surgical procedures and management

Apr 15th, 2015
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WOUND HEALINGForms of wound healing:1. First intention2. Second intention.First intention (primary) healing occurs when tissue is cleanly incised and re approximated and repair occurs without complication. Second intention (secondary) healing occurs in open wounds through formation of granulation tissue* and eventual coverage of the defect by spontaneous migration of epithelial cells. Most infected wounds and burns heal in this mannerGranulation tissue is the red, granular, moist tissue that appears during healing of open wounds. Microscopically, it contains new collagen, new blood vessels, fibroblasts, and inflammatory cells, especially macrophages.Primary healing is simpler and requires less time and material than secondary healing. It sometimes happens that primary healing is possible but there is insufficient reserve to support secondary healing.Eg. Ischemic limb may heal primarily, but if the wound opens and becomes secondarily infected, it may not heal.Healing phasesInjury profoundly disrupts the chemical environment and architecture of tissues.The postinjury environment, characterized by impaired perfusion coinciding with inflammation, invokes a number of fundamental biochemical, physiologic, and cellular coping mechanisms in process of healing.Process includes CoagulationInflammationFibroplasias and matrix depositionAngiogenesisEpithelializationContraction. Cells involved are platelets, leukocytes (especially macrophages), fibroblasts, vascular endo

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