Wound Healing And Tissue Repair (2).pptx

General surgery presentation

1. Wound Healing And Tissue Repair Dr Shukla Saumitra Dhirendra DNB General Surgery Resident

2. Stages of Sound healing : 1: Haemostasis 2: Inflammation 3: Proliferation 4: Remodelling

3. Heamostasis Exposure of Subendothelial extracellular matrix. Platelet Plug Formation Platelet Adhesion & Release of Granules Deposition Of Extracellular Matrix,Chemotaxis epithelialisation and angiogenesis

4. Tissue factor Initiates coagulation cascade resulting In Initation Of Coagulation Cascade Thrombin Formation

5. Inflammation Historically this phase has been described by rubor ( redness) , tumor (swelling), calor (heat), dolor (pain) Early Inflammatory Phase: -In 1-2 days, - Platelet Activation –Influx of PMN ,Neutrophils - Minimizes bacterial contamination of wound. -Platelets and locally Injured tissue releases histamine and serotonin increasing vascular permeability.

6. Late inflammatory Phase Days 2-3 Monocytes appear and differentiates into macrophage. Macrophages function as phagocytic cells and release proteolytic enzymes to help debride the wound. Macrophages are also Primary producer of cytokines and growth factors promoting fibroblast proliferation and angiogenesis.

7. Proliferation Starts Around Day 3 and lasts for 2-4 weeks. Mainly Fibroblast Activity with Production Of Ground substance,collagen,angiogenesis and re- epithilization of wound Wound tissue formed in early part of this phase –Granulation tissue. In later Part of og this phase there is increase in tensile strength of the wound by fibroblast.

8. Remodelling -Begins 2-3 weeks after injury and lasts for a year . -Characterized by maturation of collagen. -Type 3 Collagen which is prevalent during proliferation phase is replaced by stronger type1 Collagen. -This happens until normal skin ratio of 4:1 Type 1 to type3 collagen is established. -Collagen Crosslinking Happens and increased tensile strength in wound ,maximal in 12 weeks post injury and represents 80% of uninjured skin strength.

9. Bone

10. Nerve

11. T endon -Intrinsic healing consists of Vincular blood flow and synovial Diffusion. -Extrinsic Healing Depends on Formation of Fibrous bands between tendons and tendons sheath. -Early active mobilization prevents adhesions limiting the range of motions and promotes more active intrinsic healing.

12. Abnormal Wound Healing

13. Types Of Wound healing

14. Classification Of Wounds

15. Assessment Of Wound -First to Asses Life Threatening and then Limb threatening injury. Assess site,size,geometry and and nature of wound. Look for contamination , Infection, swelling and Pulsatile bleeding. Look for skin loss , degloving injury ,what structures are visible. Correlate Clinically with Mechanism Of injury , eg High pressure injuries.

16. Principles

17. Management Of Wound -All Wounds Should Be irrigated to reduce Bacterial Contamination. -Wounds Should be explored to Determine the extent of injury to see damage to underlying neurovascular structes,joints,tendons and bones. -Repair Of damaged structures may be attempted once the wounds are clean. -Skin grafts has no inherent blood supply. -Split thickness grafts consists of epidermis and a small portion of dermis while full thickness grafts consists of epidermis and majority of Dermis. -A Flap Tissue consists of its own blood supply.

18. Negative Pressure Wound therapy -Helps to Draw Wound Edges together,remove exudates,reduce edema and promote Granulation Tissue formation. -Not Recommended in setting of exposed vessels , malignancy,untreated osteomyelitis,necrotic tissue or non enteric and unexplores fistulae.

19. Degloving Injury - Degloving injury is avulsion of of skin and subcutaneous fat from the underlying fascia ,muscle or bone. -May be Open or Close. -closed injuries occur due to shearing forces like motor vehicle accidents. - hemolyphatic lesion “Morel lavallee lesion.

20. Acute Compartment Syndrome -occurs when there is increased interstitial pressure within a closed osteofascial compartment resulting in microvascular compromise. -most commonly occurs after lower limb fractures ,both open and closed. -other causes soft tissue traums,arterial injuries,burns and prolonged compression. -characterized by pain out of proportion to injury mainly passive movement of affected compartment muscles. -Fasciotomy is the treatment of choice which involves incising the skin and deep fascia with long axial incisions

21. Necrotising fascitis -This is a severe ,rapidly progressing infection of soft tissue and fascia associated with significant morbidity and mortality . -Commonly polymicrobial but monomicrobial presentation with Streptococcus pyogenes is also frequent. -other organisms include stap aureus, Ecoli,pseudomonas,Clostridium . -Associated usually with history of trauma or Surgery or wound contamination -DM is most common comorbidity upto 30% -Treatment consists of Appropriate antibiotics with urgent surgical debridement.

22. Chronic Wounds -fail to progress through the normal stages of wound healing in a timely manner - eg Leg ulcers ,pressure ulcers. - Mx : debridement, control of infection and inflammation and appropriately selected dressings to correct moisture imbalances.

23. Ulcer Break in the epithelial continuity. A prolonged inflammatory phase leads to overgrowth of granulation tissue and attempts to heal by scarring leave a fibrotic margin.

24. Pressure Injury Preventable skin assessment, regular repositioning every 2–4 hours Use of pressure-redistributing devices Education on self-care Nutritional support for any deficiencies Surgery is not first-line treatment and is only considered when the above measures have been fully implemented . Primary closure and skin grafting should be avoided as they are likely to fail

25. ABNORMAL WOUND HEALING Hypertrophied scar Excess collagen arranged in parallel pattern Do not extend beyond the boundary of the original incision/ wound Eventually regress more common in areas of increased tension, wounds crossing tension lines, deep dermal burns and wounds left to heal by secondary intention (longer than 3 weeks). Keloid Excess collagen arranged in disorganised pattern extend beyond the boundaries of the original incision/wound Do not spontaneously regress Caused by minor trauma/ genetic predisposition/ mainly seen in people with darker skin

26. Contractures -Scar Contractures cause severe functional,psychological and aesthetic Problems. -Contractures may cause joint restriction of movement of joints ,leading to deformity ,impairment and disability. -Surgical contracture release and reconstruction is and effective option. -Key treatment replacement of scar tissue with healthy tissue. Many flaps like Z plasty , Y-V plasty,V-Yplasty,W-plasty .