home Audience 5 How a wound heals by secondary intention. How does the process of wound healing by secondary intention occur? Types of wound healing

How a wound heals by secondary intention. How does the process of wound healing by secondary intention occur? Types of wound healing

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In medicine, there are three main types of wound healing: healing under the scab, as well as by secondary and primary intention. A specific healing method is always chosen by the doctor, based on the patient’s condition and the characteristics of his immune system, the nature of the wound received, as well as the presence of infection in the affected area. The stages of wound healing, or rather their duration, depend directly on the type of wound and its scale, as well as on the type of healing itself.

In this article you will learn everything about the type of wound healing and its characteristics, what are the features and how to properly care for the injury after the healing process.

Healing by first intention

This type of regeneration is the most perfect, since the entire process takes place over a short period of time, and a fairly thin, but very durable scar is formed.

As a rule, wounds after operations and suturing, as well as minor injuries after cuts, heal by primary intention if the edges of the wound do not have strong discrepancies.

Wound healing using this method is possible in the absence of an inflammatory process accompanied by suppuration. The edges of the wound are tightly connected and fixed, resulting in normal and rapid healing of the wound without the formation of a large amount of coarse scar tissue.

Only a thin scar remains at the site of the wound, which at first after formation has a red or pink color, but later gradually brightens and acquires almost the same tone as the skin.

The wound heals by primary intention if its edges are completely close to each other, while there are no areas of necrosis or any foreign bodies between them, there are no signs of inflammation, and the damaged tissues have fully retained their viability.

Secondary tension

Secondary intention mainly heals wounds that cannot be sutured and those that were not sutured on time due to the fact that the person turned to doctors late. Wounds also heal by secondary intention, in which the process of inflammation and pus formation actively develops. With this healing method, granulation tissue first develops in the wound cavity, gradually filling all the available space, forming a fairly large and dense scar of connective tissue. Subsequently, this tissue is covered with epithelium on the outside.

Secondary healing processes usually occur against the background of fairly intense inflammation that occurs due to primary as well as secondary infection, and are accompanied by the release of pus.

The type of secondary intention can be used to heal wounds with severe divergence of the edges and a significant wound cavity, as well as for those injuries in the cavity of which there are necrotic tissues or foreign bodies, blood clots.

This technique is also used in cases where the patient has hypovitaminosis, general exhaustion of the body, metabolic processes are disrupted, due to which not only the body’s defenses decrease, but also the intensity of the natural processes of tissue regeneration.

The granulation tissue that develops in the wound cavity has a very important biological significance for the overall healing process and the body as a whole. It is a kind of physiological as well as a mechanical barrier that creates an obstacle to the absorption of toxins, microbes from the wound cavity and decay products of the inflammatory process, which are toxic to the body, into the body tissues.

In addition, granulation tissue secretes a special wound secretion, which promotes faster cleansing of the wound mechanically, and also has a natural bactericidal effect, which prevents the spread of bacteria and other pathogenic microorganisms from the damaged area to the skin and healthy tissue.

It is through the process of granulation in the wound cavity that dead tissue is separated from living tissue while simultaneously filling the damaged space.

Of course, only granulation tissue that is not damaged has all the protective properties, so when changing dressings it is very important to be extremely careful and careful not to cause additional damage to the wound.

Healing under the scab

This type of healing usually restores scratches, minor wounds, abrasions, burns, small and shallow wounds, as well as bedsores, ulcers and other skin injuries.

During the healing process, a crust forms on the surface of the wound or other damage, having first a red and then a dark brown color, which is called a scab. Such a formation consists of lymph, coagulated blood and wound exudate mixed together and covering the surface of the injury with the formed substance.

The scab is a fairly dense formation that perfectly protects the wound from contamination, penetration of harmful microorganisms, mechanical damage, while holding the edges of the injury together, ensuring their relative immobility.

Treatment of minor abrasions and cuts

Abrasions and various small wounds can be treated and treated at home, on your own, but be sure to follow all the rules of care and use the right products.

First of all, when receiving any wound, it must be washed with soap and water to clean it of dirt and microorganisms that have gotten inside.

After this, the wound should be dried with a napkin and, using a gauze swab, treat the damage with a pharmaceutical solution of hydrogen peroxide, carefully wetting the surface.

