Dressings
Dressings protect the wound from further trauma and provide a moist environment for healing and antibacterial. Sometimes, in addition to a wet dressing or medicinal cast or splint is made in the affected limb. If the aberrant healing is suspected, a compression bandage can be used to remove scar hypertrophy. Dressing changes on a regular basis is essential to prevent infection and optimize wound healing.
1) Ideal Dressing
Provide protection against further injury or infection
Allows movement of the joints and body parts proximal to the wound
Has some compression on the wound to control bleeding and scarring
Absorbs the liquid flowing from the wound
Ultimately help to improve the aesthetic result of the scar resulting
Showing posts with label Healing Of Wounds. Show all posts
Showing posts with label Healing Of Wounds. Show all posts
Friday, 26 August 2011
Abnormal Wound Healing
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| Abnormal Wound Healing |
Stay within the boundaries of the original scar
Common areas of occurrence are the back, shoulders or sterum
Red is often raised and itchy
Resolves with time and often treated conservatively
2) keloid scars
Extend beyond the borders of the original scar
The public areas are of appearance of the sternum, the deltoid and the earlobe
More often the case with the very pigmented
Not heal spontaneously and demand treatment with bandages pressure, surgery, radiotherapy or topical steroids, relapses are common.
3) Chronic wounds
Laceration and open claims over 24
Require débribement, irrigation, and healing by secondary intention or tertiary
Wound sepsis is determined by counting the total number of bacteria per gram of tissue load (> 105 bacteria / gram of tissue)
Systemic antibiotics are not useful, however, antibiotic topical cream (silver sulfadiazine, bacitracin, Neosporin) for areas of partial thickness loss can be helpful. Note that some of these agents inhibit epithelialization and the early stages of wound healing
Biological dressings can be used
The final closing will take place until the bacterial contamination is controlled
The deep sutures should be minimized and monofilament. If signs of infection is in the revaluation, which is part of the wound is opened by removing the sutures
Types of Wound Healing
The types of wound healing
1.) Healing by first intention
The primary wound healing or primary closure
Describes the wound closed, the approximation of the margins of the wound or graft or flap investment, or the wounds created and closed in the operating room.
The best choice for the fresh wounds of well vascularized areas
Indications include recent (<24 years), clean wounds, where the viable tissue is free of tension and rapprochement and eversion of skin edges are feasible.
The injury is treated with irrigation and débribement and tissue margins are calculated using simple methods or sutures, grafts or flaps.
The wounds are treated within 24 hours after injury, before the development of granulation tissue.
Final appearance of a scar depends on: his initial injury, the amount of pollution, and ischemia as well as the method and accuracy of the wound, but they are often faster and more aesthetically pleasing to healing.
2). Healing by second intention
secondary healing or spontaneous recovery
Describes an open wound, and allowed to close by epithelialization and contraction.
Commonly used in the treatment of contaminated or infected wounds.
The open wound is healing without surgery.
Indicated in highly contaminated or infected wounds.
Unlike the primary lesion, the approximation of the edges of the wound is re-epithelialization and wound contraction by myofibroblasts.
The presence of granulation tissue.
Late complications are wound contracture and hypertrophic scars
3.) Healing by third intention
tertiary delayed healing or primary closure
Useful for the management of wounds that are too badly contaminated with primary closure, but seems clean and well vascularized after 4-5 days of observation open. During this period, the inflammatory process reduces the concentration of bacteria from the wound to allow secure closure.
Subsequent repair of a wound initially left open or not previously treated.
Indicated for infected wounds or unhealthy with a high content of bacterial, wound with a length of time since the injury, or serious injury with a crushing component with significant devitalized tissue.
Often used in infected wounds, where the number of bacteria, the main obstacle for the closure and the inflammatory process can be left débribe wounds.
Wound edges are approximated within 3-4 days, and the tensile strength developed with primary closure.
4) partial thickness wounds
The wound is superficial, does not penetrate the entire dermis.
Type of healing seen with first-degree burns and abrasions.
