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.



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




  Growth hormone


  Vitamin C


Growth inhibitory factors


  Contact inhibition


Sytemic factors

  Diabetes mellitus

  Old age


  Vitamins C deficiency

  Steroid therapy

  Servere anemia



  Anti cancer drugs


d. Local factors



  Forign bodies

  Presence of necrotic tissue


  Tension in the wound

  Excessive movement

  Inffective treatment


Physiotherapy management


  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



  • 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


  • 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



  • 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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