Chronic Inflammation & Wound Healing PDF

Chronic Inflammation Intended Learning Outcomes By the end of this session students should be able to: ▪ Revise the signs of inflammation. ▪ Describe chronic inflammation and the impact this may have on the patient and clinician ▪ Explain contributing factors to chronic inflammation ▪...

Chronic Inflammation Intended Learning Outcomes By the end of this session students should be able to: ▪ Revise the signs of inflammation. ▪ Describe chronic inflammation and the impact this may have on the patient and clinician ▪ Explain contributing factors to chronic inflammation ▪ Compare acute and chronic inflammation ▪ Be aware of how chronic inflammation impacts dentistry - orally and systemically 2 Types of Inflammation Inflammation Acute Chronic Inflammation Inflammation 3 4  Acute Inflammation Chronic Inflammation Due to early response by the body Occurs after a delay Short duration Longer duration Image from Waldem website Feb Image from Glendale 2021 periodontics website Feb 2021 5 6 Consider the causative factors 7  Considerations of Chronic Inflammation ▪ Process is longer ▪ Therefore likely to have more tissue damage ▪ Main inflammatory cells are lymphocytes (what is it in acute inflammation)? ▪ You can see a more fibrotic appearance – why? ▪ The host defence cannot clear the insult – so what can it do? ▪ Granuloma 8 Granulomatous How is this enlarge area surviving? Nutrients etc? 9 Comparison of acute and chronic inflammation 10 11 As a healthcare clinician what challenges do you forsee for patients with chronic conditions? 12 Wound Healing 13 Intended learning outcomes By the end of the session students should be able to: ▪ List and give examples of the causes of ‘wounds’ ▪ Explain risk factors that predispose an individual to develop a wound ▪ Define the different types of wounds ▪ Offer appropriate terminology to describe a wound ▪ Describe the stages primary, secondary and tertiary intention (healing) ▪ Recognise complications associated with wound healing 14 Causes of ‘wounds’ Surgical Trauma Pressure incisions Friction Poor circulation 15 Risk factors for developing a wound Types of wounds Medical therapies (steroids, Broken ▪ Intentional skin chemo, radiation) ▪ Unintentional Disease Age process (acute or (young or old) ▪ Open wound chronic) ▪ Closed wound Hereditary Nutrition ▪ Clean wound status ▪ Contaminated Stress ▪ Infected 16 Description of wounds Abrasion Contusion Incision Penetrating Puncture Laceration wound wound 17 Factors influencing tissue healing Wound is free from foreign Extent of bodies & damage pathogens Body’s Health status response 18 Stages of wound healing 19 Stages of Wound Primary Healing (first intention) - Regeneration Inflammation Proliferative Maturation 20 Inflammation - Primary healing (1st intention) ▪ 1st few hours wound becomes inflamed & blood clot forms ▪ Cell debris / platelet fill the space ▪ Cellular involvement of: 1. Phagocytes – macrophages 2. Fibroblasts What will you see? Feel? 21 Proliferation - Primary healing (1st intention) ▪ Epithelial cells profileration across wound to begin closure process and replace damaged cells. ▪ Starts before end of inflammatory stage (so overlapping) 1. Angiogenesis 2. Granulation tissue 3. Contraction ▪ Clot becomes a scab & separates after 3 – 10 days 22 Maturation - Primary healing (1st intention) ▪ Collagen starts to degrade as soon as produced ▪ When collagen production equals degradation, maturation phase starts ▪ Can last for a year or more ▪ Stronger collagen laid down ▪ Excess blood vessels removed and scar loses redness 23 Stages of Wound Secondary Healing (second intention) – Repair Inflammation Proliferative Maturation 24 Inflammation - Secondary healing (2nd intention) ▪ Inflammatory reaction is more intense. ▪ Necrotic tissue – slough on top of wound. ▪ Healing by indirect union of granulating surfaces 25 Proliferation - Secondary healing (2nd intention) ▪ Similar process as primary but more intense ▪ Phagocytes ▪ Bloody supply is plentiful – reduce or prevent infection ▪ Granulation tissue forms at base of cavity ▪ Fibroblasts in convert to myofibroblasts to start contraction process 26 Maturation - Secondary healing (2nd intention) ▪ Collagen laid down horizontally ▪ Wound contraction pronounced ▪ Tissue uneven (scar tissue) 27 Comparing primary & secondary intention 28 Tertiary Healing 29 Factors affecting wound healing Local Systemic Age & Ischemia Alcoholism gender Foreign Hormones Nutrition body Immuno- Infection Stress compromised Diseases & Medication e.g. Obesity 30 Complications of wound healing Haemorrhage Infection Dehiscence Fistula Keloid scar 31  Image references ▪ http://archive.jpda.com.pk/volume-18-issue-1/multidisciplinary-treatment-in-a-patient-with-nifedipine-induced-gingival-enlargement/ ▪ https://insideouthealthwellness.com/how-to-combat-chronic-inflammation/ ▪ https://www.sciencedirect.com/science/article/pii/S1870199X18300156 ▪ https://en.wikipedia.org/wiki/Tuberculosis_radiology ▪ https://www.cohenmedical.com/chronic-inflammation/ ▪ https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/ ▪ https://mealsandmiles.com/2012/04/04/runner-down/ ▪ https://www.msdmanuals.com/en-gb/professional/multimedia/image/v34540251 ▪ https://www.medicalnewstoday.com/articles/325533 ▪ https://advancedtissue.com/2013/12/caring-diabetic-foot-ulcers/ ▪ https://www.cpcmg.net/cuts-scrapes-wise-advice-urban-legends/ ▪ https://www.thinglink.com/scene/640187830496133120 ▪ https://www.infobloom.com/what-is-a-suture.htm ▪ https://lacerationrepair.com/wound-blog/absorbable-sutures/ ▪ https://www.sciencephoto.com/media/264214/view/close-up-of-penetrating-stab-wound ▪ https://www.stopfootpaintoday.com/library/puncture-wounds-foreign-objects-in-foot.cfm ▪ https://www.cpcmg.net/cuts-scrapes-wise-advice-urban-legends/ ▪ https://www.thinglink.com/scene/640187830496133120 ▪ https://www.infobloom.com/what-is-a-suture.htm ▪ https://lacerationrepair.com/wound-blog/absorbable-sutures/ ▪ https://www.sciencephoto.com/media/264214/view/close-up-of-penetrating-stab-wound ▪ https://www.stopfootpaintoday.com/library/puncture-wounds-foreign-objects-in-foot.cfm ▪ https://quizlet.com/259935142/surgery-surgical-wound-healing-flash-cards/ 32