Healing occurs mainly by epithelialization fall of skin elements.
Unless the secondary recovery of contraction of full thickness wounds
Low production of collagen and scar tissue formation
1.) Healing by first intention
The primary wound healing or primary closure
Describes the wound closed, the approximation of the margins of the wound or graft or flap investment, or the wounds created and closed in the operating room.
The best choice for the fresh wounds of well vascularized areas
Indications include recent (<24 years), clean wounds, where the viable tissue is free of tension and rapprochement and eversion of skin edges are feasible.
The injury is treated with irrigation and débribement and tissue margins are calculated using simple methods or sutures, grafts or flaps.
The wounds are treated within 24 hours after injury, before the development of granulation tissue.
Final appearance of a scar depends on: his initial injury, the amount of pollution, and ischemia as well as the method and accuracy of the wound, but they are often faster and more aesthetically pleasing to healing.
2). Healing by second intention
secondary healing or spontaneous recovery
Describes an open wound, and allowed to close by epithelialization and contraction.
Commonly used in the treatment of contaminated or infected wounds.
The open wound is healing without surgery.
Indicated in highly contaminated or infected wounds.
Unlike the primary lesion, the approximation of the edges of the wound is re-epithelialization and wound contraction by myofibroblasts.
The presence of granulation tissue.
Late complications are wound contracture and hypertrophic scars
3.) Healing by third intention
tertiary delayed healing or primary closure
Useful for the management of wounds that are too badly contaminated with primary closure, but seems clean and well vascularized after 4-5 days of observation open. During this period, the inflammatory process reduces the concentration of bacteria from the wound to allow secure closure.
Subsequent repair of a wound initially left open or not previously treated.
Indicated for infected wounds or unhealthy with a high content of bacterial, wound with a length of time since the injury, or serious injury with a crushing component with significant devitalized tissue.
Often used in infected wounds, where the number of bacteria, the main obstacle for the closure and the inflammatory process can be left débribe wounds.
Wound edges are approximated within 3-4 days, and the tensile strength developed with primary closure.
4) partial thickness wounds
The wound is superficial, does not penetrate the entire dermis.
Type of healing seen with first-degree burns and abrasions.
Healing occurs mainly by epithelialization fall of skin elements.
Unless the secondary recovery of contraction of full thickness wounds
Low production of collagen and scar tissue formation
Types Of Wounds
Types of wounds
1) injuries - injuries in which the fabric is cut or torn. Treatment, the fabric must be first cleaned of any blood clots and foreign substances, débribed and watered. Local anesthetic is administered, and atraumatic technique works in the wound where the wound margins are carefully realigned the prevention of crush injury to other tissues. Sterile dressing is applied and immobilization is recommended for complex wounds of the head.
2) abrasion - where damage is removed the surface layer of the fabric, as seen with first degree burns. The wound is clean of all guests, sometimes using a brush to prevent traumatic tattoos and dirt and gravel, and must be made in the early days of the injury. Local anesthetic may be used for pain, but the treatment is non-surgical wound, wet dressings and topical antibiotic to protect the wound and to support the healing process.
3) Bruising injuries. resulting from a coup of the skin and soft tissue, but leaving the outer layer of intact skin. These injuries usually require a minimum of attention because there is an open wound. However, the strokes should be evaluated for possible hematoma deep to the surface or other tissue damage that may indicate a more serious illness. An expanding hematoma can damage the skin cover and drainage applications.
4) avulsions - Lesions in which the fabric is torn off, in whole or in part. In a partial avulsion, the tissue is high, but it is attached to the body. Total avulsion means that the tissue is completely torn from the body without a point of attack. In case of partial avulsion of the torn fabric is still well vascularized and viable tissue is carefully cleaned and irrigated and the flap is reattached to its anatomical position in some stitches. If the torn fabric is inanimate, it is often removed and the wound is closed with a skin graft or local flap. In the case of avulsion of all, the fabric is often very thick and requires debulking of the fat content and methods before it can be regrafted. Important to describe avulsion amputation of limbs, fingers, ears, nose, scalp, or eyelids, and require a new treatment plant of the team.
