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Wounds, wound healing and complications

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Hesham El-Hawary
Hesham El-Hawary
Gesundheit & Medizin
1 von 121
In the Name of Allah, the Most Beneficent, the Most Merciful And whosoever fears Allah and keeps his duty to Him, He will make a way for him to get out (from every difficulty). (2) And He will provide him from (sources) he never could imagine. And whosoever puts his trust in Allah, then He will suffice him. Verily, Allah will accomplish his purpose. Indeed Allah has set a measure for all things. (3) Surat Aţ-Ţalāq Wounds, Wound Healing And Complications ELHAWARY
Wounds, Wound Healing And Its Complications Assistant professor OMFS Cairo University MSA University Umm Al-Qura University Wounds, Wound Healing And Complications ELHAWARY
Wound Healing And Suture Materials WOUND – WOUND HEALING Wounds, Wound Healing And Complications ELHAWARY
Definition • Type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound) • In pathology: it specifically refers to a sharp injury which damages the dermis of the skin Wounds, Wound Healing And Complications ELHAWARY
Wounds, Wound Healing And Complications ELHAWARY
Classifications of wounds wound According to the According to exposure to the level of risk of outer sepsis environement Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma http://woundbegone.blogdrive.com/ Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://en.wikipedia.org/wiki/File:Knee_puncture.JPG Wounds, Wound Healing And Complications ELHAWARY
Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush http://journal.nzma.org.nz/journal/120-1267/2867/ injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://www.podiatrytoday.com/article/6303 Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision http://en.wikipedia.org/wiki/File:Bruises.jpg Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush http://www.buzzle.com/articles/hematoma-treatment.html injury Wounds, Wound Healing And Complications ELHAWARY
Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://www.smrteam.com/na1_crushinjury.htm Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis • No viscus entered Clean wound • No septic area • No break in aseptic technique Clean • Such wounds should never become contaminated infected; infection rates less than 3% wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean • Operation enters a non-infected area but contaminated may encounter bacteria wounds • Careful control of the area should result wound in minimal spillage of organisms Contaminated • Examples of this include surgery on the wounds upper gastrointestinal tract, biliary tree or respiratory tract • Infection rates for this type of surgery Dirty wounds should be less than 10% Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound • Gross spillage of organisms, where there Clean is infection already present but without contaminated wounds pus formation wound • There is a major break in aseptic Contaminated technique wounds • There is an open wound that has been exposed for less than 4 h (e.g. following major trauma) Dirty wounds • In this type of wound, sepsis frequently exceeds 30% Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds • This is an operation through an infected Dirty wounds area (e.g. perforated viscus, abscess or traumatic wound) that has been exposed for over 4 h Wounds, Wound Healing And Complications ELHAWARY
Wound Healing And Suturing WOUND HEALING Wounds, Wound Healing And Complications ELHAWARY
Definition • The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function Wounds, Wound Healing And Complications ELHAWARY
Definition • The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function Wounds, Wound Healing And Complications ELHAWARY
Definition • The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function • As a secondary consideration, this should be combined with an attempt to produce as perfect a cosmetic result as possible Wounds, Wound Healing And Complications ELHAWARY
Classification of wound healing Wounds, Wound Healing And Complications ELHAWARY
Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 month Wounds, Wound Healing And Complications ELHAWARY
Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 month Wounds, Wound Healing And Complications ELHAWARY
Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture Wounds, Wound Healing And Complications ELHAWARY
Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture Wounds, Wound Healing And Complications ELHAWARY
Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture Wounds, Wound Healing And Complications ELHAWARY
Differences between primary and secondary healing Wounds, Wound Healing And Complications ELHAWARY
Differences between primary and secondary healing Feature Primary healing Secondary healing Cleanness Clean Unclean Infection Generally uninfected May be infected Margins Surgically clean Irregular Healing Scanty granulation tissue Granulation tissue fill the gap Healing period Short long Healing direction Direct healing From the bottom to the edge Outcome Neat linear scar Contracted irregular wound Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Phases of wound healing Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Phases of wound healing Inflammation Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Phases of wound healing Proliferation Inflammation Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Phases of wound healing Maturation & Remodeling Proliferation Inflammation Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
