Wound Healing
Classify wound and describes in detail the stage of wound healing.
Answer.
Wound is discontinuity or break in epithelium.
A wound is break in the integrity of skin or tissues often which may be associated with disruption ofthe structure and function.
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Classification Of Wound
Rank And Wakefield Classification
Tidy wounds:
- They are wounds such as surgical incisions and wounds caused by sharp objects.
- It is incised, clean, healthy wound without any tissue loss.
- Usually, primary suturing is done. Healing is by primary intention.
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Untidy wounds:
- They are due to crushing, tearing, avulsion, devitalised injury, vascular injury, multiple irregular wounds, burns.
- Fracture of the underlying bone may be present.
- Wound dehiscence, infection, delayed healing are common.
- Liberal excision of devitalized tissue and allowing to heal by secondary intention is the management.
- Secondary suturing, skin graft or flp may be needed.
Classification Based On Type Of Wound
- Clean incised wound
- Lacerated wounds
- Bruising and contusion
- Hematoma.
- Closed blunt injury.
- Puncture wounds and bites.
- Abrasion
- Traction and avulsion injury.
- Crush injury
- War wounds and gunshot injuries.
- Injuries to bones and joints, may be open or closed.
- Injuries to nerves, either clean cut or crush.
- Injuries to arteries and veins (major vessels).
- Injury to internal organs, may be of penetrating or
- Non-Penetrating (Blunt) Types.
- Penetrating wounds.
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Classification based on Thickness of the Wound
- Superficial wound
- Partial thickness wound
- Full thickness wound
- Deep wounds
- Complicated wounds
- Penetrating wound.
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Classification based on Involvement of Structures
- Simple wounds
- Combined wounds.
Classification based on the Time Elapsed
- Acute wound
- Chronic wound.
- Classifiation of surgical wounds
- Clean wound
- Clean contaminated wound
- Contaminated wound
- Dirty infected wound
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Stages Of Wound Healing
- Epithelialization: Epithelialization occurs mainly from the edges of wound by process of cell migration and multiplication.
- This is brought about by marginal basal cells.
- Thus within 48 hours entire wound is re-epithelialized.
- Wound contraction: It starts after 4 days and usually complete by 14 days.
- It is brought about by specialized fibroblasts.
- Because of their contractile elements, they are called as myofibroblasts.
- Wound contraction readily occurs when there is loose skin as in back.
- Connective tissue formation: Formation of granulation tissue is most important and fundamental step in wound healing. Injury results in release of mediators of inflmmation.
- This result in increased capillary permeability, later kinins and prostaglandin act and play chemotactic role for white cellsand firoblasts.
- In fist 48 hours, PMN leukocytes dominate. They play role of scavengers by removing dead and necrotic tissue. Between 3rd and 5th day, PMN leukocytes diminished but monocytes increases.
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- By 5th or 6th day,firoblasts appear which proliferate and eventually give rise to protocollagen, which is converted in collagen in presence of enzyme protocollagen hydroxylase; O2, ferrous ion and ascorbic acid are necessary. The wound is fier-gel-flid system.
- IV.Scar formation: Following changes takes place during scar formation:
- Fibroplasia and lying of collagen is increased.
- Vascularity becomes less.
- Epithelialization continues.
- Ingrowth of lymphatics and nerve fier takes place.
- Remodeling of collagen takes place with cicatrization result in scar.
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