woundhealing bacteria inflammation and repair

Wound healing and recovery

1. WOUND HEALING
PRESENTED BY ,
SpurthiBS
Doctor of Pharmacy (PharmD)
Malligecollege of pharmacy

2. WOUND:
A circumscribed injury which is caused by externalforce
and it can involve any tissue andorgan.
It can be classified basedon:
Origin of the wound.
Contamination of thewound.
Depth of thewound.

3. BASED ONORIGIN
Mechanical
1.Abradedwound
2.Puncturedwound
3.Incisedwound
4.Cutwound
5.Crushedwound
6.Tornwound
7.Bitewound
8.Shotwound
Chemical
Acid &base
Radiation
Thermal
Burning &freezing
Special
Toxins &venoms

4. BASED ONCONTAMINATION
1.Cleanwound
2.Clean & contaminatedwound
3.Contaminatedwound

5. BASED ON THEDEPTH
1.Superficial wound = onlyepidermis.
2.Partial thickness wound = epidermis +dermis.
3.Fullthicknesswound=epidermis + dermis+
subcutaneousfats
4.Deep wound = epidermis + dermis+
subcutaneous fats + exposed muscles, boneconnective
tissue, organsetc.

6. HEALING
Healing is the body’s response to injury in an
attempt to restore normal structure and
function.
The process of healing involves 2 distinctprocesses:
a.REGENERATION
b.REPAIR

7. REGENERATION
whenhealingtakesplacebyRegeneration:Is
proliferationofparenchymalcellsandusually
theoriginalresultsincompleterestorationof
tissues.
Tomaintainproperstructureoftissues,thesecells
areunderconstantregulatorycontrolofthecell
cycle.

8. REPAIR
Iswhenhealingtakesplacebyproliferationofconnective
tissue elements resulting in fibrosis andscarring.
Two processes are involved inrepair:
a.Granulation tissueformation
b.Contraction ofwound
Cells involved in the process ofrepair;
1.Mesenchymalcells
2.Endothelialcells
3.Macrophages
4.Platelets
5.Parenchymal cells of injuredorgans

9. TYPESOFWOUNDHEALING
HEALINGBYFIRSTINTENTIONalso calledas
PRIMARYUNION.
HEALINGBYSECONDINTENTIONalso calledas
SECONDARY HEALING.

10. HEALINGBYFIRSTINTENTION
Healing of wound with followingcharacteristics:
Clean anduninfected
Surgicallyincised
Without much loss of cells andtissue
Edges of wound are approximated by surgicalsutures.

11. STEPSINPRIMARYWOUNDHEALING
INITIALHEMORRHAGE :Immediatelyafterinjury,thespace
betweenthesurfacesofincisedwoundisfilledwithbloodwhich
soonclots,andpreventfurtherinfection.
ACUTEINFLAMMATORY RESPONSE:Thisoccurswithin24
hoursofappearanceofpolymorphsfromthemarginsofincision.
EPITHELIALCHANGES:Thebasalcellsofepidermisfrom
bothcutmarginsstartsproliferatingandmigratingtowards
incisionalspaceintheformofepithelialspurs.
Awellapproximatedwoundiscoveredbyalayerofepithelialcell
in48hrs.Themigratedepithelialcellseparatesthenecroticcells
andclotformingascabwhichcastoff.Thebasalcellscontinuesto
divide.By5
thdaynewepidermisisformed.

12. ORGANISATION :by3
rdday,fibroblastsalsoinvadesthe
woundarea.By5
thdaynewcollagenfibrilsstartforming
whichdominatetillhealingiscompleted.
In4weeksascartissuewithscantycellularandvascular
elements,afewinflammatorycellsandepithelialisedsurface
isformed.

13. HEALINGBYSECONDARYINTENTION
This is defined as the healing of a wound with followingfeatures.
iii.
i.Open with large tissue defects, at timesinfected
ii.Having extensive loss of cells and tissues,and
The wound is not approximated by sutures but is leftopen.
STEPS IN HEALING OF SECONDARYWOUND:
Initialhaemorrhage:asaresultofinjurythewoundspaceis
filledwithbloodandfibrinclotwhichdries.
Inflammatoryphase:thereisinitialacuteinflammatory
responsefollowedbyappearanceofmacrophageswhichclear
offthedebris.

14. EPITHELIALCHANGES:Theepidermalcellsfromboththe
marginsproliferateandmigrateintothewoundintheformofspurs
tilltheymeetinthemiddleandre-epithelialisethegapcompletely.
However,theproliferatingepithelialcellsdonotcoverthewound
completelyuntilthegranulationtissuefromthebasehasstartedfill
thewoundspace.
GRANULATION TISSUE:Themainbulkofsecondaryhealingis
bygranulation.Granulationtissueisformedbyproliferationof
fibroblastsandneovascularisation.Thenewlyformedgranulation
tissueisdeepred,granularandveryfragile.Withtime,itbecomes
palewhiteduetoincreasedincollagenanddecreasedbloodsupply.
WOUND CONTRACTION :Thisphaseisnotseeninprimary
healing.Duetotheactionofmyofibroblastspresentingranulation
tissue,thewoundcontractstoone-thirdofitsoriginalsize.Itoccurs
duringtheformationofactivegranulationtissue.

16. DIFFERENCE BETWEEN 1˚ & 2˚ UNION OFWOUND
FEATURES PRIMARY SECONDARY
CLEANLINESS CLEAN NOTCLEAN
INFECTION NOTINFECTED INFECTED
MARGINS SURGICALLYCLEAN IRREGULAR
SUTURES USED NOTUSED
HEALING SMALLGRANULATION
TISSUE
LARGEGRANULATION
TISSUE
OUTCOME LINEARSCAR IRREGULARWOUND
COMPLICATION NOTFRQUENT FREQUENT

17. FACTORSAFFECTINGWOUNDHEALING
Local factors Systemicfactors
INFECTION NUTRITIONALFACTORS
LOCATION OF THEWOUND AGE OF THEPATIENT
IMMOBILISATION SYSTEMICINFECTION
PHYSICALFACTORS ADMINISTRATION OF
GLUCOCORTICOIDS
UNCONTROLLED DIABETES

18. COMPLICATIONS OF WOUNDHEALING
INFECTION
Wounds may provide a portal of entry to microorganisms.
Infections of the wound delay the healing process. Systemic
conditions such as diabetes mellitus, immunosuppressivestate
etc. make the individual prone toinfection.
KELOID AND HYPERTROPICSCAR
Keloids are overgrown scar tissues with no tendency for
resolution. They occur in wound, which heal withoutany
complications.

19. Hypertrophic scar occur in wounds where healing isdelayed.
These scars are more cellular andvascular.
Keloid and hypertropic scars are not seen in the wounds of
the oralcavity.
PIGMENTARYCHANGES
These are common in healing of wounds on skin and may
appear and may appear as hyperpigmented and hypopigmeted
areas.
In oral cavity hypopigmented scars are less common but some
lesions leave hyperigmentation while healing e.g.lichenplanus,
lichenoidreactions.