– 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
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
• 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
• To reduce pain and prevent infection
• To promote healing
• Wound debridement and cleaning to remove dirt particles
• Improve physical function
Means of treatment
– It promotes development of granulation tissue and mechnical distribution of non- visible tissue.
- Promotes wound healing
- Most effective during inflammatory phase
- 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
- 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
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.
• 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.