Wound healing afmc
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All About wound and wound healing
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Wound healing afmc
- 1. WOUND HEALING DR VIPIN V NAIR
- 2. PREVIEW • Wound definition and classification • Principles of wound healing • Phases of wound healing • Factors affecting • Complications • Newer Horizons
- 3. Understanding how the body repairs damaged tissue and what factors influence the wound healing process helps us to aid better scarless wound healing
- 5. FUNCTION •Protection • Sensation • Temperature regulation • Metabolism - Vit D • Psychosocial communication
- 6. WOUND
- 7. ULCER • Break in continuity of covering epithelium- skin, mucous membrane. Molecular death of epithelium or its traumatic removal • Ulcer is a type of wound.
- 12. Rank and Wakefield classification Tidy Incised Clean Healthy tissue Seldom Tissue Loss Untidy Crush or avulsed Contaminated Devitalized tissue Often tissue loss
- 13. Untidy Tidy AIM
- 14. Based on Type
- 23. WOUND CLEAN DIRTY DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND CLEAN CONTAMINATED CONTAMINATED
- 24. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 25. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 26. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 27. WOUND CLEAN DIRTY CLEAN CONTAMINATED CONTAMINATED DEGREE OF BACTERIAL CONTAMINATION OF SURGICAL WOUND
- 28. Surgical wound
- 29. Wound healing
- 32. Phases of Wound healing
- 33. Classification of wound closure and healing
- 36. Phases of wound healing
- 38. •Limit blood loss •Debridement •Sealing the wound
- 40. • Vessel damage ---- bleeding---- platelet plug — fibrin frame work deposition Haemostasis (Activated by intrinsic & extrinsic pathways)
- 42. PMNs •Peak at 24-48 hrs •Phagocytosis of bacteria &tissue debris • Major source of cytokines
- 43. T lymphocytes •1 week •Bridges from inflammatory to proliferative phase
- 44. Macrophages •By 48-96 hrs upto complete healing •Phagocytosis • Activation and recruitment of other cells
- 47. Fibroblastic activity • Collagen • Proteoglycans • Glycosaminoglyc ans
- 48. Day 3 – week 3
- 49. Angiogenesis
- 50. Deposition of type III collagen in Random fashion
- 52. Maturation and Re-modelling Aim •Wound shrinkage •Strength •Scar contraction
- 53. •Maturation of collagen •Type I replacing Type III, ratio 4:1 Realignment of collagen fibers along the lines of tension
- 56. INFECTION
- 59. POOR BLOOD SUPPLY •Wound healing is a highly energy dependant process •Initial response neovascularization •Persistent ischemia results in apoptosis
- 61. WOUND TENSION
- 62. FOREIGN BODIES • Acts a physical barrier • Asylum for bacteria • Inability to contract • Prevent epithelization
- 64. POOR TECHNIQUE • Placement of Incision • Flap design • Proper extension to prevent retraction pressure • Careful haemostasis • Proper selection of suture materials • Proper suturing technique
- 66. NUTRITONAL DEFICIENCIES Vit A: involved in epithelisation and collagen production Vit C: production and modification of collagen Zinc: enzyme co-factor, role in cell proliferation Protein: impaired immune and inflammatory responce
- 67. HEALING SLOWS DOWN WITH AGING
- 69. STEROIDS • Lysosomal stabalization--- impaired phagocytosis • Impairment of chemotaxis of microphages • Fibroblast genome inhibition--- decreased collagen, decreased strength and increased dehiscence
- 70. SMOKING Vasoconstriction Which is not transient— 1 cigarette for 90 min 1 pack for whole day
- 71. Systemic factors
- 72. Abnormal Healing
- 73. Skin - mutilating or debilitating scars, burn contraction
- 74. GI tract - Strictures or Stenoses
- 76. Solid organs - Cirrhosis, Pulmonary fibrosis
- 78. History of wound healing
- 79. Some historical perspectives of wound management
- 81. THE CHANGING TRENDS..... A Paradigm Shift Active Passive
- 82. THE TWO MAIN AIMS • Taking care of the systemic deterrents • Provide and promote the loco regional factors
- 83. • THE SYSTEMIC • THE LOCAL –Promote the autolytic enviroment –Counteract Infection –Promote GFs
- 84. General principles of wound management Goal – To aid the natural body process. – Create optimal conditions for the patient to heal themselves painlessly and quickly. – To produce optimal functional and cosmetic end result. 84
- 85. Achieved by – Minimize infections and complications. – Provide and promote the loco- regional factors. – Promote the autolytic environment. – Promote granulation. – Preserve function.
- 86. •THE PATIENT •THE WOUND •THE PLAN
- 87. 1. THE PATIENT • The whole patient not just the hole.
- 90. 2. THE WOUND Initial assessment, monitoring the healing and elements of wound documentation
- 91. Meticulous examination of the wound • The depth and configuration of the wound. • The extent of nonviable tissue. • The presence of foreign bodies and other contaminants. • Neurovascular examination • Radiography detail
- 96. Visitrak Grid
- 100. Lab test
- 101. Nutritional status-Albumin, prealbumin and transferrin
- 102. Level of physiological inflammation-CRP,ESR
- 103. Degree of diabetes control-Plasma glucose, HbA1c
- 104. Hematology
- 105. Biochemistry
- 106. Others-tcPo2, Toe Pressure, ABPI
- 107. 3) THE PLAN-WCP A •Acute B •Chronic C •Problem
- 108. A)Management of acute wounds • Antibiotics • Primary, secondary and the delayed primary. • Sutures, staples ,tissue adhesives or adhesive tapes
- 109. B)Management of chronic wounds
- 110. WOUNDBED PREPARATION-WBP Debridement Exudate management Bacterial imbalance resolution Undermined epidermal margin
- 111. THE FRAMEWORK CALLED TIME • T tissue management • I inflammation & infection control • M moisture balance • E epithelial edge &extras!
