Wound healing occurs through three main processes: primary intention, secondary intention, or delayed primary intention. Primary intention involves healing through direct wound approximation and results in less scarring. Secondary intention occurs when wound edges cannot be directly opposed, resulting in more granulation tissue formation and scarring. Delayed primary intention involves initial wound gaping followed later by edge approximation. The healing process generally involves hemostasis, inflammation, proliferation, and remodeling over weeks. Factors like infection, poor nutrition, medications, and low blood flow can delay healing.
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Wound healing occurs through three main processes: primary intention, secondary intention, or delayed primary intention. Primary intention involves healing through direct wound approximation and results in less scarring. Secondary intention occurs when wound edges cannot be directly opposed, resulting in more granulation tissue formation and scarring. Delayed primary intention involves initial wound gaping followed later by edge approximation. The healing process generally involves hemostasis, inflammation, proliferation, and remodeling over weeks. Factors like infection, poor nutrition, medications, and low blood flow can delay healing.
Wound healing occurs through three main processes: primary intention, secondary intention, or delayed primary intention. Primary intention involves healing through direct wound approximation and results in less scarring. Secondary intention occurs when wound edges cannot be directly opposed, resulting in more granulation tissue formation and scarring. Delayed primary intention involves initial wound gaping followed later by edge approximation. The healing process generally involves hemostasis, inflammation, proliferation, and remodeling over weeks. Factors like infection, poor nutrition, medications, and low blood flow can delay healing.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as PPT, PDF, TXT or read online from Scribd
Wound healing occurs through three main processes: primary intention, secondary intention, or delayed primary intention. Primary intention involves healing through direct wound approximation and results in less scarring. Secondary intention occurs when wound edges cannot be directly opposed, resulting in more granulation tissue formation and scarring. Delayed primary intention involves initial wound gaping followed later by edge approximation. The healing process generally involves hemostasis, inflammation, proliferation, and remodeling over weeks. Factors like infection, poor nutrition, medications, and low blood flow can delay healing.
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WOUND HEALING
WOUND HEALING 1. Primary union Healing by first intention
2. Secondary union Healing by second intention
3. Delayed Primary union
Healing by tertiary intention
HEALING BY 1ST INTENTION
CHARECTERISTICS: Simplest and fastest type of wound closure clean and uninfected Superficial wounds Deep wounds with well approximated edges Epithelial regeneration predominates over fibrosis Lower risk of infection, minimal tissue loss and minimal scarring
EXAMPLE: Surgical wound with well approximated edges
Clot forms Neutrophils come in Epithelium begins to regenerate
With in 3 to 7 days: Macrophages come in Granulation tissue is formed New blood vessels Fibroblasts Collagen begins to bridge incision Epithelium increases in thickness
Weeks later: Granulation tissue gone Collagen is remodeled Epidermis full, mature (but without dermal appendages!) Eventually, scar forms
How do wounds heal by primary intention?
Hematoma (day 1) Initially wound is filled with coagulated blood and cell detritus and influx of neutrophils Inflammation and early granulation tissue(days 2-3) Macrophages stimulate the ingrowth of fibroblasts and angioblasts, which start forming collagen. Epidermal cells forms a bridge that seals off the defect Fully developed granulation tissue(days 4-6) Neo-vascularization reaches its peak, so entire area looks swollen and red. Also newly formed capillaries and granulation tissue contains fibroblasts that form ECM
Blanching (week 2) Deposits of collagen compress and replace the blood vessels, thus reduce the blood flow through the healing wound. Scar formation Macrophages become less prominent. Granulation tissue is replaced by fibrous scar. By the end of 3rd month tissue has approx 80% of its original strength.
Remodeling of the scar This takes several months and tissue acquire more tensile strength.
6 hours
24 hours
2 days
1 week
HEALING BY 2ND INTENTION
CHARACTERISTICS: Occurs in larger wounds that have gaps between wound margins There is extensive loss of cells and tissues The wound is not approximated by surgical sutures but is left open and at times infected Contents are sloughs and blood clot Fibrosis predominates over epithelial regeneration Healing is slower, with more inflammation and granulation tissue formation and more scarring
EXAMPLES: Infarction Large burns and ulcers Extraction sockets
The sequence of events in second intention: 1. Initial hemorrhage 2. Inflammatory phase 3. Epithelial changes 4. Granulation tissue formation 5. Wound contraction 6. Presence of infection
Differences from healing by 1st intention
1. More inflammation 2. More granulation tissue 3. Wound contraction
FACTORS DELAYING WOUND HEALING
1. Infection is the most common cause of delay in healing, by prolonging the inflammatory response and by increasing local tissue injury. 2. Poor nutrition and specially Vitamin C deficiency inhibits collagen synthesis and retards healing. 3. Glucocorticoids have a known anti-inflammatory effect and their administration results in poor wound strength due to diminished fibrosis. 4. Mechanical variables such as local pressure or torsion may cause wounds to pull apart or dehisce.
5) Poor perfusion secondary to arteriosclerosis, diabetes, or obstructive venous drainage also impairs healing. 6) Foreign bodies like glass fragments, steel fragments, or bone may disturb healing.
Aberrations of cell growth: May be due to a genetic predisposition (Keloid formation). This condition is more common in African American patients.
HEALING BY DELAYED PRIMARY CLOSURE (THIRD INTENTION)
This healing process takes place when approximation of wound edges is delyed by 3-5 days or more after injury or surgery
The condition contribute to a decision for a dalyed closure are:
1. Removal of an inflamed organ 2. Heavy contamination of wound
1st intention 1. Two edges are approximated together 2. Minimal tissue loss 3. No sepsis 4. Minimal amount of granulation tissue, so the scar is very thin 5. Little contraction of the scar
2nd intention 1. Wide gap 2. Marked tissue loss and necrosis 3. Sepsis might by present 4. Large amount of g.t so the scar is large and wide. 5. Much contraction of the scar reaching 5-10 % of the original one
SOME TERMS WOUND CONTRACTION: Reduction in size of wound healing by secondary intention is called wound contraction (myofibroblasts in granulation tissue)
CONTRACTURE: Are deformities of extremities caused by irregular scars formed over the joints.
DEHISCENCE (split apart)
Opening of a healing or partially healed wound with separation of its edges. (mechanical)
KELOID: Hyperplastic scars with irregular deposits of excessive collagen in dermis.
PROUD FLESH: Excessive granulation tissue preventing wound closure or proper epithilialization was historically called proud flesh.