There is no need to pour hydrogen peroxide directly from the bottle onto the wound. This product allows you to not only effectively disinfect the surface of the injury and the skin around it, eliminating almost all types of harmful microorganisms, but also helps stop bleeding.

Then it is best to apply a sterile bandage. If the wound is very small or the damage is a scratch or minor abrasion, you can fold a piece of bandage according to the size of the injury or take a cotton pad, soak it in a solution, for example, apply it to the wound and secure it with a plaster or bandage. If the bandage becomes saturated with blood, it must be changed to a fresh one, repeating the treatment of the wound.

It is necessary to change a bandage soaked in blood so that later, when replacing the dressing material, you do not accidentally tear off a blood clot that has formed on the surface of the wound, which will later become a scab.

Once a crust has formed, the bandage should be removed and the lesion left open. Wounds under a scab heal best and much faster in the air.

Post-healing care

After the formation of a scab on the surface of the injury, which indicates the beginning of the normal healing process, it is very important to ensure that the scab is not injured by any careless movement.

Under no circumstances should you try to tear off a scab prematurely, when new tissues underneath have not yet formed. Such actions can lead not only to infection and an increase in the recovery time of damaged tissues, but also to the formation of a scar, which will subsequently require treatment and adjustment. After the formation of full-fledged tissue, the scab will fall off on its own.

It is important that the surface of the scab always remains dry. If the crust becomes wet with water, for example, when washing your hands or body, it should be dried immediately with a paper napkin.

After the scab falls off, you can use various ointments, creams or folk remedies to accelerate the formation of epithelium at the site of the former injury, as well as to soften and moisturize young tissue and prevent the formation of a serious scar.

Damage restoration

The recovery time for any injury largely depends on its characteristics, location, location, depth, size, healing method used, medications, proper care, timely treatment and changing of bandages.

The healing method plays a significant role in the healing process and recovery time.

If the wound heals by primary intention, is clean, and there is no inflammatory process, then healing occurs in about 7 to 10 days, and tissue restoration and strengthening occurs within about a month.

If the wound gets infected and an inflammatory process develops with pronounced suppuration, then healing occurs by the method of secondary intention and the recovery period is delayed. In this case, the timing of complete healing will be individual, since much depends on the condition and correct functioning of the patient’s immune system, the presence of diseases of the endocrine system and any chronic ailments.

If the human body is weakened and there are disturbances in metabolic processes, then the recovery time in the presence of an inflammatory process can be very long and last several months.

The speed of healing of wounds under the scab primarily depends on the state of the immune system and on proper care of the wound site. It is very important not to rip off the crust that has formed, but to wait for it to fall off on its own after the process of regeneration of new tissue is completed.

With the help of special preparations, such as various antiseptic solutions, medicinal powders in powder form, as well as gels, creams and ointments, in many cases it is possible not only to significantly speed up the recovery time, but also to make the scar after healing much smaller, softer, lighter or not formed at all. Traditional medicine can also be used for the same purpose, but it is important that any prescriptions for treating wounds are made only by a qualified doctor.

What to do in case of suppuration and microbial infection of the wound

If an infection has entered the wound cavity, an inflammatory process will certainly begin, the intensity of which primarily depends on the general health of the person, as well as on the type of microorganisms that have penetrated into the wound cavity.

When suppuration begins, wounds should be treated frequently, changing dressings at least twice a day, but if the dressing material becomes contaminated more quickly, changing dressings is carried out more often, as necessary, each time treating the wound.

When changing dressings, the surface of the wound and the skin around it must be treated with an antiseptic solution, after which, if necessary, special ointments are applied that help not only fight microorganisms, but also eliminate inflammation, swelling, accelerate the cleansing of the wound cavity, and also maintain the necessary moisture balance in the wound, without allowing it to dry out.

It is important to carry out dressings correctly and in a timely manner, using sterile instruments, sterile materials, the right means to eliminate inflammation and accelerate healing, and also following the rules for changing dressings.

Wound healing is a normal physiological process whose function is to protect the patient's homeostasis. This process is controlled by general humoral factors and local factors of the affected area.