http://en.wikipedia.org/wiki/File:Wound_healing_phases.png Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing • Inflammatory phase • Proliferative Phase • Remodeling Phase Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing Starts 1st day lasts from 3-5 days • Proliferative Phase • 1st vasoconstriction • 2nd blood clot formation • Remodeling Phase • 3rd platelets aggregation • 4th platelets degranulation • 5th vasodilatation • 6th chemotaxis • Leucocytes • Neutrophils • Macrophages Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing • Inflammatory phase Starts 3rd day lasts for 3rd week • 1st Angiogenesis • 2nd fibroblasts migration • Remodeling Phase • 3rd formation of granulation tissue • 4th reepithelialization Wounds, Wound Healing And Complications ELHAWARY
Normal sequence of wound healing • Inflammatory phase Starts from weeks to years • Proliferative Phase • The fibroblasts start to disappear • Collagen type III is gradually replaced by stronger type I collagen • The tensile strength of the scar tissue gradually increase Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound  Scrub the area with surgical antiseptic tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound  Scrub the area with surgical antiseptic tension  Drape the body with sterile surgical drapes Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood • Areas of good blood supply heal better than areas supply of poor blood supply Local factors Wound • Proper surgical technique tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous • Bridging a gap can be achieved by plastic surgery irradiation Factors techniques rather than suturing under tension Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous • Bridging a gap can be achieved by plastic surgery irradiation Factors techniques rather than suturing under tension Poor • Incision along lines of collagen bundles (Langer’s technique lines) Nutritional • Skin creases deficiencies • Transverse at the joints Systemic Systemic • Longitudinal on long parts (limbs) factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
http://www.beltina.org/health-dictionary/langers-lines-skin.html Wounds, Wound Healing And Complications ELHAWARY
http://hi.baidu.com/hilygogo/blog/item/35cbe8f0db3a7baba50f5271.html Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiation Factors • Predispose excess scar tissue formation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiation Factors • Predispose excess scar tissue formation Poor • Types technique • Exogenous: enter at time of injury Nutritional • Endogenous: hair, fat, necrotic tissue, tooth deficiencies fragment Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiation Factors • Predispose excess scar tissue formation Poor • Types technique • Exogenous: enter at time of injury Nutritional • Endogenous: hair, fat, necrotic tissue, tooth deficiencies fragment Systemic Systemic • Requires: proper cleaning and disinfection before factors diseases closure Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous irradiation • Radiation effect Factors • Hypovascularity Poor • Hypocellularity technique • Hypoxia Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Surgical technique affect the blood supply to area technique • Incision place: along lines of collagen bundles Nutritional (Langer’s lines) deficiencies • Flap design Systemic Systemic • Sharp clean cut factors diseases • Proper extension to prevent retraction Therapeutic pressure agents • Careful haemostasis • Proper suture material selection Age • Proper suturing technique Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Vitamins: A & C technique • vit. A: Involved in epithelialisation and Nutritional collagen production deficiencies • vit. C: Production and modification of collagen Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Vitamins: A & C technique • Minerals: Zinc Nutritional • Acts as an enzyme cofactor deficiencies • Has a role in cell proliferation Systemic Systemic • It accelerates wound healing in experimental factors diseases models Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Vitamins: A & C technique • Minerals: Zinc Nutritional • Protein: The main building block in wound healing deficiencies • A malnourished, hypoproteinaemic patient Systemic Systemic has impaired inflammatory and immune factors diseases responses, vital for normal wound healing Therapeutic and prevention of wound infection. agents • Protein amino acids are essential for collagen production which is itself a protein. Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic • Several diseases are known to impair wound factors diseases healing via a number of mechanisms Therapeutic • Important examples include diabetes, uraemia and agents jaundice Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique • Immunosuppressive drugs dampen the Nutritional inflammatory and immune responses, hence deficiencies impairing wound healing Systemic • Chemotherapeutic agents for malignancy Systemic factors diseases • Immunosuppressive and antiprostaglandin drugs used for inflammatory conditions such as Therapeutic agents rheumatoid disease; corticosteroid therapy N.B. Steroids have the additional effect of increasing Age the fragility of small blood vessels Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents • Prior to puberty, the rate of wound healing is Age increased compared to postpuberty Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Classification of wounds according to risk of Infection sepsis Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating technique complications