Wound Healing can be explained as:
Dynamic process involving tissue response to insults
Continuous sequence of signals and responses
Platelets, fibroblasts, epithelial, endothelial, and immune cells come together outside their usual domains
Orchestration of very complex event leading to
1) COAGULATION:- it is summarized as following events
a) Vessel Rupture - Platelet aggregation and coagulation
b) Platelet degranulation - Release of cytokines and growth factors like PDGF, TGF-1IGF-1, PDEGF, Fibronectin, Serotonin
c) Fibrin clot formation
2) INFLAMMATION: Attraction & Activation of Infiltrating cells
- Bacteria and matrix phagocytosis
- Not essential unless wound contaminated
- Debridement / matrix turnover
- Major source of stimulatory signals
- Important for wound healing
3) MIGRATION / PROLIFERATION
- Formation of vessels
- Begin as endothelial cell buds
- Progress toward wound space, following oxygen gradient
- Immature vessels differentiate into capillaries, arterioles, and venules
- Macrophages and keratinocytes provide angiogenic stimuli
- Epidermal covering (keratinocytes) reconstituted from wound margin and hair follicle remnants
- Keratinocytes migrate across wound
- During and after migration, differentiation and stratification of neodermis occur
- Epithelization aided by moist environment
- Migrate into wound site and replicate
- Dominant cell type at wound edge
- Synthesize and deposit collagen and proteoglycans
- Matrix deposition dependent on oxygen and substrate availability as well as growth factors
- Wound cleaning.
- Topical agent.
- Wound cover.
- Holding method.
- Splinting / Immobilization.
- Future plan.
- Type of wound.
- Location of wound.
- Wound status.
- Patient status.
- Co-morbid conditions.
a) Type of Wound
- Clean –but depth of tissue loss should be assesed
- Superficial – Spray, Seal, Film, Collagenase effective for dressing
- Deep – Early wound closure, Graft / Flap,
- Delayed wound closure
- Contaminated – Expectant – Short term temporary wound cover.
- Infected – Discharge Necrotic tissue- proper discontamination.
b) Location of Wound
- Face, Hands, Feet, Ears, Perineum,Joints
c) Wound Status
- Depth, Infection, Arterial supply, Venous drainage, Lymphatic drainage, Edema, Exudation etc. should be considered.
4) Wound Cleaning
- Irrigation with normal saline.
- Potable water.
- Antibacterial solutions .
- Chlorhexidine, Povidone Iodine
- Cetavlon / Savlon, Hydrogen peroxide.
5) Topical Agent – Purpose
- Infection prevention – SSD, SSD + Chlor. Povidone iodine, Framycetin.
- Infection control – Povidone iodine, SSD. Mupirocin, Chlorhexidine, Nadifloxacin, Miconizole.
- Indigenous – Honey, Jaggery, Herbal, Camphor containing creams.
- Edema reduction – Glycerine + Acriflavin
- Epithelisation promotion – Collagen+ SSD, P.D.G.F, E.G.F creams.
- Debridement – Collagenase – Proteases. Hydrogen Peroxide, Eusol solution,
- For examples Pappain + Urea, Benzoic acid, Bromelain.
6) Wound Debridement
- Mechanical – Scrubbing , Sepsis, Tissue damage. Waterjet .
- Surgical – Sharp – Daily Analgesia required!
- Enzymatic – Proteolytic enzymes.
- Biological – Maggot therapy.
- Autolytic – Wound bed, bacteria.
7) Wound Cover
- Non-adherent – Impregnated tulle gras ,Wide variety
- Indigenous – Banana leaf dressing.
- Boiled potato peel bandage.
- Long term adherence – Films, Collagen, Amnion.
- Non-adherent – Alginates, Hydrocolloids, Hydrogels – Unsuitable for exuding wounds, Expensive,
- Drug eluting – Silver nano particles, Drug releasing hydrogels – Effective,R educed dressing frequency. Availability and Cost should be considered.
- Biosynthetic Dressings
- If needed – Support, Protection.
- Absorbent as Gamgee.
- No discharge – Gauze alone.
- Holding – Bandage, Net – Bandafix.
- Adhesive tapes - With discharge.
- Consider splinting, Immobilization.
- Gentle cleaning.
- Use of Spray , Shower, Syringe – asepto.
- Clean surrounding normal skin. Wipe dry.
- Surgical debridement
- Topical agent.
- Non adherent dressing, secondary dressing.
- Bandaging , Adhesive tapes .