- 113. T-TISSUE MANAGEMENT • The wound continuum • Assessment for nonviable tissue. • Wound debridement is the principal intervention
- 118. Every rule has an exception..
- 119. Assess and Investigate • Five cardinal signs of infection:R.C.T.D.F • 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
- 120. I-INTERVENTION • Role of antibiotics - Topical vs Systemic • Debridement • Medicated dressings
- 121. M-MOIST WOUND HEALING • The Exudate continuum • Dressings and other wound care products
- 123. Debridement • Single most important wound care tool • Reduce bioburden and promote wound healing
- 124. Without debridement ,wound persistently exposed to cytotoxic stressors and competes with bacteria for O2 and nutrition.
- 130. NPWT Mechanisms • Reduction of edema • Removal of wound fluid rich in deleterious enzymes • Mechano-transduction – Increased growth factor release – Matrix production – Cellular proliferation. – Microstrain and macrostrain
- 131. Clinical benefits – Decrease wound size – Accelerated wound bed preparation – Accelerated wound healing – Improved graft take
- 132. Hyperbaric oxygen O2 as a drug and hyperbaric chamber as delivery system
- 133. Inhalation of 100% O2 ,Increase tissue Po2 10 times higher Delivered at 1.9 to 2.5 atm for session of 90- 120 mins. Once daily, 5 to 6 times a week Stimulate angiogenesis Enhance fibroblast and leukocyte function
- 134. Growth Factors
- 137. DRESSINGS • Dry dressings • Wet to dry dressings • Polyurethane film dressing - breathable and nonbreathable • Vasline tules • Antibiotic impregnated tules INACTIVE • Hydrogels –fibre and foams • Hydrocellular dressings • Foams • Alginates • Crystaline silver and slow iodine releasing materials ACTIVE
- 138. DRESSINGS PASSIVE • HYDROGELS –FIBRE AND FOAMS • HYDROCOLLOID • HYDROFIBRES • ALGINATES • SEMIPERMEABLE FILMS INTERACTIVE • HYDROCOLLOIDS • FOAMS • FILMS OCCLUSIVE
- 139. DRESSING CHOICE ADD OR MAINTAIN DAMP GAUZE GELS RETAIN TRANSPARENT FILMS NON ADHESIVE GAUZE ABSORB FILLER COVER
- 140. Surgical Dressings- 07 classes Films Composites Hydrogels Alginates Hydrocolloid Foams Absorptive dressings
- 141. Passive dressings
- 142. Film dressings
- 143. Composite dressings
- 145. Hydrogel dressings
- 146. Alginate dressings
- 147. Foam dressings
- 148. Absorptive dressings
- 153. E- EDGE , EPITHELIAL ADVANCEMENT,EXTRAS! •Signs of edge advancement •Cleansing Agents
- 155. Basic elements in a chronic wound care plan- Summary Cleanse Debris from the Wound Possible Debridement Manage Exudate Promote Granulation and Epithelialization When Appropriate Possibly Treat Infections Minimize Discomfort
- 156. Empower the patient and responsible family member Teach the correct way to dressing Irrigation Compression
- 157. Problem wounds
- 158. The Problem wound
- 159. Wounds in patient on steroids Prone to infections decreased rate of angiogenesis collagen deposition and cellular proliferation
- 160. • Vit A as useful adjunct • Dose-25,000 IU daily orally • 2 Lakh IU topically 3 times a day
- 161. Wounds in patient with irradiation Progressive endarteritis and microvascular damage Aggressive debridement results in large non healing ulcers hence should be conservative Often need flap cover
- 162. The pressure sore wound Often debilitated patients Pressure offloading Nutrition building Surgical debridement Often require flap cover Consider administration of growth hormones and anabolic steroids like oxandrolene Recurrence is a rule after successful treatment
- 163. Wounds in patient with Diabetes Functional microangiopathy and neuropathic derangements. Debridement Blood sugar control Pressure offloading Growth factors
- 164. New Horizon
- 165. Electrostimulation 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 based on wound
- 166. Hyperbaric Oxygen • Developed 1662 by Henshaw • Atmospheric pressure at sea level = 1 ATA = 1.5ml O2/dL • Normal Tissue O2 tension is 40-50 mmHg. • O2 tension < 40 mmHg = chronic wound
- 168. Honeysoft • Natural dressing • Honey-impregnated dressing Chronic unhealing wounds. • Impregnated into a compress of EVA (ethylenevinylacetate) mesh
- 169. "MAX8," • A novel hydrogel, to seal wounds and at the same time deliver an antibacterial punch.
- 171. Pressure garments
- 172. Silicon gel sheet
- 173. Other ointments
- 175. Stem cell therapy
- 177. Gene therapy
- 181. God heals and , the doctor takes the fees Benjamin Franklin Thanks