Incisional • Prophylactic antibiotics Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating technique complications Incisional • Prophylactic antibiotics Hernia • Treatment • Prophylactic antibiotics • Empirical antibiotic Hypertrophic • Therapeutic /specific antibiotics scaring • I&D • Antiseptic packs Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating technique complications Incisional • Prophylactic antibiotics Hernia • Treatment • Prophylactic antibiotics • Empirical antibiotic Hypertrophic • Therapeutic /specific antibiotics scaring • I&D • Antiseptic packs Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional © 2009 Nucleus Medical Art, Inc. Hernia Hypertrophic scaring Keloid scarring Contractures http://www.empowher.com/media/reference/wound-dehiscence Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition: Total breakdown of all the layers of the Infection surgical repair of a wound • Etiology / causes: • Suture breakage Dehiscence • Knot slippage • Cutting out of sutures • Excess tension on the suture line complications Incisional © 2009 Nucleus Medical Art, Inc. Hernia Hypertrophic scaring Keloid scarring Contractures http://www.empowher.com/media/reference/wound-dehiscence Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional _hernia/info-incisional-hernia-gen-1.htm Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition: Breakdown of the deeper layers of a Infection wound in which the skin layer remains intact with protrusion of underlying structures through the deeper defect Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional _hernia/info-incisional-hernia-gen-1.htm Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition: Excess collagen scar tissue formation - Infection almost an over healing of a wound Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition Infection • Clinical features: • It is non-progressive after 6 months • Does not extend beyond the edges of the Dehiscence wound. • It occurs most frequently around joints and where Langer's lines of tension are crossed by complications Incisional the incision Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition Infection • Clinical features: • Etiology: Poor skin suturing • The edges of the skin are overlapping instead Dehiscence of being accurately apposed complications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition Infection • Clinical features • Treatment: • Difficult Dehiscence • Further surgery should not be attempted for at least 6 months • Excision of the scar and re-suturing often has complications Incisional disappointing results, resulting in the same over Hernia healing • Radiotherapy used to be used but has now been abandoned Hypertrophic • Some improvement can be achieved with local scaring injection of corticosteroids directly into the scar, a process that might need repeating several Keloid times scarring Contractures http://www.ehow.com/about_542243 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition: Overhealing with excess collagen scar Infection formation due to abnormality in collagen metabolism Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition Infection • Clinical features: • Excess scar tissue • Extends out beyond the wound edges Dehiscence • Continue to enlarge after 6 months • Prevalence is higher in • Patients with dark skin complications Incisional • young patients Hernia • Burn wounds Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Definition Infection • Clinical features • Treatment: • Excision generally results in a larger recurrence Dehiscence • Although excision followed by compression bandaging can have slightly better results • Corticosteroid injections give some complications Incisional improvement Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Infection • Burns Dehiscence • Incision crosses Langer's lines complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement Dehiscence • It is therefore essential to avoid vertical incisions across a joint if possible complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement Dehiscence • Surgical treatment include • Skin grafting • local flaps complications Incisional • wound Z-plasty Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.html Wounds, Wound Healing And Complications ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.html Wounds, Wound Healing And Complications ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.html Wounds, Wound Healing And Complications ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.html Wounds, Wound Healing And Complications ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.html Wounds, Wound Healing And Complications ELHAWARY
http://www.aafp.org/afp/2003/0601/p2329.html Wounds, Wound Healing And Complications ELHAWARY
Thank you Dr. Hesham El-Hawary Ass. Professor OMFS Facebook: Hesham El-Hawary Twitter: @elhawary_hesham Email: hesham@elhawarydentalclinc.com Website: www.elhawarydentalclinic.com Wounds, Wound Healing And Complications ELHAWARY

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Wounds, wound healing and complications

  • 1. In the Name of Allah, the Most Beneficent, the Most Merciful And whosoever fears Allah and keeps his duty to Him, He will make a way for him to get out (from every difficulty). (2) And He will provide him from (sources) he never could imagine. And whosoever puts his trust in Allah, then He will suffice him. Verily, Allah will accomplish his purpose. Indeed Allah has set a measure for all things. (3) Surat Aţ-Ţalāq Wounds, Wound Healing And Complications ELHAWARY
