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1、PrinciplesofWoundManagementSurgery?HaemostasisAsepsisAnesthesiaTraumaticWoundsUsuallyuntidyDamagetotissuesisextensive,andextentunclear–suchasgunshotorblastinjuries,crushinjuries,lacerationsorburnsAndcontaminatedMosttraumaticwoundsarepotentiallycontaminated,andhen
2、celikelytobeinfectedWoundhealingHealinginvolvesmanyhumoral,chemical,environmentalandcellularfactorsTheprocessmaybeconsideredasoccurringinthreeoverlappingphasesFORMOFHEALINGFirstintention(cleanlyincision,nocomplication).Secondintention(openwound)SecondintentiontoF
3、irstintentionPhasesofhealingPhaseI:Vasodilatationofcapillariesinwoundedgesandmigrationofplasma,leucocytesandmacrophagesintothewoundspacePhaseII:Developmentofgranulationtissue,avascularandcellulartissuecomprisingnewvascularendothelium,fibroblasts,macrophagesandmas
4、tcellsPhaseIII:Remodeling;thewoundassumestheappearanceofanavascularfibrousscarBuildingblocksofhealingCollagenSynthesizedwithinfibroblasts,extrudedassolublefibrilswhichbecomeinsoluble,thickerandtougherduetointermolecularcross-linksProteoglycansLargeproteinpolysacc
5、haridecomplexesalsosynthesizedbyfibroblastsduringthe2ndphase,responsibleforstabilizationandmaturationofcollagenFibronectinPolymorphicglycoprotein,synthesizedbyfibroblastsduring2ndphaseandformanimmobilemeshforcell-to-cellandcell-matrixadhesionChemicalfactorsPlatel
6、ets,leucocytes,mastcellsandthecomplementsystemreleaseHistamineSerotoninKinins(bradykininandkallidin)ProstaglandinsConnective-tissueactivatingpeptideTheepidermalgrowthfactor(urogastrone)AndotherfactorsChemicalfactorsThesefactorsaredirectlyinvolvedinthehealingproce
7、ssbyinducingvasodilatation,capillaryengorgementandincreasedvascularpermeability,thusstimulatingthesynthesisofgranulationtissue,immigrationofleucocytesandactivationofwoundfibroblastsThefibroblastFibroblastsareactivatedbymacrophagesandplateletfactorsTheyproducecoll
8、agen,fibronectinandtheproteoglycansofgroundsubstanceSpecializedfibroblasts(myofibroblasts)areresponsibleforwoundcontractioninsecondaryhealingThewoundenvironmen
