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Wound healing
Skin: anatomy
Content:
Wound healing
Skin: anatomy
Epidermis
Subcutaneous
tissue (fat)
Dermis
Fascia/Muscle
The layers just described are clearly seen here. On the top you see
the reflected skin and subcutaneous tissue, which have been pulled
back to expose the muscle layer below.
Skin has 2 layers: The outer epidermis and the underlying dermis
Epidermis: Provides waterproofing and serves as a barrier to infection,
there are no blood vessels
Skin anatomy
6
/
Skin anatomy:
Wound healing
Skin: anatomy
q Classification of wounds
Wound healing
10
Incisions
Punctures
Lacerations
Burns
Bites
Abrasions
Surgical
Traumatic
National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary.
CDC NEISS All Injury Program 2005 Results.
EU Injury Database Report 2009.
Lammers. Principles of wound management. In: Roberts and Hedges. Clinical Procedures in Emergency Medicine. 5th ed.
Saunders Press; 2010.
5. Pfaff and Moore. Emerg Med Clin North Am. 2007;25:189.
1.
2.
3.
4.
Patient history
Neurovascular exam
Foreign bodies
Hemostasis
medical costs
Infected tissue: Deposition and proliferation of microorganisms in the tissue with consequent host reaction
Bacterial presence:
Classification of wounds
14
6
/
0-5 days
suture material is the
sole factor in holding
together the wound
Suture high tensile
strength needed
5- 14 Days
stabilization of the wound
closure is gradually taken
over by collagen
Suture- highest tensile
strength needed
Remodeling phase
Exceptions:
Epidermis
Serosa, mucosa and submucosa of the small
intestine. These tissue types adhere within 24-48
hours (gastight and watertight).
The colon becomes stable after 5-7 days.
hours
4-6 days
weeks
Maximum response
0.3
Neutrophils
Phagocytosis
Lymphocytes
ym
mp
m
phocyyte
es
e
10
30
100
F
Further sy
synthesis
of ECM
ECM formation
Angiogenesis and
granulation tissue
formation
Re-epithelialization
0.1
I Hemostasis
Coagulation
Platelet activation
300
V Scar maturation
Days
Weeks
Proliferative phase
Months
Remodeling Phase
6
/
Foy HM, Evans SRT. Teaching technical skills-Errors in the process. In: Grand SRT. Surgical Pitfalls: Prevention and
Management. Saunders; 2009:11-22.
Tenets of Halsted
Wound healing
Skin: anatomy
Tissue
Factors
Wound
Healing
Operative/
Surgeon
Factors
Patient
Factors
Local
foreign body reactions
Increased skin tension
Blood supply
Continued presence of microorganisms
Infection
Leaper. Basic surgical skills and anastomoses. In: Bailey and Loves Short Practice of Surgery. 25th ed.
Edward Arnold Ltd; 2008.
Infection
Deficiency syndromes
persisting disease
Immunosuppression/
Metabolic factors
Advanced age
Systemic
Smoking
Obesity
Classification of wounds:
Definition
No trauma effect
No inflammation
No breach of sterility
Tracheobronchial system, GI tract and urogenital
tract intact
Opening of the GI tract
Appendectomy
Opening of the oropharynx
Opening of the vagina
Opening of the urinary tract collecting system for
sterile urine
Opening of the bile system with sterile bile
minimal breach of sterility
Class
I Clean
II Cleancontaminated
32
Definition
Class
III
Contaminated
IV Dirty
Infected
33
Handling of tissue
- If the suture enters and exits from the skin at an acute angle,
the wound may become inverted with poor healing, producing
a poor cosmetic result needing revision.
- Short-handled holders are used for skin closure, but longhandled holders are needed for sutures placed deep inside
the body.
Leaper D. Basic surgical skills and anastomoses. In: Bailey and Loves Short Practice of Surgery. 25th ed.
Edward Arnold Ltd; 2008.
swelling
Edges should be everted
The knot should be placed to one side of the wound
Knots must be secure, with the ends long enough to
grasp if the suture is to be removed
Use no touch technique whenever possible
*Minimum
14-28 days
Weeks
14-28 days
8-12 weeks
8-12 weeks
healing times shown here are for healthy individuals without medical complications.
7-14 days
7-14 days
5-7 days
7-14 days
5-7 days
7-14 days
Wound healing
Skin: anatomy
Scarring
Dehiscence
Infection
Depressed
Hypertrophic
Harahap (ed)
(ed). Surgical Technique
Techniques for Cutaneous Scar Revision. Marcel Dekker; 2000:81-106.
Elevated
Keloids
Narrow
Flat surface
Lammers. Principles of Wound Management. In Roberts Clinical Procedures in Emergency Medicine. Saunders Press. 2010.
in all cases
events