Wound Healing

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1

What are the 3 distinct phases of first intention healing

A) Phase 1, inflammatory response and debridement process
(B) Phase 2, collagen formation (scar tissue)
(C) Phase 3, sufficient collagen laid down

2

Phase 1: Lag Phase or Inflammatory Response Phase

• This stage begins within minutes of injury and lasts approximately 3–5 days.
• This stage controls bleeding
• A scab forms to seal the wound
• Leukocytes move in to fight infection
• Basal cells migrate across the skin edges, closing the surface of the wound.
• Fibroblasts in the deeper tissue begin the reconstruction of the nonepithelial tissue.
• The wound does not gain tensile strength during this phase.

3

Phase 2: Proliferation Phase

• This stage begins around the 3rd postoperative day for up to 20 days.
• The fibroblasts secrete collagen that forms into fibers that give the wound approximately 25–30% of its original tensile strength.
• New networks are formed by the 5th to 8th day, and lymphatic networks are reformed by the l0th day, many of which diminish during the final phase of wound healing.

4

Phase 3: Maturation or Differentiation Phase

• This stage begins on the l4th postoperative day, until the wound is completely healed (up to l2 months).
• myofibroblasts is completed in approximately 2l days.
• Collagen formation causes scar tissue to pale.
• A small, white, mature surface scar, called a cicatrix, appears during the maturation phase.

5

Factors Influencing Wound Healing

First consideration is the physical condition of the patient

  • Age
  • Nutritional status
  • Disease
  • Smoking
  • Obesity
  • Radiation exposure
  • Immunocompromised or immunosupressed
6

Factors Influencing Wound Healing

Second consideration is intraoperative tissue handling

•Length and direction of the incision
•Dissection technique (sharp or blunt)
•Duration of surgery
•Amount of tissue handling (tissue should be handled as little and as gently as possible)
•Achievement of hemostasis
•Precise tissue approximation
•Elimination of dead space
•Secure wound closure

7

Factors Influencing Wound Healing

Third consideration is the application of the principles of asepsis through the use of sterile technique

• Any microbial contamination of the wound could lead to an infection, causing an increase in morbidity or mortality.

8

What is an abnormal tract between two epithelium-lined surfaces that is open at BOTH ends. It occurs most often after bladder, bowel, and pelvic procedures. Abnormal drainage is a prevalent sign. Surgery is required for correction.

Fistula

9

What is an abnormal tract between two epithelium-lined surfaces that is open at ONE END only. Its occurrence is highest in bladder, bowel, and pelvic procedures. Abnormal drainage is a common sign. Surgery is often required to correct this condition.

Sinus tract

10

What is the separation of wound layers that have not been closely approximated or air that has become trapped between tissue layers. The space may allow for serum or blood to collect and provide a medium for microbial growth, resulting in a wound infection. It is eliminated by use of proper suturing techniques, wound drains, and/or pressure dressings.

Dead space

11

What can occur because of either a failure to properly absorb the material or an irritation caused by the material that results in inflammation. It occurs most frequently with silk and is characterized by an evisceration (referred to as “spitting”) of the material from the wound or sinus tract formation.

Suture complications