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1. WOUND ASSESSMENT &MEASURMENTS SUPERVISED BY :DR.MOSTAFA AHMED LECTURER AT FACULTY OF PHYSICAL THERAPY

2. Connective tissue fibers are: 1. Collagenous. F 2. Elastic. F 3. Reticular. F

3. White collagenous fibers: are formed of protein called collagen, which is glue-like substance arranged in bundles . Yellow elastic fibers: are elastic in nature (stretchable), and formed of protein called elastin. Reticular fibers: are formed of protein called reticulin, reticular fibers are arranged in the form of fine network. Matrix: ground interstitial substance: the C.T. cells and the C.T. fibers are embedded in a soft gelly -like substance called the matrix.

4. Functions of the proper C.T 1. It support and connect the different organs & Tissues together. 2. The matrix acts as medium for transport of nutrition. 3. Specific function for each fiber & cell. As Fibroblast cell are responsible for C.T fiber formation & injuries repair, mast cells release heparin & chemotactic factors, Elastic fiber gives Elasticity, collagen fibers gives strength, while pigment cells are responsible for melanin production.  

5. Repair of wounds   The healing of skin wound requires 2 processes: 1- Regeneration of the epidermis 2- Fibrosis in the dermis

6. There are 2 types of wound healing: 1. Primary union of wound 2. Secondary union of wounds-healing

7. 1. Primary union of wound = healing by first intention: As the surgical incision healing where no epithelial loss. This Occurs in clean surgical wounds with closely approximated in edges, incision and sutures induce inflammation in both edges.

8. 2. Secondary union of wounds-healing by 2nd intention: Where there is epithelial loss. This Occurs in septic or open wounds with separated edges Formation of new capillaries (Neovascularization) proliferation of Fibroblasts granulation weak tissue takes place all around the cavity of the wound. Infection of wound causes emigration of a large number of neutrophils to the wound area leading to exudation of fluid from the septic granulation tissue (pyogenic membrane pus once the infection is overcomed

9. Complications of 2ry union: 1. Chronic ulcer: in a wide wound, cauterization occurs at the bottom before the cavity is filled up with granulation tissue- and this will hinder the healing process ulcer. 2. Sinus or Fistula . 3 . Massive outward growth of granulation tissue hinder epithelization 4. Keloid formation: Keloid Excessive formation of solid fibrous Tissue in the dermis leading to projecting swelling covered by thin epidermis, recurrence of keloid after surgical removal is common. Keloid develops during the healing of burn or smallpox vaccination vesicles.  

10. Phases of wound healing There are 3 phases of wound healing: 1. Inflammatory phase: which prepares the area for healing 2. Fibroblastic phase, which rebuilds the structure. 3. Remodeling phase: which is the final from.  

11. Inflammatory phase: Inflammatory is normal and necessary for the healing process , any blood vessels that traversed the wound will be cut at the time of injury. These cut vessels will pour blood into the wound, then blood will be coagulated with sealing off the injured vessels and lymphatic channels leading to temporary closing of the wound

12. Under the umbrella of the inflammatory phase, there are 2 processes: a. Phagocytosis b. Neovascularization.  

13. Phagocytosis wound decontamination : The main purpose of the process is to prevent wound infection, because all wound even meticulous sterile conditions are contaminated

14. B) Neovascularization = capillary canalization or vascular sprouting Healing will not take place, unless new blood vessels are present to supply O2 and nourishment to the injured tissue (injured tissues till now have no blood due to sealing off blood vessels & lymphatic).

15. 2.Fibroblastic phase: rebuilding phase: With the inflammatory phase completed, rebuilding can commence (start or begin). The name of this phase is acquired from the repair cells or the cells of scar production (fibroblasts). The purpose of this phase is to repair or rebuild and to provide strength to the wound. Fibroblasts begin to synthesize or produce collagen.

16. 3 Processes are included under the umbrella of the Fibroblastic phase to achieve wound closure ( 1st)Epithelialization. (2nd) Wound contraction. (3rd) collagen production .

17. A) Epithelialization Epidermis of the skin has a stratified squamous epithelium (from the cell layers to the superficial cell layers). So, epithelialization means epidermal regeneration or surface covering

18. B) Wound Contraction Epithelialization close the wound surface only while wound contraction is a process , which pulls the whole, wound together leading to wound shrinking or decreasing the wound area. This wound contraction = wound shrinking and its centripetal force can useful in some regions and can be harmful and detrimental in other regions. If contraction is uncontrolled as in abdomen and gluteal region where skin is loose and mobile, while the deep structures are fixed. In this condition wound contraction is useful with no CONTRACTURE formation.

19. 3.Remodeling phase: Successful wound healing requires more than closing the wound with sufficient tensile strength. Remodeling requires the scar to change to fit the tissue. Remodeling of the scar maturation represent the final aggregation. Orientation and arrangement of the collagen fibers.

20. 2 Processes are involved under the umbrella of the remodeling phase A) Synthesis-lysis balance: B) Collagen fiber orientation

21. CLINICAL ASSESSMENT OF LEG ULCER CLINICAL ASSESSMENT OF LEG ULCER FEATURES VENOUS ARTERIAL NEUROTROPHIC TRAUMATIC MALIGNANT SITE gaiter area 70%, lateral 20%, circumferential 5% malleoli , heel, metatarsal heads, 5 MT base pressure area site of trauma face, lips, toungue SIZE/SHAPE large shallow ,vertically oval, small deep variable variable variable MARGIN irregular regular regular     EDGE sloping   punched out sloping everted/rolled FLOOR granulation slough/ necrotic slough variable black mass