Updates of Wound Healing
Sherif Shaban Mohammed Abdul Moaty;
Abstract
Wounds can be categorized as partial-thickness wounds, full-thickness wounds or as either acute or chronic wounds. Wound healing is a dynamic process involving soluble mediators, a variety of cells and extra-cellular matrix. Recently these phases are greatly understood on the basis of cytokines and growth factors.
When the integrity of human skin is broken the healing process begins by hemostasis phase in which blood coagulates and platelets aggregate. During the stage of inflammation, damaged parenchymal cells, platelets and activated complement pathways produce vasoactive mediators.
Lastly restructuring of the newly synthesized tissue occurs depending on continued synthesis and catabolism of collagen at a low rate.
Particular emphasis should be placed on several host factors which can adversely affect wound healing as extremes of age, diabetes mellitus, chronic renal failure, obesity, malnutrition, smoking and use of immunosuppressive medication. Also sepsis, whether present as local bacterial colonization of the wound site or as a systemic inflammatory response leads to healing failure.
Dressings can be classified based on their construction and function into passive, modern interactive and bioactive dressings. Passive dressings include absorbing and non-absorbing groups while modern interactive group of dressings involves non-absorbing films and silicone as well as the absorbing group including foam, hydrogel, alginate, hydrocolloids and hydrofibers. Bioactive dressings include iodine, silver, honey, chitosan, collagen and hyaluronic acid dressings as well as cultured skin tissues which are all arranged in groups known as (drug delivery systems, skin substitutes and biological dressings).
Selection of the proper wound dressing remains the main challenge in the process of wound dressing. Plenty of factors and principles have to be in consideration for choosing the appropriate dressing which involve wound characters (size, location, level of exudation, stage of healing, surrounding skin and bioburden). Effective wound dressing requires an understanding of the ideal dressing properties aside from the timing of the healing cycle in which dressing to be chosen. Dressing to be an ideal one for specific wound, it should fulfill a list of criteria (humidity maintenance, gaseous exchange, protection, atraumatic on removal, thermal insulation, high absorption properties and cost effective).
Surgical site infection (SSI) is one of the post operative complications which represent a quarter of all nosocomial infections. NNIS system of the CDC data shows that of all SSIs, 47%; are superficial, 23%; are deep, and 30%; are organ/space. Patient related factors which increase the risk of (SSI) include (older age, pre-existing infection, diabetes and smoking). Surgical wound are classified into; clean, clean/contaminated, contaminated and dirty wounds. The majority of SSIs are largely preventable and evidence-based strategies have been available preoperative, intraoperative and postoperative.
Low frequency ultrasound (LFUS) and Extracorporeal shock wave therapy (ESWT) are considered to be one of the effective technological modalities of acoustic energy in the field of wound healing promotion at the level of molecular basis. Collagen synthesis and its tensile strength both are documented to be stimulated by LFUS. ESWT is approved to promote granulation tissue formation and reduction of chronic wound size.
When the integrity of human skin is broken the healing process begins by hemostasis phase in which blood coagulates and platelets aggregate. During the stage of inflammation, damaged parenchymal cells, platelets and activated complement pathways produce vasoactive mediators.
Lastly restructuring of the newly synthesized tissue occurs depending on continued synthesis and catabolism of collagen at a low rate.
Particular emphasis should be placed on several host factors which can adversely affect wound healing as extremes of age, diabetes mellitus, chronic renal failure, obesity, malnutrition, smoking and use of immunosuppressive medication. Also sepsis, whether present as local bacterial colonization of the wound site or as a systemic inflammatory response leads to healing failure.
Dressings can be classified based on their construction and function into passive, modern interactive and bioactive dressings. Passive dressings include absorbing and non-absorbing groups while modern interactive group of dressings involves non-absorbing films and silicone as well as the absorbing group including foam, hydrogel, alginate, hydrocolloids and hydrofibers. Bioactive dressings include iodine, silver, honey, chitosan, collagen and hyaluronic acid dressings as well as cultured skin tissues which are all arranged in groups known as (drug delivery systems, skin substitutes and biological dressings).
Selection of the proper wound dressing remains the main challenge in the process of wound dressing. Plenty of factors and principles have to be in consideration for choosing the appropriate dressing which involve wound characters (size, location, level of exudation, stage of healing, surrounding skin and bioburden). Effective wound dressing requires an understanding of the ideal dressing properties aside from the timing of the healing cycle in which dressing to be chosen. Dressing to be an ideal one for specific wound, it should fulfill a list of criteria (humidity maintenance, gaseous exchange, protection, atraumatic on removal, thermal insulation, high absorption properties and cost effective).
Surgical site infection (SSI) is one of the post operative complications which represent a quarter of all nosocomial infections. NNIS system of the CDC data shows that of all SSIs, 47%; are superficial, 23%; are deep, and 30%; are organ/space. Patient related factors which increase the risk of (SSI) include (older age, pre-existing infection, diabetes and smoking). Surgical wound are classified into; clean, clean/contaminated, contaminated and dirty wounds. The majority of SSIs are largely preventable and evidence-based strategies have been available preoperative, intraoperative and postoperative.
Low frequency ultrasound (LFUS) and Extracorporeal shock wave therapy (ESWT) are considered to be one of the effective technological modalities of acoustic energy in the field of wound healing promotion at the level of molecular basis. Collagen synthesis and its tensile strength both are documented to be stimulated by LFUS. ESWT is approved to promote granulation tissue formation and reduction of chronic wound size.
Other data
| Title | Updates of Wound Healing | Other Titles | الحديث فى التئام الجروح | Authors | Sherif Shaban Mohammed Abdul Moaty | Issue Date | 2015 |
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