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5/12/2018 Pa Tho Physiology of Wound Healing.ppt Rao 3 - slidepdf.com
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Pathophysiology of
Wound HealingDr jayneshthra rao
HTF
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Wound Healing
Replacement of destroyed or lost tissueby a viable tissue
Regeneration is the replacement ofthe lost tissue by a tissue of the sametype.
Repair is replacement of the destroyedtissue by a fibrous scar.
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Stages of wound healing byprimary intention
Day 1
Wound filled with blood clot.
Acute inflammation in the surroundingtissue .
Proliferation of epithelial cells.
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Day 5Collagen deposition
Day 7
Sutures removed
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Delayed primary Closure
Wound initially left open & later primaryclosure.² Dirty and infected traumatic wounds² Extensive tissue loss.
² High risk of infection.
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Healing by 2nd intention
No formal wound closure.
Heal by granulation tissue formation.
Tissue loss / gross wound contamination.
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Wound healing by 2nd intention
The process is similar to healing by primaryintention but only slower due to massive lossof tissue.
The inflammatory reaction is more intense. There is more scarring.
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Wound healing by 2nd intention
Wound left open & heals largely by:
± Formation of granulation tissue.
± Contraction
Occurs in a wound with extensive loss of soft tissue.
± Severe burns.
± Abscess cavities & ulcer.
Ingrowth of granulation tissues from wound marginfollowed by accumulation extracellular matrix with laying
down of collagen).
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STAGE 1
HEMOSTASIS
STAGE 2
INFLAMMATION
STAGE 3
GRANULATION
STAGE 4MATURATION
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Phases of Wound Healing
Carefully regulated systemic cascade ofoverlapping processes that requirecoordinated completion of variety of cellular
activities. This process involves 4 overlapping phases.
² Hemostasis (immediate)
² Inflammation (early day 1-2, late day 2-3)
² Proliferation (day 3 to week 2)
² Remodelling & Scar maturation (1 to several weeks)
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Phases of Wound Healing
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Inflammatory Phase
Haematoma formation
Infiltration by neutrophils
Infiltration by macrophages
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Proliferative Phase
Epidermal regrowth
Dermal repair
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Remodelling Phase
Replacement of the granulation tissue by afibrous tissue
Remodelling of connective tissue to achieve
wound strength Extracellular matrix > collagen > scar
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Wound Strength
After sutures are removed at oneweek, wound strength is only 10% of
unwounded skin ( Walker·s Law)
B y 3-4 months, wound strength is
about 80% of unwounded skin(Walker·s Law)
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Factor That Impedes Wound
Healing Local² Inadequate blood supply
² Increase skin tension
² Poor venous drainage² Presence of foreign body
² Presence of slough or non viable tissue
² Infection
² Excess local mobility
² Underlying osteomyelitis
² Malignant transformation (Marjolin·s ulcer)
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Factor That Impedes Wound
Healing Systemic² Advancing age and general immobility
² Obesity
² Malnutrition² Deficiency in protein and vitamins
² Systemic malignancy and terminal illness
² Anemia
² Chemotherapy/ Radiotherapy
² Immunosuppresion drugs (corticosteroid)
² Organ failures.
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Abnormal Wound Healing
Non healing wound
² Chronic wound which normal process of healing is
disrupted at one or more points.² Predisposing factors:
Changes in the profile and activities of the cells
Alteration in the composition ECM
Failure of epithilialization
Presence of free radicals and microorganism.
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Abnormal Wound Healing
Excessive wound healing² Hypertrophied scar:
wound crosses tension line
Areas of increase tension & movement in skin.
Deep dermal burns
Wounds heal by secondary intention ( >3 weeks)
² Keloids Do not have specific cause although genetic
predisposition is implicated
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Hypertrophic scar
Excessive build up of scar tissue confined tothe initial boundary of the wound
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KeloidExcessive build up of scar tissue that
invades the normal skin beyond the originalboundary of the wound
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Thank you