Vulnus Wound Healing

• Problem in discontinuity of tissue that makes seperated normal continuity.

Vulnera

1. Open Wound2. Closed Wound

Type of Vulnera

1. Open Wound– Vulnus Excoriatum

body/skin erosion, simple wound, ex: road friction– Vulnus Laceratum

body wound that cause by dull shaped object, irregular margin, usually under skin exposed, ex: many object that cause more massive than excoriation

– Vulnus Punctumbody wound cause by long sharp object that penetrate the body, ex: knife stab

– Vulnus Scissum/Incisivum:body wound cause by sharp object, regular margin, ex: knife laceration

– Vulnus Caesumbody wound caused by wide sharp object, ex: axe

Type of Vulnera

1. Open Wound– Vulnus Sclopetorum

shot wound, ex: gun shot wound– Vulnus Morsum

wound cause by bite, ex: human bite, animal bite

Type of Vulnera

2. Closed Wound- Vulnus Contussum

wound that make haematom subcutan, skin intact, ex: haematom wound at skin

- Vulnus Traumaticumwound that not seen outside, but bleed inside, ex: organ haematom

Type of Vulnera

• Phase of Wound Healing:1. Homeostasis and Inflamation2. Proliferation3. Maturation and Remodeling

Hemostasis precedes and initiates inflammation with the ensuing release of chemotactic factors from the wound site. Wounding by definition disrupts tissue integrity, leading to division of blood vessels and direct exposure of extracellular matrix to platelets. Exposure of subendothelial collagen to platelets results in platelet aggregation, degranulation, and activation of the coagulation cascade. Platelet granules release a number of wound-active substances, such as platelet-derived growth factor (PDGF), transforming growth factor- (TGF-), platelet-activating factor (PAF), fibronectin, and serotonin. In addition to achieving hemostasis, the fibrin clot serves as scaffolding for the migration into the wound of inflammatory cells such as polymorphonuclear leukocytes (PMNs, neutrophils) and monocytes.

1. Homeostasis and Inflamation

The proliferative phase is the second phase of wound healing and roughly spans days 4 through 12 It is during this phase that tissue continuity is re-established. Fibroblasts and endothelial cells are the last cell populations to infiltrate the healing wound, and the strongest chemotactic factor for fibroblasts is PDGF. 11,12 Upon entering the wound environment, recruited fibroblasts first need to proliferate, and then become activated, to carry out their primary function of matrix synthesis remodeling. This activation is mediated mainly by the cytokines and growth factors released from wound macrophages.

2. Proliferation

The maturation and remodeling of the scar begins during the fibroplastic phase, and is characterized by a reorganization of previously synthesized collagen. Collagen is broken down by matrix metalloproteinases (MMPs), and the net wound collagen content is the result of a balance between collagenolysis and collagen synthesis. There is a net shift toward collagen synthesis and eventually the re-establishment of extracellular matrix composed of a relatively acellular collagen-rich scar.

3. Maturation and Remodeling

A. The hemostatic/inflammatory phase.

B. Latter inflammatory phases reflecting infiltration by mononuclear cells and lymphocytes.

C. The proliferative phase with associated angiogenesis and collagen synthesis

Procedure Of Wound Management

• Clean• Debride• Irrigate• Excise

Management of Sterile Wound

•Stop the bleeding•Close “ one by one”

Management of Contaminative Wound

• Wash the area surrounding of the wound • Do desinfection surrounding the wound• Close the wound• Local anestesia• Wash the wound with H2O2/ diluted Povidon• Do the evaluation• Wound toilet and debridement• Prevention to tetanus etc.

Management of Infection Wound

• Disinfection surrounding the wound• Don’t do infiltratif anestesia, do with

block anestesia or general anestesia• Washing by H2O2/ diluted povidone• Debridement• Don’t do primary closure• Sistemic antibiotic• Prevention tetanus etc.

ADJUNCTS TO WOUND TREATMENT

• Antitetanus• Antibiotics if necessary• Immobilisation• Analgesics

COMPLICATIONS OF WOUND HEALING

• Wound infection• Systemic infections• Chronic wounds and ulcers• Scars and contractures• Keloids• Lymphoedema• Bone complications: osteitis, osteomyelitis• Tetanus• Pressure ulcers