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Wound healing

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  • 1.WOUND HEALINGMBBS, Resident Plastic surgery, HMC, Peshawar ansoor Khan M

2. Complex & dynamic process of restoring cellular structures & tissue layers 3. SCARING Full thickness wounds EPITHELIZATION Partial thickness wounds HEALING w o u n dh e a l i n g 4. Phases of wound healing 5. Inflammatory phase (day1-4) 6. Limit blood loss Debridement Sealing the wound 7. Inflammatory phase Haemostasis Inflammation 8. Vessel damage ---- bleeding---- platelet plug ---- thromboxane A2 --- Vascular contraction and coagulation pathway activation --- fibrin frame work depositionHaemostasis (Activated by intrinsic & extrinsic pathways) 9. Inflammation Serotonin/Histamine --- increased vascular permeability TGF neutrophil chemotaxis, starts 6-8 hrs, max in 24 hrs Monocyte/ Macrophage max 3-4 days Phagocytosis, cytokines (IL-1, TNF), mediators (TGF, PDGF, FGF)Activated by platelet secretary products (PDGF, TGF, FGF, Serotonin, Histamine) 10. Proliferative Phase (day 4-21) 11. Filling wound gap with granulation tissue 12. EVENTS Fibroplasia, angiogenesis, contraction,re-epithelization 13. FIBROPLASIA Chemotactic TGF, PDGF, EGF, IL-1Fibroblasts peaks at 7 thdayCollagen & Matrix deposition,Wound contraction 10-21 days 14. ANGIOGENESIS Hypoxia, lactic acidosis, and FGF-1 (most potent), heparin, TGF, prostaglandinEndothelial cells proliferation 15. EPITHELIALIZATION Basal layers thickens, elongates andcells detaches and migrates 16. Tailoring the way reality lives Phase(day 21-2years) 17. S hrinkageL oss of oedemaS trengthS care contraction 18. EVENTS Regression of vessels & granulation tissue Wound contraction Collagen remodelling (replacing collagen III with I) Maximum strength at the 12 week 19. WOUND CONTRACTION Begin in the proliferative phase (4-5 thday) Continues throughout the healing process Maximum 10-21 day Brings edges close at a rate of 0.6-0.75mm/day Depends on the laxity of the skin 20. LOCAL FACTORS Venn diagram 21. RISK FACTORSRISK FACTORSSYSTEMIC RISK FACTORS RISK FACTORSRISK FACTORS 22. ISCHEMIA Wound healing is a highly energy dependant process 23. Sugar is the main fuel for wound healing ISCHEMIA 24. So it take a rich blood supply to heal a wound ISCHEMIA 25. Initial responseneo-vascularizationPersistent ischemia resultsin apoptosis 26. INFECTION Collagenase production and destruction of collagen 27. FOREIGN BODIES Acts a physical barrierAsylum for bacteriaInability to contractPrevent epithelization 28. HYPOTHERMIA Vasoconstriction and decreased blood supply 29. PAIN Adrenaline surge causing vasoconstriction 30. Keep the woundswet ,warmandcomfortable 31. SMOKING Vasoconstriction Which is not transient1 cigarette for 90 min1 pack for whole day 32. SMOKING Carboxihemoglobin---O2 carrying capacity.Subcutaneous PO2 33. 1 pack/ day--- 3 times increased chances of flap or graft loss 2 packs/day--- 6 times increased chances of loss of flaps and graftsSMOKING 34. 35. STEROIDS Lysosomal stabalization--- impaired phagocytosis Impairment of chemotaxis of microphages Fibroblast genome inhibition--- decreased collagen, decreased strength and increased dehiscence 36. HEALING SLOWS DOWN WITH AGING 37. CUTIS LAXA SYNDROME 38. EHLER-DANLOS SYNDROME 39. OSTEOGENESIS IMPERFECTA 40. FETAL WOUND HEALING (SCARLESS) ADULT:collagen production, remodelling, scar formation FETAL:Altered growth substances (Tenascin etc), absence of inflammation, deposition of hyaluronic acid rich matrix and deposition of organized collagen leading to regeneration 41.