Wound Healing Process Type

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Healing is define as process of replacing damaged tissues with healthy tissues. 

Wound healing take place by two methods regeneration of cell and repair of damaged tissues.

Wound healing occur in four sequential steps, hemostasis, inflammation, proliferation and maturation. 


Hemostasis


Hemostasis is a process of blood clotting to stop blood flow. It is first quick response by body to prevent blood loss.

  • Vasoconstriction 

After injury blood vessels sevierly undergoes for vasoconstriction. It result in decreased blood flow toward injured area. It last for 5 to 10 minutes.


  • Platelet aggregation 

At the site of injury platelet aggreagate in lare number. It then send chemical signals to form or activate fibrin molecule. It forms a cascade like structure to prevent blood loss.


  • Fibrin (Platelet) plug formation 

Platelet plug is formed by multiple cascade formation. At last fibrin molecule covers the cascade act like glue to hold blood clot.

Inflammatory Phase

See:- Inflammation

Inflammation is complex process result in formation of edema, swelling, redness and pain at injured site.

It start with dilation and widening of blood vessels to supply more amount of blood component at injured site. It involve increasing vascular permeability to allow enzyme, antibodies, wbc, rbc, growth factor and nutrients to react at injured site.

It result in series of biochemical reaction causing edema, pain and pus formation. Redness occur over skin due to widening of blood vessels and accumulation of blood.

Fluid accumulation from blood vessels and circulatory system result in formation of edema.

Proliferative phase


Proiferative phase involve formation of granular tissues and regeneration of new tissues.

Granular tissues are composed of collagen and Extracellular matrix where angiogenesis occurs. Angiogenesis is process of formation of new blood vessels. It occurs in 2 to 4 weeks. And then new skin tissues cover the damaged tissues a process called as epithelialization.

Maturation

Maturation phase is last phase initiate once the wound is closed. It last for months to year. Newly form capillaries, endothelia cells and necrostic cells get autolysis and disappear. The collagen fiber get organized and achieves maximum strength.


Wound Healing Type

There are three types of wound healing,
  1. Healing by first intention
  2. Healing by second intention
  3. Healing by third intention

Healing by first intention


Healing by first intention involves clean deep wound that heal by surgical sutures. It involve less tissue damage and edges were closed.

It has small sized wound with less granulation tissue and scar is rarely seen.

Healing start after hour of performing surgical sutures. If there is no infection then complete healing will take place in 2 to 4 days. 

Healing by second intention


Healing by second intention occur when large tissue damage occur and celllular destruction occur. This type of wound take ling time to heal. 

The wound is open due to large tissue damage and granulation tissue fill up the space for healing. 

It involve large granulation tissue  formation and large amount of scar formation. 

Due to loss of epidermal layer chances if infection were very high.
Example. Burn, ulcer, accidental injury, infected wounds etc.

Healing by third intention

Healing by third intention involve large tissue damage and injury due to secondary cause like less circulation and infection. Wound is observed for 4 to 5 days before closure.

In this suturing is not work, becauses granulation tissue fill up the wound.

Condition which are treated with third intention has problem with blood circulation and infection. Suturing is not performed till favorable condition comes.

Factors influencing wound healing 


  • Infection

Presence of infection causes inflammation, swelling, edema in tussues. It increase time of healing due to constant inflammattory reactions.


  • Movement

Heaing take place properly when the part is steady. Moment of specific part results in delay time and area of wound healing increases.


  • Foreign particles

Any foreign particle such as dust, small glass, steel obstruct the wound healing. This foreign substance remain there because body is not able to degrade those sibstances.0


  • Size and type of wound

Small wounds are heal earlier than large wound.

  • Blood supply

Amount of blood supply increases time of healing. Ex. Wounds on face heal quickly then wound present on one of leg.

  • Location

Example bone. Bones are covered with interveining tissues which prevent blood flow close to bone. Skin fails to contract and healing take place slowly.


  • Nutrition

Person woth malnutrition, PEM, and vitamin deficiency result in delaying healing process.

  • Age

It is rapid in younger compared to aged individual.

  • Hematological abnormalities

Bleeding disorder, clotting abnormalities and low blood cell count slow healing process.

  • Metabolic status

DM can delayed healing. It lengthen metabolic process increasing time of healing.

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