1) injuries - injuries in which the fabric is cut or torn. Treatment, the fabric must be first cleaned of any blood clots and foreign substances, débribed and watered. Local anesthetic is administered, and atraumatic technique works in the wound where the wound margins are carefully realigned the prevention of crush injury to other tissues. Sterile dressing is applied and immobilization is recommended for complex wounds of the head.
2) abrasion - where damage is removed the surface layer of the fabric, as seen with first degree burns. The wound is clean of all guests, sometimes using a brush to prevent traumatic tattoos and dirt and gravel, and must be made in the early days of the injury. Local anesthetic may be used for pain, but the treatment is non-surgical wound, wet dressings and topical antibiotic to protect the wound and to support the healing process.
3) Bruising injuries. resulting from a coup of the skin and soft tissue, but leaving the outer layer of intact skin. These injuries usually require a minimum of attention because there is an open wound. However, the strokes should be evaluated for possible hematoma deep to the surface or other tissue damage that may indicate a more serious illness. An expanding hematoma can damage the skin cover and drainage applications.
4) avulsions - Lesions in which the fabric is torn off, in whole or in part. In a partial avulsion, the tissue is high, but it is attached to the body. Total avulsion means that the tissue is completely torn from the body without a point of attack. In case of partial avulsion of the torn fabric is still well vascularized and viable tissue is carefully cleaned and irrigated and the flap is reattached to its anatomical position in some stitches. If the torn fabric is inanimate, it is often removed and the wound is closed with a skin graft or local flap. In the case of avulsion of all, the fabric is often very thick and requires debulking of the fat content and methods before it can be regrafted. Important to describe avulsion amputation of limbs, fingers, ears, nose, scalp, or eyelids, and require a new treatment plant of the team.
Stages In Healing Of Wounds
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| Stages In Healing Of Wounds |
1.) Inflammatory Phase
The first response to injury
1-4 day after injury
Characterized by redness, cancer, pain, heat
Platelet aggregation and activation
Press leukocytes (neutrophils, macrophages), migration, phagocytosis and mediator
Dilation of the veins
Lymphatic blockade
Exudative
Wounds closed primary purpose, it will take 4 days
In wounds closed by secondary intention or tertiary continues until complete epithelialization
2). Proliferative phase
4-42 Day
Fibroblast proliferation stimulated macrophages release growth factors
The increased amount of collagen synthesis in fibroblasts
Granulation tissue and neovascularization
Gains tensile strength
3.) Remodeling Phase
6wks-1 year
Intermolecular cross-linking of collagen through the vitamin C-dependent hydroxylation
Characterized by an increase in tensile strength
Type III collagen type I was replaced
Scar surfaces
Healing Of Wounds
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| Healing Of Wounds |
In the inflammatory phase, bacteria and debris are phagocytized and removed, and the factors that are released that cause migration and division of cells involved in the proliferative phase.
The proliferative phase is characterized by angiogenesis, collagen deposition, the formation of granulation tissue, epithelialization, angiogenesis and wound contraction.In, formation of new blood vessels by fibroplasia cells.In the vascular endothelium and tissue formation granulation, fibroblasts grow and form a new provisional extracellular matrix (ECM) by secreting collagen and fibronectin.Concurrently, re-epithelialization of the epidermis is where skin cells proliferate and drags on above the wound, provides coverage for the new tissue.
In the contraction, the wound is smaller by the action of myofibroblasts, which establish a grip on the wound edges and contract using a mechanism similar to that of smooth muscle cells. When the roles of the cells are close to complete, redundant apoptotic cells.
The maturation and remodeling phase, collagen is a redesigned and reorganized along lines of tension and the cells that are no longer needed removed from apoptosis.
However, this process is not only complex but fragile and susceptible to interruption or failure leading to the formation of chronic nonhealing wounds. Factors that may contribute to this include diabetes, venous or arterial disease, aging, and infection.
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