  • 2. Wounds, Wound Healing And Its Complications Assistant professor OMFS Cairo University MSA University Umm Al-Qura University Wounds, Wound Healing And Complications ELHAWARY
  • 3. Wound Healing And Suture Materials WOUND – WOUND HEALING Wounds, Wound Healing And Complications ELHAWARY
  • 4. Definition • Type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound) • In pathology: it specifically refers to a sharp injury which damages the dermis of the skin Wounds, Wound Healing And Complications ELHAWARY
  • 5. Wounds, Wound Healing And Complications ELHAWARY
  • 6. Classifications of wounds wound According to the According to exposure to the level of risk of outer sepsis environement Wounds, Wound Healing And Complications ELHAWARY
  • 7. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 8. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 9. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 10. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 11. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 12. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 13. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma http://woundbegone.blogdrive.com/ Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 14. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://en.wikipedia.org/wiki/File:Knee_puncture.JPG Wounds, Wound Healing And Complications ELHAWARY
  • 15. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush http://journal.nzma.org.nz/journal/120-1267/2867/ injury Wounds, Wound Healing And Complications ELHAWARY
  • 16. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://www.podiatrytoday.com/article/6303 Wounds, Wound Healing And Complications ELHAWARY
  • 17. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 18. Classification according to the exposure to the outer environment Incision http://en.wikipedia.org/wiki/File:Bruises.jpg Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury Wounds, Wound Healing And Complications ELHAWARY
  • 19. Classification according to the exposure to the outer environment Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush http://www.buzzle.com/articles/hematoma-treatment.html injury Wounds, Wound Healing And Complications ELHAWARY
  • 20. Classification according to object causing wound Incision Laceration Abrasion Open Puncture Penetration wound Gunshot Contusion Closed Hematoma Crush injury http://www.smrteam.com/na1_crushinjury.htm Wounds, Wound Healing And Complications ELHAWARY
  • 21. Classification According to level of risk of sepsis Wounds, Wound Healing And Complications ELHAWARY
  • 22. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
  • 23. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
  • 24. Classification According to level of risk of sepsis • No viscus entered Clean wound • No septic area • No break in aseptic technique Clean • Such wounds should never become contaminated infected; infection rates less than 3% wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
  • 25. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
  • 26. Classification According to level of risk of sepsis Clean wound Clean • Operation enters a non-infected area but contaminated may encounter bacteria wounds • Careful control of the area should result wound in minimal spillage of organisms Contaminated • Examples of this include surgery on the wounds upper gastrointestinal tract, biliary tree or respiratory tract • Infection rates for this type of surgery Dirty wounds should be less than 10% Wounds, Wound Healing And Complications ELHAWARY
  • 27. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
  • 28. Classification According to level of risk of sepsis Clean wound • Gross spillage of organisms, where there Clean is infection already present but without contaminated wounds pus formation wound • There is a major break in aseptic Contaminated technique wounds • There is an open wound that has been exposed for less than 4 h (e.g. following major trauma) Dirty wounds • In this type of wound, sepsis frequently exceeds 30% Wounds, Wound Healing And Complications ELHAWARY
  • 29. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds Dirty wounds Wounds, Wound Healing And Complications ELHAWARY
  • 30. Classification According to level of risk of sepsis Clean wound Clean contaminated wounds wound Contaminated wounds • This is an operation through an infected Dirty wounds area (e.g. perforated viscus, abscess or traumatic wound) that has been exposed for over 4 h Wounds, Wound Healing And Complications ELHAWARY
  • 31. Wound Healing And Suturing WOUND HEALING Wounds, Wound Healing And Complications ELHAWARY
  • 32. Definition • The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function Wounds, Wound Healing And Complications ELHAWARY
  • 33. Definition • The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function Wounds, Wound Healing And Complications ELHAWARY
  • 34. Definition • The process by which the body is trying to achieve anatomical integrity of the injured part and to restore full function • As a secondary consideration, this should be combined with an attempt to produce as perfect a cosmetic result as possible Wounds, Wound Healing And Complications ELHAWARY
  • 35. Classification of wound healing Wounds, Wound Healing And Complications ELHAWARY
  • 36. Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 month Wounds, Wound Healing And Complications ELHAWARY
