Factors Affecting Wound Healing
Write briefly on factors inflencing wound healing.
Answer.
General Factors
General factors affcting wound healing are as follows:
- Age
- Malnutrition
- Vitamin defiiency (Vitamin C, Vitamin A)
- Anemia
- Malignancy
- Uremia
- Jaundice
- Diabetes, metabolic diseases
- HIV and immunosuppressive diseases
- Steroids and cytotoxic drugs
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Age: In younger age group, wound healing is faster and better while in elderly healing is delayed due to reduction in collagen synthesis, epithelialization, growth factors and angiogenesis.
But fial scar will be excellent in old individuals.
Malnutrition and Vitamin deficiency: Adequate vitamins,trace elements, fatty acids and proteins are essential for wound healing. Vitamin A deficiency affects monocyte activation, inflammatory phase, collagen synthesis and growth factor actions.
Vitamin K deficiency affects synthesis of prothrombin (ll), factors VII, IX and X. Vitamin E, being an antioxidant stabilizes the cell membrane.
Vitamin C defiiency impairs collagen synthesis, fibroblast proliferation and angiogenesis; increases the capillary fragility and susceptibility for infection.
Vitamin K deficiency affects synthesis of prothrombin (ll), factors VII, IX and X. Vitamin E, being an antioxidant stabilizes the cell membrane.
Vitamin C defiiency impairs collagen synthesis, fibroblast proliferation and angiogenesis; increases the capillary fragility and susceptibility for infection.
Zinc is an essential cofactor for RNA and DNA polymerase;magnesium is a co-factor for synthesis of proteins and collagen;copper is a required co-factor for cytochrome oxidase.
Anemia: Hemoglobin less than 8% causes poor oxygenation of tissues preventing healing of the wounds.
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Diabetes mellitus: In diabetic patients, wound healing is delayed because of several factors such as microangiopathy, atherosclerosis, decreased phagocytic activity, proliferation of bacteria due to high blood sugar, etc.
Metabolic causes: Obesity causes hypoperfusion, reduced microcirculation, increased wound tension, and hence prevents wound healing.
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Jaundice and uremia: Jaundiced and uremic patients have poor wound healing because firoblastic repair is delayed.
HIV and immunosuppressive diseases and malignancy: HIV and immunosuppression of varying causes, malignancy leads into poor wound healing.
Drugs: Steroids interfere with activation of macrophages,firoblasts and angiogenesis in the early phase of healing (proliferative).
Non-steroidal anti-inflammatory drugs (NSAIDs) decrease collagen production.
Chemotherapeutic agents used in oncology inhibit cellular proliferation, protein synthesis.
Alcohol consumption decreases the phagocyte response and proinflmmatory cytokine release; diminishes host response and thus increasing the infection rate.
Non-steroidal anti-inflammatory drugs (NSAIDs) decrease collagen production.
Chemotherapeutic agents used in oncology inhibit cellular proliferation, protein synthesis.
Alcohol consumption decreases the phagocyte response and proinflmmatory cytokine release; diminishes host response and thus increasing the infection rate.
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Local Factors
Local factors affcting wound healing are as follows:
- Infection
- Presence of necrotic tissue and foreign body
- Poor blood supply
- Venous or lymph stasis
- Tissue tension
- Hematoma
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- Large defect or poor apposition
- Recurrent trauma
- X-ray irradiated area
- Site of wound
- Underlying diseases such as osteomyelitis and malignancy
- Mechanism and type of wound-incised/lacerated/crush/avulsion
- Tissue hypoxia locally reduces macrophage and firoblast activity
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Wound infection: Infection prolongs inflmmatory phase,releases toxins and utilizes vital nutrients thereby prevents wound epithelialization. The β-hemolytic streptococci more than 105 per gram of tissue prevent wound healing. Formation of biofilm on the wound surface by microorganisms prevents wound healing.
Presence of necrotic tissue and foreign body: Necrotic tissue and foreign bodies such as sutures cause intense inflammatory reaction and infection.
Poor blood supply: Improper blood supply to wound delays wound healing.
Tissue tension: It affects quantity, aggregation and orientation of collagen fiers.
Hematoma: It precipitates infection and delays wound healing.
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Hypoxia: Hypoxia prevents firoblast proliferation and collagen synthesis; it also promotes bacterial invasion into the wound.
Site of wound: Movement of wound area delays wound healing. e.g. wound over the joints and back has poor healing.
X-ray irradiated area: Both external radiotherapy or ionizing radiation cause endarteritis, fibrosis and delay in wound healing. Radiation may itself cause local tissue necrosis, sepsis and hypoxia.
Poor apposition: Poor apposition leads to the infection in the wound area which delays healing.
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