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Wound Healing: Dr. Shaimaa Alaraby Specialist of General Surgery

This document summarizes the stages of normal wound healing: 1. The inflammatory phase lasts 2-3 days and involves bleeding, blood clot formation, and the arrival of inflammatory cells like macrophages. 2. The proliferative phase lasts from days 3 to 3 weeks. It involves fibroblast activity, collagen deposition, new blood vessel growth, and re-epithelialization of the wound surface. 3. The remodeling phase lasts from 3 weeks to 18 months. It involves collagen maturation and realignment, decreased vascularity, and wound contraction through fibroblast activity. Potential complications include inadequate or excessive scar formation, as well as contractures resulting from exaggerated wound edge contraction.

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Osama Fadel ahmed
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198 views21 pages

Wound Healing: Dr. Shaimaa Alaraby Specialist of General Surgery

This document summarizes the stages of normal wound healing: 1. The inflammatory phase lasts 2-3 days and involves bleeding, blood clot formation, and the arrival of inflammatory cells like macrophages. 2. The proliferative phase lasts from days 3 to 3 weeks. It involves fibroblast activity, collagen deposition, new blood vessel growth, and re-epithelialization of the wound surface. 3. The remodeling phase lasts from 3 weeks to 18 months. It involves collagen maturation and realignment, decreased vascularity, and wound contraction through fibroblast activity. Potential complications include inadequate or excessive scar formation, as well as contractures resulting from exaggerated wound edge contraction.

Uploaded by

Osama Fadel ahmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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WOUND HEALING

DR. SHAIMAA ALARABY


SPECIALIST OF GENERAL SURGERY
Definition
• Wound healing is a mechanism whereby the
body attempts to restore the integrity of the
injured part.
• Stages of wound healing:
1. Inflammatory phase.
2. Proliferative phase.
3. Maturation phase.
NORMAL WOUND HEALING
1. Inflammatory phase: It begins immediately after
wounding and lasts 2–3 days.
• 1. Bleeding is followed by vasoconstriction and
thrombus formation to limit blood loss (haemostasis).
• 2. Platelets then release PDGF, platelet factor IV and
transforming growth factor beta (TGF). These attract
inflammatory cells such as PMN and macrophages.
• 3. Platelets and the local injured tissue release
vasoactive amines, such as histamine, serotonin and
PGs, which increase vascular permeability.
• 4. Macrophages remove devitalized tissue, and
microorganisms while regulating fibroblast activity in
the proliferative phase of healing.
NORMAL WOUND HEALING
2. Proliferative phase:
• lasts from the third day to the third week.
• 1. Fibroblast activity with the production of collagen and
ground substance (glycosaminoglycans and proteoglycans).
• 2. Angioneogenesis the growth of new blood vessels as
capillary loops.
• 3. Re-epithelialisation of the wound surface. Fibroblasts
require vitamin C to produce collagen.
• The wound tissue formed in the early part of this phase is
called granulation tissue. In the latter part of this phase,
there is an increase in the tensile strength of the wound
due to increased collagen, which is at first deposited in a
random fashion and consists of type III collagen.
NORMAL WOUND HEALING
3. The remodeling phase:
• From 3 weeks up to one year or 18 months.
• 1. Maturation of collagen (type I replacing
type III until a ratio of 4:1 is achieved).
• There is a realignment of collagen fibers along
the lines of tension, decreased wound
vascularity.
• 2. Wound contraction due to fibroblast and
myofibroblast activity.
Classification of wound closure and
healing
1. Primary intention
• Wound edges opposed
• Normal healing
• Minimal scar
2. Secondary intention
• Wound left open
• Heals by granulation, contraction and epithelialisation
• Increased inflammation and proliferation
• Poor scar
3. Tertiary intention (also called delayed primary intention)
• Wound initially left open
• Edges later opposed when healing conditions favorable.
SURGICAL WOUND CLASSIFICATIONS
1. Clean:
• Uninfected, no inflammation, Resp, GI, GU tracts not entered, closed
primarily
• Examples: Ex lap, mastectomy, neck dissection, thyroid, vascular, hernia,
splenectomy
2. Clean-contaminated:
• Resp, GI, GU tracts entered, controlled, no unusual contamination
• Examples: Chole, SBR, Whipple, liver txp, gastric surgery, bronch, colon
surgery
3. Contaminated:
• Open, fresh, accidental wounds, major break in sterile technique, gross
Spillage from GI tract, acute nonpurulent inflammation
• Examples: Inflamed appendix, bile spillage in chole, diverticulitis, Rectal
surgery, penetrating wounds
4. Dirty:
• Old traumatic wounds, devitalized tissue, Existing infection or perforation,
Organisms present BEFORE procedure
• Examples: Abscess I&D, perforated bowel, peritonitis, wound debridement,
positive cultures pre-op
complications of wound healing

• The complex wound healing process may be ‘derailed’ at


many steps. The principle pathological problems may be
summarised as;
1. Inadequate scar formation – leading to wound dehiscence;
2. Excessive scar formation – either hypertrophic or ‘keloid’
scarring
3. Contracture formation – an exaggeration of normal wound
edge contraction forming deformities (particularly after
burn injuries).
Hypertrophic Scars
• They occur when the remodelling stage exists for a
longer period of time and they are more cellular and
more vascular than mature scars.
• They are red, raised, itchy and tender.
• They will eventually mature and become pale and flat.
Such scars usually exist in areas where wound healing
has been delayed, for example, due to infection, or in
children or where skin tension is high (such as at the tip
of the shoulder).
• They remain within the confines of the wound area
itself.
Hypertrophic Scar
Keloid Scars
• They are regions of extreme overgrowth
beyond the confines of the original wound
area.
• They are more frequently associated with
certain racial groups, such as Afro-Carribeans.
They often occur in the central chest region,
back and shoulders.
Keloid Scar
Contracture
• Where scars cross joints or flexion creases, a
tight web may form restricting the range of
movement at the joint.
• Treatment may be simple involving multiple Z-
plasties or more complex requiring the inset
of grafts or flaps.
• Splintage and intensive physiotherapy are
often required postoperatively.
Contracture
As doctors we do not
study to pass exams we
study for the day when
we are the only thing
between the patient
and the grave
• Thank you
• Any questions
‫ما تفرحوا ساااااااي في محاضرة تانية‬
‫‪we r not done yet‬‬
Naaah we r done thank u
have a nice day
Got you

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