Académique Documents
Professionnel Documents
Culture Documents
healing ,wound
infection and
wound care
Section of Plastic Surgery
Definition of wound
Haemostasis.
Inflammation.
Proliferation.
Remodelling.
Sequence of events in
Haemostasis phase
The vessels constrict.
1. Physical injury
2. Antigen- antibody reaction.
3. Infection.
weeks.
1 - Epithelialization ---- Migration of keratinocytes across a
partial thickness wound to restore epidermal
continuity
Macrophages release growth factors which are
chemoattractant to fibroblasts.
2 - Fibroplasia ------- fibroblast migrate along network of fibrin
into the wound.
Fibroblasts secrete GAGs and produce collagen and
elastin.
When GAGs hydrated , become ground substance.
3 - Angiogenesis
Sequence of events in
remodelling phase
Begins 2-4 weeks after injury.
Contracture
A pathological manifestation of wound
contraction resulting in tissue shortening
that compromises joint mobility and function
(and potentially growth in children).
Fetal wound healing
1. Mobilization
2. Migration
3. Mitosis
4. Cellular differentiation.
Myofibroblast
First identified by
Gabbiani in 1971.
It resembles fibroblast
but also contain alpha-
actin smooth muscle.
This muscle fiber
responsible for wound
contraction.
Increased numbers of
myofibroblast are found
in abnormal
contracture.
Factors affecting wound
healing
Local factors
1. Blood supply.
2. Radiation.
3. Infection.
4. Trauma.
5. Nerve injury.
6. Foreign body.
7. Pressure.
8. Edema.
Factors affecting wound
healing
Systemic factors:
1. Nutrition.
2. Pharmacological -- steroids, chemotherapy.
3. Endocrine --- diabetes.
4. Medical --- jaundice, uraemia, cancer.
5. Age.
6. Smoking.
7. Toxins.
Factors affecting wound
healing
Congenital factors:
1. Ehlers Danlos.
2. Progeria.
3. Werners.
4. Epidermolysis bullosa.
5. Cutis laxa.
6. Pseudoxanthum elasticum
Ehlers Danlos
syndrome
Secondary intention.
Types of wounds
Abrasion / Friction.
Laceration.
Contusion.
Burns.
Punctured wound
Evaluate underlying
damage
Explore wound for
foreign body
Debride and leave open
or close depend on time
since bite and anatomic
location
Friction/abrasi
on
Cleanse to remove
foreign material
Consider scrub
brush/dermabrasion
to prevent traumatic
tattoos , should be
within 24 hours of
injury
Contusion
Consider need to
evacuate hematoma if
collection is present
Early : minimize by
cooling
with ice(24-48hrs)
blood
Burns wound
Manage according to
trauma protocol
Life threatening injuries
must give priorities
Major burns needs
admission and IV fluids
resuscitation
Full thickness
circumferential burns
around chest and arms
needs escharotomy
Wound on face
Important to use careful technique.
Amputated wounds :
Transfer of amputated part in proper way and in time.
Cheek injury:
Parotid duct and facial nerve injury.
Eyelids injury :
Align grey line and repair in layers
Ear injuries :
Cauliflower
Goal
Obtain a closed wound as soon as possible to
prevent infection,
fibrosis and secondary
deformity
Management of clean wound
General principles :
1. Immunization.
2. Pre-anaesthsia.
3. Local anesthesia.
4. Tourniquet.
7. Closure.
8. Dressing.
Contaminated wound
Difference between
contamination and wound
infection
Exceptions
1. Heavy bacterial contamination(human bite)
2. Long time lapse since wounding(relative).
3. Crush or ischemic tissue
4. Sustained high level of steroid ingestion
Antibiotics
Wound closure
5. Buried sutures
6. Monofilament skin sutures
7. Porous tape
Followup
.If doubt exists, it is always safer to delay the closure.
Classification of wound according
to associated risk of infection
Biological dressings :
Final closure :
6. With flap or skin graft
7. Convert the chronic contaminated wound bacteriologically to an acute clean
wound by debridement
Ideal characteristics of dressing
Available, absorptive.
Barrier (protective).
Epithelialization encouraged.
Flexible.
Non irritant.
Thank you