  • 37. Classification of wound healing • Primary Intention • Occurs when: – The edges are clean and held together with ligatures – There is little gap to bridge Healing • Healing properties (When uncomplicated) – Occurs quickly – Rapid ingrowth of wound healing cells (macrophages, fibroblasts, etc.) – Restoration of the gap by a small amount of scar tissue. • soundly united within 2 weeks • Dense scar tissue is laid down within 1 month Wounds, Wound Healing And Complications ELHAWARY
  • 38. Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture Wounds, Wound Healing And Complications ELHAWARY
  • 39. Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture Wounds, Wound Healing And Complications ELHAWARY
  • 40. Classification of wound healing • Secondary Intention • Occurs when: – The edges are separated – The gap can not be directly bridged – Extensive epithelial loss – Severe contamination – Significant subepithelial tissue damage • Healing properties – Occurs slowly – Granulation; healing from the bottom towards the surface – Restoration of the gap by a small amount of scar tissue. • Scaring • Wound contracture Wounds, Wound Healing And Complications ELHAWARY
  • 41. Differences between primary and secondary healing Wounds, Wound Healing And Complications ELHAWARY
  • 42. Differences between primary and secondary healing Feature Primary healing Secondary healing Cleanness Clean Unclean Infection Generally uninfected May be infected Margins Surgically clean Irregular Healing Scanty granulation tissue Granulation tissue fill the gap Healing period Short long Healing direction Direct healing From the bottom to the edge Outcome Neat linear scar Contracted irregular wound Wounds, Wound Healing And Complications ELHAWARY
  • 43. Normal sequence of wound healing Wounds, Wound Healing And Complications ELHAWARY
  • 44. Normal sequence of wound healing Wounds, Wound Healing And Complications ELHAWARY
  • 45. Normal sequence of wound healing Phases of wound healing Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
  • 46. Normal sequence of wound healing Phases of wound healing Inflammation Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
  • 47. Normal sequence of wound healing Phases of wound healing Proliferation Inflammation Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
  • 48. Normal sequence of wound healing Phases of wound healing Maturation & Remodeling Proliferation Inflammation Hemostasis Days Weeks Months Wounds, Wound Healing And Complications ELHAWARY
  • 50. Normal sequence of wound healing • Inflammatory phase • Proliferative Phase • Remodeling Phase Wounds, Wound Healing And Complications ELHAWARY
  • 51. Normal sequence of wound healing Starts 1st day lasts from 3-5 days • Proliferative Phase • 1st vasoconstriction • 2nd blood clot formation • Remodeling Phase • 3rd platelets aggregation • 4th platelets degranulation • 5th vasodilatation • 6th chemotaxis • Leucocytes • Neutrophils • Macrophages Wounds, Wound Healing And Complications ELHAWARY
  • 52. Normal sequence of wound healing • Inflammatory phase Starts 3rd day lasts for 3rd week • 1st Angiogenesis • 2nd fibroblasts migration • Remodeling Phase • 3rd formation of granulation tissue • 4th reepithelialization Wounds, Wound Healing And Complications ELHAWARY
  • 53. Normal sequence of wound healing • Inflammatory phase Starts from weeks to years • Proliferative Phase • The fibroblasts start to disappear • Collagen type III is gradually replaced by stronger type I collagen • The tensile strength of the scar tissue gradually increase Wounds, Wound Healing And Complications ELHAWARY
  • 54. Factors affecting healing Wounds, Wound Healing And Complications ELHAWARY
  • 55. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 56. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 57. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 58. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 59. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound  Scrub the area with surgical antiseptic tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 60. Factors affecting healing Wound • Infection – delay healing & change type of healing sepsis • To avoid infection: Blood  Shave the skin immediate preoperatively supply  Scrub the operator hands with surgical scrub Local factors Wound  Scrub the area with surgical antiseptic tension  Drape the body with sterile surgical drapes Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 61. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 62. Factors affecting healing Wound sepsis Blood • Areas of good blood supply heal better than areas supply of poor blood supply Local factors Wound • Proper surgical technique tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 63. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 64. Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 65. Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous • Bridging a gap can be achieved by plastic surgery irradiation Factors techniques rather than suturing under tension Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 66. Factors affecting healing Wound sepsis Blood supply Local factors Wound • Tension across a healing a healing wound tension • Separate wound edges Foreign • Impairs blood supply bodies • Complicate wound healing Previous • Bridging a gap can be achieved by plastic surgery irradiation Factors techniques rather than suturing under tension Poor • Incision along lines of collagen bundles (Langer’s technique lines) Nutritional • Skin creases deficiencies • Transverse at the joints Systemic Systemic • Longitudinal on long parts (limbs) factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 69. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 70. