Académique Documents
Professionnel Documents
Culture Documents
1. Clean Wounds
a. Surgical Procedure thru skin cleaned
with disinfectant
b. No entry to GIT, Respiratory Tract &
Urinary Tract
c. Infection rate less than 2%
3. Contaminated Wounds
a. Major CONTAMINATION
b. Infection rate-less than 5%
4. Infected Wounds
a. Established infection before
a wound is made
b. Infection rate -50% or more
B. Mechanisms Involved in Wound Healing
1.Epithelization
Epithelialization
This process is characterized primarily by
proliferation and migration of epithelial
cells adjacent to the wound
Epithelialization
Marginal basal cells at edge of the wound
lose their firm attachment to underlying
dermis, enlarge, and begin to migrate across
surface of the provisional matrix.
Fixed basal cells near the cut edge undergo
a series of rapid mitotic divisions, and they
appear to migrate by moving over one
another in a leapfrog fashion until the
defect is covered.
C. Phases of Wound Healing
Epithelialization
1.Epithelization
Stitch Abscess
Epithelial migration also occurs in the
suture tracts. Contact with connective
tissue causes KERATINIZATION which
induces an intense localized
inflammatory reaction.
B. Mechanisms Involved in Wound Healing
2. Contraction
a. Does not begin until the 4th day.
2. Contraction
2. Migratory phase
a. Macrophages clear debris and
bacteria. It also releases growth
factors.
b. Fibroblast migrate to the wound to
begin the healing process.
c. Hypoxia & wound growth factors
stimulates neo-vascularization.
d. Epithelization
C. Phases of Wound Healing
3. Proliferative phase
a. Fibroblast that have migrated to the
wound begin to form collagen &
wound strength begins to increase
3. Proliferative phase
d. Tensile Strength
Strength /unit of Scar(5th) day.Refers
to load applied per unit of cross section
area in lbs/in2 or kg/cm
2
e. Burst Strength
Strength of the entire wound. Increase
in strength is rapid for 17 days & slow
for the next 10 days. Amount of pressure
necessary to rupture a viscus.
C. Phases of Wound Healing
3. Proliferative phase
4. Remodeling Phase
a. Wound essentially healed with scar.
Haphazardly laid down collagen breaks
down and new collagen is laid down along
the line of stress.
1. Primary Intention
a. Suture right after Surgery or after wounding.
2. Secondary Intention
No suturing
wound allowed to granulate
(+) Epithelization & Wound Contraction
Dirty Wounds
Abscess & heavily infected wounds or
Carbuncle
Miles Operation
Fistulectomy
D. Types of Wound Closure
3. Tertiary Intention
These includes:
1. Proteases
2. Enzymes
3. Proteoglycans
4. Attachment glycoproteins
PDGF
Is one of several platelet-derived growth
factors and initiates many healing events.
Its functions include chemotaxis for
fibroblasts and macrophages as well as
smooth muscle cells.
TGF-B
Produced by platelets.
It increases collagen synthesis specifically by
enhancing matrix gene expression & by
inhibiting collagenase production and activity.
Excessive amount is extremely important in the
pathophysiology of fibrotic states such as keloid
and hypertrophic scar.
F. Extracellular Matrix Metabolism
Glycosaminoglycans, Proteoglycans,
Fibronectin, Laminin, Elastin
F. Extracellular Matrix Metabolism
Steps in Synthesis
A. Transcription- where the amount of RNA
for the specific collagen is controlled
B. Translation- where actual synthesis
occurs on ribosomes on the rough
endoplasmic reticulum
Degradation
Mammalian Collagenase coming from:
Inflammatory Cells
Fibroblast
Epithelial Cells
F. Extracellular Matrix Metabolism
Ground Substance -Proteoglycans
composed of glycosaminoglycans sub-
units attached by covalent bonds to a
protein core. Form bottlebrush-like
structure and as macromolecules, occupy
significant space in the extracellular
matrix.
Functions
Molecular shock Absorbers
Provide for moisture storage
Sequester cytokines
F. Components of Extracellular Matrix
COMPONENT FUNCTION
Chronic wounds
1. Silk
a. Most commonly used suture material
b. Protein filament produced by silkworm
c. Silk losses much of its Tensile strength when
exposed to moisture and should be used dry
Types of Suture Materials
II Non-Absorbable Sutures-
2. Cotton
a. Stimulates an inflammatory reaction greater than
silk
b. Much cheaper than silk
Types of Suture Materials
II Non-Absorbable Sutures-
3. Nylon
a. Comes in monofilament and a braided form
b. High tensile strength and extremely low tissue
reaction
c. The loss in Tensile strength is in the range of
15-20% per year by hydrolysis
Types of Suture Materials
II Non-Absorbable Sutures-
4. Polypropylene
a. Synthetic monofilament suture
b. Tensile strength retention is indefinite
c. Suture encapsulated by tissue
Types of Suture Materials
II Non-Absorbable Sutures-
5. Polyester
a. First synthetic braided suture material shown to
last indefinitely in tissues
c. Blood loss
d. Tissue manipulation and Trauma
Facilitating postoperative healing
Edema and inflammation associated w/ manual
suturing significantly reduced
Types of Suture Materials
Films-
Mimic skin performance
Hydrocolloids-
Absorbs fluid
Debrides soft necrotic tissue
Protects wound
WOUND DRESSINGS
Hydrogels
Creates moist environment
Foams
Debrides
High absorbancy rates
WOUND DRESSINGS
Impregnates
1. Malnutrition
2. Diabetes
3. Steroids
4. Chemotherapy
5. Vitamin C deficiency
6. Zinc deficiency