Wound Healing Classification

Wound Healing

• A wound is a disruption of any tissue (soft tissue, bone, or internal organs)
• An ulcer is a disruption or break in the continuity of any lining (skin, mucous membrane, etc.)

Classification of Wounds

• Tidy wound
• Untidy wound:
  • Crushing
  • Tearing
  • Avulsion
  • Vascular injury
  • Multiple irregular wounds
  • Burns
• Clean incised wound: primary suturing
• Lacerated wound: ragged edges with some part of the tissues getting devitalized
• Bruise or contusion: blunt force to tissues wherein blood vessels are damaged underneath
• Hematoma: localized collection of blood after blunt trauma or after surgery
• Abrasion: superficial injury (scratch/graze/pressure/contact) where the surface is rubbed off

Classification of Surgical Wounds

• Clean wound:
  • Herniorrhaphy
  • Surgeries of the brain, joints, heart, transplant
  • Infective rate is less than 2%
• Clean contaminated wound:
  • Appendicectomy
  • Bowel surgeries, gastrojejunostomy
  • Gallbladder, biliary, and pancreatic surgeries
  • Infective rate is 10%
• Contaminated wound:
  • Acute abdominal conditions
  • Open fresh accidental wounds
  • Infective rate is 15-30%
• Dirty infected wound:
  • Abscess drainage
  • Pyocele
  • Empyema gallbladder
  • Faecal peritonitis
  • Infective rate is 40-70%

Wound Healing

• Wound healing is a complex method to achieve anatomical and functional integrity of disrupted tissue
• Types of wound healing:
  • Primary Healing (First Intention)
  • Secondary Healing (Second Intention)
  • Healing by Third Intention (Tertiary Wound Healing or Delayed Primary Closure)

Phases of Wound Healing

• Inflammatory Phase:
  • Begins immediately after formation and lasts for 72 hours
• Proliferative Phase (Collagen/Fibroblastic Phase):
  • Begins from the 3rd day and lasts for 3-6 weeks
• Remodelling Phase (Maturation Phase):
  • Begins at 6 weeks and lasts for 6 months to 1 or 2 years

Factors Affecting Wound Healing

• General factors:
  • Age, obesity, smoking, alcohol, stress
  • Malnutrition
  • Vitamin deficiency (Vit C, Vit A)
  • Anaemia, hypoxia
  • Malignancy
  • Uraemia
  • Jaundice
  • Diabetes, metabolic diseases
  • HIV and immunosuppressive diseases
  • Steroids and cytotoxic drugs
• Local factors:
  • Infection
  • Presence of necrotic tissue and foreign body
  • Poor blood supply
  • Tissue tension
  • Haematoma
  • X-ray irradiated area
  • Site of wound
  • Underlying diseases like osteomyelitis and malignancy
  • Mechanism and type of wound: incised/lacerated/crush/avulsion

Complications of Wound Healing

• Keloid:
  • Common in black and females
  • Extends into adjacent normal skin
  • Site: Common over the sternum
  • Other sites: upper arm, chest wall, front lower neck
  • Treatment: injection / intralesional excision
• Hypertrophic scar:
  • Anywhere in the body