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiation Factors • Predispose excess scar tissue formation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 71. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiation Factors • Predispose excess scar tissue formation Poor • Types technique • Exogenous: enter at time of injury Nutritional • Endogenous: hair, fat, necrotic tissue, tooth deficiencies fragment Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 72. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign • If present leads to: bodies • Infection Previous • Prolong the inflammatory reaction irradiation Factors • Predispose excess scar tissue formation Poor • Types technique • Exogenous: enter at time of injury Nutritional • Endogenous: hair, fat, necrotic tissue, tooth deficiencies fragment Systemic Systemic • Requires: proper cleaning and disinfection before factors diseases closure Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 73. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 74. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous irradiation • Radiation effect Factors • Hypovascularity Poor • Hypocellularity technique • Hypoxia Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 75. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 76. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Surgical technique affect the blood supply to area technique • Incision place: along lines of collagen bundles Nutritional (Langer’s lines) deficiencies • Flap design Systemic Systemic • Sharp clean cut factors diseases • Proper extension to prevent retraction Therapeutic pressure agents • Careful haemostasis • Proper suture material selection Age • Proper suturing technique Wounds, Wound Healing And Complications ELHAWARY
  • 77. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 78. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Vitamins: A & C technique • vit. A: Involved in epithelialisation and Nutritional collagen production deficiencies • vit. C: Production and modification of collagen Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 79. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Vitamins: A & C technique • Minerals: Zinc Nutritional • Acts as an enzyme cofactor deficiencies • Has a role in cell proliferation Systemic Systemic • It accelerates wound healing in experimental factors diseases models Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 80. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor • Vitamins: A & C technique • Minerals: Zinc Nutritional • Protein: The main building block in wound healing deficiencies • A malnourished, hypoproteinaemic patient Systemic Systemic has impaired inflammatory and immune factors diseases responses, vital for normal wound healing Therapeutic and prevention of wound infection. agents • Protein amino acids are essential for collagen production which is itself a protein. Age Wounds, Wound Healing And Complications ELHAWARY
  • 81. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 82. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic • Several diseases are known to impair wound factors diseases healing via a number of mechanisms Therapeutic • Important examples include diabetes, uraemia and agents jaundice Age Wounds, Wound Healing And Complications ELHAWARY
  • 83. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 84. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique • Immunosuppressive drugs dampen the Nutritional inflammatory and immune responses, hence deficiencies impairing wound healing Systemic • Chemotherapeutic agents for malignancy Systemic factors diseases • Immunosuppressive and antiprostaglandin drugs used for inflammatory conditions such as Therapeutic agents rheumatoid disease; corticosteroid therapy N.B. Steroids have the additional effect of increasing Age the fragility of small blood vessels Wounds, Wound Healing And Complications ELHAWARY
  • 85. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents Age Wounds, Wound Healing And Complications ELHAWARY
  • 86. Factors affecting healing Wound sepsis Blood supply Local factors Wound tension Foreign bodies Previous Factors irradiation Poor technique Nutritional deficiencies Systemic Systemic factors diseases Therapeutic agents • Prior to puberty, the rate of wound healing is Age increased compared to postpuberty Wounds, Wound Healing And Complications ELHAWARY
  • 87. Complications of wound healing Wounds, Wound Healing And Complications ELHAWARY
  • 88. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 89. Complications of wound healing • Classification of wounds according to risk of Infection sepsis Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 90. Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating technique complications Incisional • Prophylactic antibiotics Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 91. Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating technique complications Incisional • Prophylactic antibiotics Hernia • Treatment • Prophylactic antibiotics • Empirical antibiotic Hypertrophic • Therapeutic /specific antibiotics scaring • I&D • Antiseptic packs Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 92. Complications of wound healing • Classification of wounds according to risk of Infection sepsis • Prevention of wound infection • Environment Dehiscence • Theatre personnel • Patient preparation • Operating technique complications Incisional • Prophylactic antibiotics Hernia • Treatment • Prophylactic antibiotics • Empirical antibiotic Hypertrophic • Therapeutic /specific antibiotics scaring • I&D • Antiseptic packs Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 93. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 94. Complications of wound healing Infection Dehiscence complications Incisional © 2009 Nucleus Medical Art, Inc. Hernia Hypertrophic scaring Keloid scarring Contractures http://www.empowher.com/media/reference/wound-dehiscence Wounds, Wound Healing And Complications ELHAWARY
