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Wound and Healing

Wound healing involves two main processes: regeneration and repair. Regeneration restores original tissue structure and function, while repair results in scar tissue. Wounds are classified based on cause, appearance, depth, and surgical context. Healing occurs either by primary intention for clean wounds with opposed edges, or secondary intention for wounds with separated edges requiring granulation tissue to fill the gap. The healing process involves inflammation, proliferation of new tissue, and remodeling over time to regain strength.

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Risav Ghosh
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68 views16 pages

Wound and Healing

Wound healing involves two main processes: regeneration and repair. Regeneration restores original tissue structure and function, while repair results in scar tissue. Wounds are classified based on cause, appearance, depth, and surgical context. Healing occurs either by primary intention for clean wounds with opposed edges, or secondary intention for wounds with separated edges requiring granulation tissue to fill the gap. The healing process involves inflammation, proliferation of new tissue, and remodeling over time to regain strength.

Uploaded by

Risav Ghosh
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Wound And Healing

Dr. Sitaram Ghosh


Wound
• It is a circumscribed injury which is caused by external force and itcan
involve any tissue or organ.
• A cut or break in the continuity of any tissue caused by any injury or
operation.
Classification of wound
• Rank and Wakefield classification
 Tidy wound
 Untidy wound
Classification based on type of wound
• Clean incised wound
• Lacerated wound
• Bruising and contusion
• Hematoma
• Puncture wound
• Abrasion
• Crush injury
• Injury to bones and joints
• Injury to nerves
• Injury to arteries and veins
Classification based on thickness of wound
• Superficial wound
• Partial thickness
• Full thickness wound
• Deep wound
• Complicated wound
• Penetrating wound
Classification of surgical wound
• Clean contaminated wound
• Contaminated wound
• Dirty infected wound
• Clean wound
Healing
• Healing is the body's response to injury in an attempt to restore normal
structure and function.
The process of healing
The process of healing involves 2 distinct processes :
Regeneration
Repair
• Regeneration is when healing takes place by proliferation of
parenchymal cells and usually results in complete restoration of
original tissue.
• The original goal of all surgical procedure should be
regeneration which returns the tissue to their normal
microstructure and function.
• Repair is a healing outcome in which tissue do not return tp their normal
architecture and function
• Repair typically results in the formation of scar tissue
Types of wound healing
• Healing by first intention (wound with opposed edges)
• Healing by secondary intention (wounds with separated edges)
Healing by first intention (wound 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
Incisional wound repair
• The narrow incisional space immediately fills with clotted blood containing fibrin and
blood cells; dehydration of surface clots forms the well known scab that covers the
wound.
• Neutrophils appear at margins of incision, moving towards fibrin clots.
• Epidermis at its cut edges thickens as a results of mitotic activity of basal cells.
• Within 24 to 48 hours , spurs of epithelial cells from the both edges migrate and grow
along the cut margins of the dermis, depositing BM components as they move.
• They fuse in the midline beneath the surface scab, thus producing a continuous but thin
epithelial layers.
• By day 3 : Neutrophils replaced by macrophages
• Granulation tissue progressively invades incision space
• Collagen fibres are now present in the margins of the incision, but at first these are vertically oriented.
• Epithelial cells proliferation continues , thickening epidermal covering layer
• By day 5 : Incisional space is filled with granulation tissue
• Neovascularisation is maximal
• Collagen fibrils become more abundant and begin to bridge incision
• The epidermis recovers its normal thickness, and differentiation of surface cells yields a mature
epidermal architecture with surface keratinisation
During second week
• Continued accumulation of collagen and proliferation of fibroblast
• Leukocytic infiltrate, edema, and increased vascularity have largely disappeared.
By the end of first month
• Scar comprises a cellular tissue devoid of inflammatory infiltrate, covered now by intact
epidermis.
• Dermal appendages that have been destroyed in the line of incision are permanently lost.
• Tensile strength of the wound increases thereafter, but it may take months for the wound area to
obtain its maximal strength
Healing by secondary intention
• Wound with separate 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

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