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Wound Healing
Wound healing has been proceed through several stages:
1) Hemostasis :-
Following disruption of normal anatomic structure of tissue, blood vessels are
divided, resulting in bleeding to variable extent.
Haemostasis starts in two ways :
1- Mechanical - where blood vessel contract that decrease its diameter
2- Clotting cascade by action of platelet and growth factor derived from and from
injured cells.
2) Inflammatory Phase :-
This phase is classically represented by signs & symptoms of:
Rubor - Redness
Tumor - Swelling
Calor - Heat
Dolor - Pain
Loss of function
Rednea caused by vasodilation to injured vessels. Swelling caused by leakage of
plasma protein to interstitial space after increasing blood flow that lead to increase
local temperature of wound.
Pain is provoked by mediators released from platelet of damaged tissue. Within hours
of wounding, the cellular aspect of the inflammatory response occurs.
A fibroblast is the workhorse of the wound repair process, responsible for the
formation of all the connective tissue components in the bleeding wound.
- The inflammation continues until wound closure occurs.
- The longer the wound remains in the inflammatory phase, the more extensive scar
tissue will be formed.
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3) Proliferative Phase - includes:-
a. Epithelialization, provide an effective barrier against bacteria, and it continues
till epithelial contact results. Epithelialization starts from wound edges at speed
of 1mm/day.
b. Contraction of wound: all wounds will contract by the effect of fibroblast &
Myofibroblast. Contraction is normal process.
c. Contracture is abnormal state that is excessive contraction at the joint surface.
d. Maturation or Remodeling phase: The wound will heal to scar, the scar will
mature over prlonged time, where the scar will be flatten and soft, redness will
fade, pruritus will disappear
Factors affecting wound Healing:-
1. Nutrition
Protein deficiency
vascularization, resistance to infection.
2. Vitamin C.
Cofactor for collagen synthesis.
3. Vitamin A.
Important in epithelial multiplication.
4. Vitamin E.
Its effect is unknown, but deficiency will impair healing.
5. Oxygen
Essential substance for effective wound.
6. Necrotic tissue & hematoma delay wound healing.
7. Bacterial count.
10
/gm competable with healing.
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Scar
A scar is a mark remaining after healing of a wound, the lay population often refers to
a scar as an unsighty healed wound; conversely surgeons tend to think of surgical scar
as an expected outcome of violation of the dermis. so the scar is the inevitable
consequence of wound repair.
The ideal scar:
1) Flat and in same level with surrounding skin.
2) Color match with surrounding skin.
3) Should be narrow.
4) Should be parallel or within favorable skin lines.
Adverse scar:
There are many types of adverse scar:
1) Wrong direction, scar along the joint.
2) Poor alignment of features as vermilion border scar.
3) Stretched scars.
4) Depressed scars.
5) Pigment alteration.
6) Tattoing.
7) Stitch marks may lead to rail road apperance.
8) Hypertrophic scars.
Arranged by: Mustafa Hürmüzlü