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Dr.Hussein hadi Nahi
Wound Management
General principles of treatment of wounds:
1. preparation of the site of injury as clipping and shaving and
2. Sharp dissection.
3. Arrest haemorrhage : the best thing by artery forceps, and
minimum ligature or electrocautary because it increase the
inflammatory phase.
4. Localize the infection, if it is infected wound.
5. Make drainage (drains) Are used for removal of accumulated
pus , serum ,and old blood within a cavity, or dead space by make
counter opening in an swelling, then irrigation of cavity by
antiseptic solution.
6. Debridment- removal of the dead tissue ( management of wound
that unsuitable for excision ). It can removred by enzymes like
streptokinase ,trysine ,or by electrocautary, or by surgical excision.
7. Apply chemotheraps or antiseptic.
8. Suture after debridement or excision of wound ,never close the
infeceted wound ,we can close only the fresh wound, and remove
the suture at proper time (7-10).
Specific treatment of wounds:
a. Clean wounds:
Primary closure (healing by first intention) is used on surgical wounds
that are closed immediately.
b. Contaminated wound:
1. The patient should be examined
2. The patient may need stabilization and treatment for shock,
dehydration, fracture or other injuries prior treatment of any wound.
3.preparation of patient by clipping the hair surrounding the wound after
control on the animal(in same time needed sedation or anesthesia).
4. It may be necessary to apply a sterile water-soluble gel to the wound.
5. The wound should be lavaged using either sterile saline or a sterile
dilute povidine-iodine solution or dilute chlrohexidine.
6. Some researchers used local antibiotic on the wound as solution or
emulsion, donُt used ointment.
7. Suture the wound, apply drains and/or bandage the wound.
Dr.Hussein hadi Nahi
3. Infected wound
1. Put clean gauze on the wound, then prepare the area surrounding
(clipping, shaving) clean, put antiseptic.
2. Remove the gauze, irrigate the wound with warm sterile normal saline
(profuse amount) if not available use tap water.
3. Remove dead necrotic tissue in the wound (debridement), dead tissue
appear as dry black senseless tissue, removal is done till blood oozes
from the wound, also cut the wound edges (refresh) to create new fresh
wound edge.
4. Irrigate the wound for the second time to remove all tissue debris in the
wound using warm sterile normal saline (profuse amount).
5. Put local antibiotics solution.
6. Suture the wound with non-absorbable suture interrupted stitches,
leaving the last two stitches (at lower part of wound) not sutured for
7. Give systemic antibiotics for at least 3 days, antitetanic serum is also
given in equine.
Type of wound healing:
1. Healing by first intention:
Occurs with clean, incised wounds that are held together. Healing is
initiated by movement of epithelial cells from the two edges of the wound
toward the center that usually meet within 4 to 7 days of the incision. It
should only be performed if less than 6 to 8 hours (within the golden
period) have elapsed since injury.
2. Healing by 2nd intention:
Wounds with considerable tissue loss, contamination, or infection, or
those older than 6 to 8 hours should be treated as open wounds. The
wounds will initially begin healing by contraction and epithelialization
and may heal completely.
3. Healing by 3rd intention:
When apart of sutured wound is opened and resutured again under aseptic
condition, healing of this wound is called of healing by 3rd intention.
4. Healing by mixed intention:
When a part of wound heals by 1st intention (sutured part) and the other
part heals by 2nd intention.
5. Healing under scab:
This type of healing occur in case of abrasion wound, the transudate dry
and form a scab usually fixed to the underlying tissue and healing
undergo under the scab. When healing is complete the scab will fall
spontaneously. This type of healing is important in healing of wound in
equine extremities.
Dr.Hussein hadi Nahi
Factor effect wound healing:
A. Local Factors: That Influence Healing:
1. Oxygenation and vascularty:
Oxygen is important for cell metabolism, especially energy production by
means of ATP, and is critical for nearly all wound healing processes, and
availability of blood supply to the area. It prevents wounds from
infection, induces angiogenesis, and are crucial promoters of cell
proliferation, migration and chemotaxis, and angiogenesis in wound
2. Infections:
It is most common important factor to delay wound healing. Once skin is
injured, micro-organisms that are normally sequestered at the skin surface
obtain access to the underlying tissues.
3. Foreign body: The presence of foreign bodies inside of wound healing
as suture materials, selection of the type of suture material, and selections
of technique are more important. Non-absorbed suture material could
form focal of infection.
4. Improper closer: Correct apposition of the tissue layers is important
to allow the good condition for the reformation of tissue layer continuity.
5. Duration of operation: When taken more time by make dryness more
tissues, and more contamination.
6. Hematoma: Collection of blood within cavities. It effects on the blood
supply and it becomes good media to bacterial growth.
7. Trauma: Repeated trauma prolong staged to wound healing the tensile
strength and delay healing.
B. Systemic Factors :That Influence Healing
1. Age: increased age is a major risk factor for impaired wound healing.
Healing in young animals more quick than old decrease
fibroplasia, decrease in cellular proliferation and nutrition, increase in
susceptibility to infection.
2. Genetic factors or disease: Such as haemophilia or genetic
conglutination effect.
3. Stress
Many diseases-such as cardiovascular disease, cancer, compromised
wound healing and diabetes—are associated with stress.
Dr.Hussein hadi Nahi
4. Radiation: All the ionized rays are harmful because are affect on
wound healing by delay of tension strength formation.
5. Steroid administration:
Many medications, such as those which interfere with clot formation or
platelet function, or inflammatory responses and cell proliferation have
the capacity to affect wound healing. As steroid caused delay in wound
healing because of reduction of protein synthesis rate, inhibition of
natural inflammatory reaction, generation of fibroblast, and debridement
6. Obesity:
Obese individuals frequently face wound complications lead to delay
wound healing; including skin wound infection, dehiscence, hematoma
and seroma formation, pressure ulcers, and venous ulcers.
7. Nutritional diseases:
Malnutrition or specific nutrient deficiencies can have a profound impact
on wound healing after trauma and surgery.
-Vitamin K deficiency: lead to haematoma formation and serum
collection, then wound disruption, and infection.
-Vitamin A deficiency: result into impair collagen synthesis.
-Vitamin C deficiency: resluted into reduction in formation of ground
- Zinc deficiency : delay wound healing.
8. Leukopenia: Decrease (WBCS) these leads to decrease the immunity
in animal and increase the wound infection.
10. Fluid and Electrolytic imbalance: Dehydration delay of wound