wound healing
TRANSCRIPT
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WOUND HEALING
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WOUND- is a type of physical trauma wherein the
skin is torn, cut or punctured (open wound), or where blunt force trauma causes a contusion (closed wound).
- a break in the continuity of any bodily tissue due to violence is understood to encompass any action of external agency, including for example surgery.
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HEALING- act or process of curing or restoring the
wound.
- prevents the egress of irritants may result in continued tissue disruption and/or infection
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WOUND HEALING
- comprises a fundamental biological activity that involves both regenerative and reparative activities.
- functions to restore the disrupted or dead tissues to its normal state.
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* An ideal repair can be achieved in tissues undergoing constant renewal but is least effective in nerve & muscle tissue.
* Nerve undergo repair only when cell bodies are intact.
* Muscle tissue is repaired by fibrous connective (scar) tissue, with permanent loss of function.
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TYPES OF WOUND HEALING:
1. PRIMARY UNION
- healing by first intention- there is narrow space between the two cut surfaces of a wound- healing is completed in 2-3 weeks
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2. SECONDARY UNION
- healing by second intention- the two cut surfaces cannot be appointed- granulation tissue tend to heal the wound from the base of wound contraction.
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3. DELAYED UNION
- there is movement between the two fractured surfaces- infection- poor blood supply- pathogenic fractures
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PHASES:
1. Hemostasis2. Inflammation3. Granulation4. Remodelling
STAGES:
1. Inflammation2. Proliferative
(Regeneration)3. Maturation
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Factors Affecting Wound Healing:
1. Infection – promotes further inflammation & tissue destruction.
2. Foreign Bodies – stimulates inflammation, thereby impending the process of healing.
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3. Old Age – due to nutritional & vascular deficiencies and deteriorating immune system.
4. Nutritional Status – Vitamin C deficiency has been associated with impaired healing
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5. Concurrent Disease:
a. Vascular Disease – any disturbance to the blood supply of a tissue will result in delayed or impaired wound healing.
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b. Diabetes Mellitus – impaired blood supply, impaired PMN leukocytes function & increased susceptibility to microbial agents.
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c. Uremia – because of disturbance in inflammation response.
d. Blood Disease – hemorrhage at the site of tissue damage, resulting in large hematomas that predispose secondary microbial infection.
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PRIMARY UNION
- Narrow space between the 2 cut surfaces.
- Undergoes hemorrhage prior to clotting.
SECONDARY UNION
- Large gap between the 2 cut surfaces that cannot be appointed.
- Initial degree of hemorrhage followed by blood clot formation.
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PRIMARY UNION
- Margins of wound subsequently undergo mild inflammatory reactions releasing plasma and polymorphonuclear leukocytes into incised space.
SECONDARY
UNION
- Mild short-lived acute inflammatory reactions occur in the wound margins at the same time.
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PRIMARY UNION
- After approximately 24 hours, capillary blood vessels from wound margins begin to bud into the wound space & then are followed by both macrophages and fibroblasts.
SECONDARY
UNION- Granulation tissue
subsequently begins to move into the wound base & sides. (These tissue comprising capillary buds, fibroblasts, macrophages, plasma cells & lymphocytes.
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PRIMARY UNION
- Macrophages are primarily associated with phagocytosis of the wound debris & haemosiderin from hemoglobin breakdown.
SECONDARY
UNION
- Component cells ensure the removal of tissue debris, these cells include macrophages, fibroblasts & polymorphonuclear leukocytes.
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PRIMARY UNION
- Fibroblasts begin to form ground substances.
SECONDARY
UNION
- Fibrous tissue is laid down in the deeper layers of the wound. Granulation tissue tends to heal the wound from the base.
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PRIMARY UNION
- At the same time or a little earlier, epithelial cells from wound margins undergo mitosis & migrate toward center of wound thereby forming a complete but thin epithelial covering. (SCAB)
SECONDARY UNION
- Wound undergoes contraction, primarily reflecting fibroblastic activity. Thus edges of the wound is closed by granulation tissue & wound contraction thereby facilitating epithelial migration & mitosis. (SCAB)
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PRIMARY UNION
- Epithelium undergoes progressive maturation to regain its full thickness.
SECONDARY
UNION
- Excessive granulation is formed so that recently healed wound may appear proud of the adjacent tissue usually resolved in a few weeks.
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PRIMARY UNION
- Healing is usually complete by 2-3 weeks.
- A longer period may be required before there is complete restoration of the tissue architecture.
SECONDARY
UNION
- Complex interactions occur between epithelia & connective tissues:
CT formation – initially is essential for the restoration of normal epithelial continuity.
ET – subsequently may be responsible for the formation of connective tissue scar growth.
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Secondary Healing differs from Primary Healing in several aspects:
1. Large tissue defects initially have more fibrin & more necrotic debris & exudates that must be removed. Inflammation reaction is more intense.
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2. Much larger amount of granulation tissue is formed.
3. Phenomenon of wound contraction. That is, the defect is markedly reduced from its original size.
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