Wound healing management – Types, & Factors affecting wound Healing

Wound healing
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Wound healing

– A wound healing  is a  discontinuity or break of the skin surface.

 

Types

I. Simple wound: when only the skin is lost.

II. Complex wound: when it invloves yhe subcutaneous  tissues, muscles, tendons, vessels.

III. Incisional wound

IV. Penetrating wound

VI. Crushed

 

Wound healing

1. By primary intension

2. By secondary intension

 

1. Primary intension

a. At zero hour

– The incision sight is filled with blood clot

 

b. At 24 hours

– Acute inflammatory reactions

– Infiltration  of neutrophils

– Proliferation of epithelial cells.

 

c. At 3rd day

– Neutrophils are replaced by macrophages.

– Granulation tissue starts appearing.

– New blood vessels grows from the surrounding tissues.

– Proliferation of fibroblasts.

 

d. On 5th day

– Neavascularization is maximum.

– Epithelial proliferation is also maximum.

 

e. After 2 weeks

– Inflammatory reaction disappers

– Fibroblast proliferation and matrix deposition is maximum

 

f. After 2 months

– Scar tissue formation consisting of connective tissue.

– It is convered with epidermis.

– In wound healing by primary intension, there is minimal inflammatory reaction and healing is far.

– It takes place is plain surgical wound with healthy tissues edges.

– There is no contamination or infection and a fine scar is produced.

 

2. Secondary intension

It takes place in extensive tissue injury like large wounds, infarction,  abscess  formation burns.

  The tissue margins are irregular, may be infected which delays the healing process.

  Granulation tissue grows from the margins to fill the defect and ultimately the wound contract and the defect is marginally reduced in size.

 

Shapes of wound closure

  Primary healing (within 5 days)

  Delayed primary  closure ( after 5 days)

  Secondary closure (closed with help of skin graft, muscle flaps, staples)

 

Factors affecting wound healing

  Growth promoting factors

  Epidermal growth factor

Platelet growth factor

  Macrophages dervied growth factor

  Lymphokines

  Fibrins

  Fibronectins

  Growth hormone

  Estrogen

  Vitamin C

 

Growth inhibitory factors

  Chalones

  Contact inhibition

 

Sytemic factors

  Diabetes mellitus

  Old age

  Malnutrition

  Vitamins C deficiency

  Steroid therapy

  Servere anemia

  Cancer

  Hemophilia

  Anti cancer drugs

 

d. Local factors

  Infection

  Ischemia

  Forign bodies

  Presence of necrotic tissue

  Irradiation

  Tension in the wound

  Excessive movement

  Inffective treatment

 

Physiotherapy management

Aims

  To reduce pain and prevent infection

  To promote healing

  Wound debridement and cleaning to remove dirt particles

  Improve physical function

 

Means of treatment

I. Modalities

 

– Hydrotherapy

– It promotes development of granulation tissue and mechnical distribution of non- visible tissue.

– Ultrasounds

 

Uses

  • Promotes wound healing
  • Most effective during inflammatory phase

 

Coupling media

  • Amorphous hydrogel
  • Hydrogel sheet
  • Sterile polyacryl sheet

 

Acute wound: Non  thermal ultrasound

Chronic wound: Thermal ultrasound

Intensity: 0.25 – 0.5 W/Cm2

Duration: 5-8 mins

Frequency: 3 MHz

 

Ultra – violet radiations

Uses

  • Promotes healing
  • Skin growth
  • Efective circulation
  • Bacterial effect

 

Infected wound

  • Krameyer lamp is useful e.g E4 dose 2-3 times  a week

 

Non- injected wounds

  • E1-E2 dose – 2 times a week
  • Laser therapy
  • Visible IRR is used

Energy: 1J/cm2

Duration: 33 sec

Power: 30 joules

 

IRR:

  • Increases skin temperature
  • Increase metabollic rate
  • Improves blood circulation to the wound
  • Duration is 8-10 mins for 3 -4 times a week

 

6. Other modalities

  • Ionoze therapy
  • Pulsed electromagnetic energy
  • Vaccum assisted closure

 

II. Compression therapy

Pneumatic compression increase the venous return and stimulates the release promotes  wound healing.

  A pressure of 35-55 mmHg is usually applied.

 

III. Exercise

  In case of ulcers and lower limb  wounds active exercise of ankle, subtalar joint and midtarsal joint essential to improve venous circulation and mobilize the joint.

  Passive movements

  Active assisted and free exercise to prevent contracture and maintain ROM.

  Walking and gait training physical re-education.

 

IV. Wound dressing

  Some of the types of dressing are

  Semi permeable foam

  Calcium alginate dressing

  Hydrophilic fiber dressing

  Collagen dressing

  Hydrocolloid dressing

  Crepe bandaging

  Elevation of the affected limb is essential.

  Cleaning the wound with sterile cotton detol and saline.


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