Wound Healing Basics

Study Notes

Wound Healing

Wound healing is the mechanism by which the body attempts to restore the integrity of an injured part.

Components of Wound Healing

Wound contraction by myofibroblasts
Granulation tissue formation
Epithelialization

Stages of Wound Healing

Clotting/Hemostasis
Inflammatory Phase
Proliferation Phase
Maturation/Remodeling Phase

Types of Wound Healing

Healing by Primary Intention: results in a nice, neat scar; occurs in clean cut wounds and incisional wounds (surgical); minimal new tissue (minimal fibrosis)
Healing by Secondary Intention: gaping of the wound; occurs in contaminated wounds
Delayed Primary Closure (Tertiary): wounds that are contaminated, left open for 4-5 days, then surgically closed by sutures

Factors Affecting Wound Healing

General Factors:
- Age
- Nutritional Status: proteins, Vit.C, Vit.A., Zinc, Copper
- Chronic Diseases: DM, Renal, Hepatic, Malignant Diseases
- Drugs: Steroids, Chemotherapy
Local Factors:
- Vascularity (irradiation)
- Impaired venous drainage (postphlebitic limb)
- Tension (prevents contraction)
- Immobilization (shearing forces)
- Adhesion to bone
- Foreign bodies and necrotic tissues
- Infection

Wound Complications

Early Complications:
- Wound Infection
- Wound Hematoma
- Wound Seroma
- Wound Failure (dehiscence): wound gaps after wound closure
Late Complications:
- Ugly scar
- Hypertrophic scar
- Keloid
- Wound contractures
- Malignant transformation (Marjolin ulcer)

Wound Failure

Definition: wound gaps after closure
Causes:
- General factors
- Local and technical factors
- Postoperative course

Wound Seroma

Definition: collection of serous fluid in the wound
Causes wound swelling
Needs observation or treatment
Large or recollecting seroma is an indication of surgical evacuation

Wound Hematoma and Bleeding

Stop the bleeding and replace if needed
Bleeding may be minimal (Compression)
If a bleeder is identified, suture it
If bleeding affects the general condition, systemic and local management are needed

Scars

Definition: the inevitable consequence of wound healing
Final stage of wound healing is the stage of remodeling and scar formation
Superficial wounds heal with epithelialization without scarring

Adverse Scars

Wound contractures: decrease scar size with loss of tissue mobility due to skin adherence to the underlying tissue
Hypertrophic Scar:
- Overabundance of fibroplasia in the dermal healing process
- Occur after trauma
- Presented by tender- itching –burning sensation
- Predisposed by hematoma and infection
- Treatment: Excision and repair
Keloid Scar:
- Overabundance of fibroplasia in the dermal healing process
- Occur after trauma
- Presented by tender- itching –burning sensation
- Genetically autosomal dominant disease and more common in negros
- Rise above the skin level and extend beyond the border of the original wound
- Treatment: Excision with intralesional cortisol injection or excision with topical application of silicon sheet

Description

This quiz covers the fundamentals of wound healing, including definitions, types of wounds, components, stages, and factors affecting wound healing. It's designed for students of General Surgery at Badr University.