Violation of integrity, continuity. Primitive animals respond to damage by regenerating through cell mitosis to restore the integrity of their integument. In higher vertebrates there is a more inferior replacement process that allows the damaged surface to be reconnected through the formation of a fibrous scar that restores physical continuity.

Regular physical activity such as walking or cycling provides additional support. This way you can support the wound healing process. If you have diabetes, your blood sugar levels should be checked regularly to optimally manage the disease and prevent impaired wound healing. Wear breathable clothing made from cotton, wool or microfiber that doesn't shrink. Avoid tight-cuffed socks or stockings with corsets or corsets, as these will cut off or reduce circulation. Limit smoking as much as possible as it contributes to circulatory problems. For optimal selection and adjustment of shoes, a visit to an orthopedic shoemaker is recommended. Avoid high heels. Be sure to move consciously and enough, such as taking the stairs instead of using the elevator. Even small exercises like spinning your leg or rocking up and down can help keep your blood flowing. Reduce existing excess weight. . Wound healing occurs in phases that follow each other in time, but sometimes overlap.

The possibility of regeneration in humans is preserved, for example, in liver cells, but even in this case it is limited by damage or deficiency of liver tissue to 75%

When required a wider healing process with more extensive damage, a lack of regeneration is detected and healing is manifested in the formation of a fibrous scar, more extensive, leading to cirrhosis.

The exudation phase for hemostasis and wound cleansing is followed by the granulation phase to create granulation tissue and the epithelialization phase for maturation, scarring, and epithelization of the wound. This process is completed for acute wounds in approximately 14-21 days, depending on the size and type of injury.

In chronic wounds, this time is disrupted and significantly increased because the reasons for causation are either unknown or insufficiently adequate. The lack of cause-and-effect therapy leads to impaired wound healing. Chronic wounds can last from several months to several years without the wound actually healing.

Leather, being a complex organ, is not subject to regeneration. There is a need to distinguish between “epithelialization” - the process that occurs during the healing of a burn and superficial skin damage. In this case, epithelial cells form a new epidermis and wound healing occurs.

Additionally, in certain cases such as pregnancy, growth and development of the mammary glands, obesity, subcutaneous tissue expanders (Tissue Expander), at first glance it seems that new skin is being formed, but in reality we are talking about remodeling, manifested in stretching and changing the architectonics of dermal collagen, which becomes thinner. In these cases, increased mitotic activity of epidermal cells is a normal reaction to stretching, which is not regeneration.

During the exudation phase, also known as the inflammatory phase, inflammatory phase or cleansing phase, cells and hormones of the immune system are essentially involved in destroying invasive bacteria and viruses and promoting the healing process. First, hemostasis follows a very specific pattern: the vessels are in contact and thus lead to a decrease in blood flow. Platelets are activated, releasing their storage materials and thereby attracting more platelets. Parallel plasma coagulation leads to a stable thrombus with the participation of fibrin. Acidosis in the wound area causes swelling, which promotes the conversion of fibrocytes into fibroblasts and dilutes toxic waste in the wound area. Decisive for cleaning the wound are.

Platelets adhere to collagen fibers.
Fibrinogen binds platelets together, creating a platelet graft.

Especially neutrophil granulocytes can dissolve dead tissue and phagocytic bacteria.

Human body cells are divided into 3 types depending on their ability to regenerate:
1. Motile cells (Labile).
2. Stable cells (Stabile).
3. Permanent cells.

Motile cells- various epithelial cells of the body, ranging from the epidermis of the skin to the cells covering internal organs, such as the urinary tract, digestive system, etc. These cells normally multiply throughout life and are able to cover the damaged area, if it is small.

Most white blood cells disintegrate, releasing hydrolytic enzymes, which in turn dissolve cellular debris. Immigrated monocytes phagocytose cellular debris. Macrophages play a key role here: they force the wound to clear by phagocytosis, in addition, they produce growth factors that stimulate subsequent phases of wound healing. Thus, they also stimulate fibroblast proliferation and initiate neovascularization. However, this activity is only possible under moist wound conditions and a wound temperature of at least 28 degrees.

Stable cells. The rate of reproduction of these cells is low; they respond to damage by rapid division and have the ability to quickly repair damage if the connective tissue base has maintained its integrity. These cells are found in the parenchyma of internal organs such as the liver, spleen, pancreas, as well as endothelial cells of blood vessels and smooth muscles.