  • 95. Complications of wound healing • Definition: Total breakdown of all the layers of the Infection surgical repair of a wound • Etiology / causes: • Suture breakage Dehiscence • Knot slippage • Cutting out of sutures • Excess tension on the suture line complications Incisional © 2009 Nucleus Medical Art, Inc. Hernia Hypertrophic scaring Keloid scarring Contractures http://www.empowher.com/media/reference/wound-dehiscence Wounds, Wound Healing And Complications ELHAWARY
  • 96. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 97. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional _hernia/info-incisional-hernia-gen-1.htm Wounds, Wound Healing And Complications ELHAWARY
  • 98. Complications of wound healing • Definition: Breakdown of the deeper layers of a Infection wound in which the skin layer remains intact with protrusion of underlying structures through the deeper defect Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.melbournegallbladder.com.au/patientinfosheets/info_incisional _hernia/info-incisional-hernia-gen-1.htm Wounds, Wound Healing And Complications ELHAWARY
  • 99. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 100. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  • 101. Complications of wound healing • Definition: Excess collagen scar tissue formation - Infection almost an over healing of a wound Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  • 102. Complications of wound healing • Definition Infection • Clinical features: • It is non-progressive after 6 months • Does not extend beyond the edges of the Dehiscence wound. • It occurs most frequently around joints and where Langer's lines of tension are crossed by complications Incisional the incision Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  • 103. Complications of wound healing • Definition Infection • Clinical features: • Etiology: Poor skin suturing • The edges of the skin are overlapping instead Dehiscence of being accurately apposed complications Incisional Hernia Hypertrophic scaring Keloid scarring http://www.ehow.com/about_542243 Contractures 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  • 104. Complications of wound healing • Definition Infection • Clinical features • Treatment: • Difficult Dehiscence • Further surgery should not be attempted for at least 6 months • Excision of the scar and re-suturing often has complications Incisional disappointing results, resulting in the same over Hernia healing • Radiotherapy used to be used but has now been abandoned Hypertrophic • Some improvement can be achieved with local scaring injection of corticosteroids directly into the scar, a process that might need repeating several Keloid times scarring Contractures http://www.ehow.com/about_542243 1_natural-herbs-hypertrophic- scars.html Wounds, Wound Healing And Complications ELHAWARY
  • 105. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 106. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 107. Complications of wound healing • Definition: Overhealing with excess collagen scar Infection formation due to abnormality in collagen metabolism Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 108. Complications of wound healing • Definition Infection • Clinical features: • Excess scar tissue • Extends out beyond the wound edges Dehiscence • Continue to enlarge after 6 months • Prevalence is higher in • Patients with dark skin complications Incisional • young patients Hernia • Burn wounds Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 109. Complications of wound healing • Definition Infection • Clinical features • Treatment: • Excision generally results in a larger recurrence Dehiscence • Although excision followed by compression bandaging can have slightly better results • Corticosteroid injections give some complications Incisional improvement Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 110. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures Wounds, Wound Healing And Complications ELHAWARY
  • 111. Complications of wound healing Infection Dehiscence complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  • 112. Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Infection • Burns Dehiscence • Incision crosses Langer's lines complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  • 113. Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement Dehiscence • It is therefore essential to avoid vertical incisions across a joint if possible complications Incisional Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  • 114. Complications of wound healing • Wound Contractures can occur with any wounds Infection • More commonly with delayed healing wounds • Contracture of a scar across a joint can result in marked limitation of movement Dehiscence • Surgical treatment include • Skin grafting • local flaps complications Incisional • wound Z-plasty Hernia Hypertrophic scaring Keloid scarring Contractures http://www.patient.co.uk/health/ Dupuytren%27s- Contracture.htm Wounds, Wound Healing And Complications ELHAWARY
  • 121. Thank you Dr. Hesham El-Hawary Ass. Professor OMFS Facebook: Hesham El-Hawary Twitter: @elhawary_hesham Email: hesham@elhawarydentalclinc.com Website: www.elhawarydentalclinic.com Wounds, Wound Healing And Complications ELHAWARY