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ABNORMAL HEALING, UNTIDY WOUND, TIDY WOUND, AIM of treatment is primary…
ABNORMAL HEALING
FACTORS INFLUENCING HEALING OF WOUND
site
structure
SYSTEMIC FACTORS
other local factors
previous radiation
pressure
vascular insufficiency
loss of tissue
contamination
contaminated with foreign body bacteria , other ppl bone eg in explotion
test for HIV hepatitis etc
clean
mechanism
incised
crush , crush avulsion
CLASSIFICATION OF WOUND CLOSURE AND HEALING
secondary intention
wound is left open
normal healing
minimal scar
tertiary intention
wound edges are initially left open
edges are opposed when healing conditions are favourable
primary intention
wound edges opposed
heals by granulation , contraction , re epitelialization , increased inflammation and proliferation
poor scar
delayed healing may lead to loss of function poor cosmetic outcome
UNTIDY WOUND
remove all contaminated or devitalized tissue IN ONE OR SEVERAL occations
definitive repair in SECOND LOOK SURGERY
DEVITALIZED TISSUE
HIGH VELOCITY MISSILES
COMPARTMENT SYNDROME
TIDY WOUND
NO tissue loss or devitalized tissue
PRIMARY REPAIR OF all structures may be possible
AIM of treatment is primary healing
primary healing decreases INFLAMMATORY and PROLIFERATIVE phases