnutrition
– Vitamin deficiancy
– Anaemia and hypoxia
– Systemic disease
– Temperature

58. THANK YOU