In chronic wounds, this phase is often significantly prolonged because bacterial inflammatory responses slow wound healing. The granulation phase begins approximately 24 hours after wound formation and reaches a maximum within 72 hours.

During this phase, new tissue is formed to fill the wound. It is characterized by the migration of accompanying vascular cells into the wound edges. These cells have the ability to form blood vessels, phagocytose bacteria, and form fibrin fibers. Fibroblasts also produce mucopolysaccharides and other substances important for wound healing.

Permanent cells. These are cells that do not divide after birth. These include striated muscle cells, heart muscles and nerve cells. Damage to these cells leads to replacement by connective tissue and scar formation.

Flaw healing through the formation of connective tissue, it comes down mainly to the unaestheticness of the scar, as well as dysfunction. Healing processes with the formation of excess fibrous tissue can lead to severe complications in the healing of internal organs: narrowing of the esophagus, cirrhosis of the liver, scars in the cornea, damage to the heart valves.

Fibroblasts can feed mainly on amino acids, which are produced by the breakdown of blood clots by macrophages. Typically, fibrin is destroyed during collagen injection. It is at this point that a wound disorder often occurs in chronic wounds: fibrin persistence. Fibrin is not destroyed, but is deposited on the wound surface.

Up to one third solely by shrinkage and two thirds by new formation. . Epithelization begins in an acute wound after 3-4 days and may take several weeks. This leads to an increase in the formation of new collagen fibers, which are stitched into a bundle. The strength of normal tissue is no longer achieved. Pressure ulcers on scar tissue are approximately 5 to 10 times faster than on normal skin. Epidermal cells usually start irregularly at the edge to spread over the wound surface.

Similar processes in the skin lead to the formation of hypertrophic scars, keloids and contractures. There are conditions in which the healing processes are impaired due to deficiency of vitamin C, excess of vitamin A, suppression of the immune system, local infection, etc. An understanding of the wound healing process and a clinical attitude towards its various stages is necessary to achieve the desired direction to obtain ideal healing.

However, epithelial islands can also be placed in the middle of specific wound areas. This also allows migration, which ultimately serves to close the wound. Our body is often damaged by aggressive agents. More or less severe trauma, caused in different ways, destroys areas of the body that from then on need repair.

The skin, being the most peripheral and superficial area, is most often affected. As a shell of internal structures, it is more stable than the organs involved. If we consider a muscle or part of the intestines or any other organ, the skin is stronger, with the exception, of course, of the bones, which have more resistance and can be considered the most energetic of the body.

Following the saying Ambroise Pare(1510-1590) - “I have bandaged the wound, and God will heal it” does not always promote successful healing, but serves to hide failure and allow nature and God to do their work away from the examining eyes.

If it is in our best interest to intervene and speed up the healing process of a wound, it is important to become familiar with the healing mechanism.

Healing is called the phenomenon by which the body tends to repair the damaged part. If an attacking agent causes damage in one place, a series of phenomena immediately arise that are aimed at reorganizing that area and develop in the same order for the purpose of repair.

Healing by primary intention (sanatio per primam intentionem) is the most economical and functionally beneficial; it occurs in a shorter time with the formation of a thin, relatively durable scar.

Rice. 2. Wound healing by primary intention

Surgical wounds heal by primary intention when the edges and walls of the wound come into contact with each other (for example, incised wounds), or if they are connected with sutures, as is observed after primary surgical treatment of the wound, or suturing of surgical wounds. In these cases, the edges and walls of the wound stick together and stick together due to a thin fibrin film. In this case, reparative regeneration goes through the same phases as the course of the wound process: inflammation, proliferation and formation of connective tissue, epithelization. The amount of necrotic tissue in the wound is small, and inflammation is insignificant.

The budding epithelium of the capillaries of the wound walls and fibroblasts pass through the fibrin gluing to the opposite side (as if stitching granulations that fill small cavities between the walls), undergo organization with the formation of collagen and elastic fibers, and a thin linear scar is formed with rapid epithelization along the line of connection of the edges of the wound. Occasional small superficial wounds with a dehiscence of up to 1 cm can also heal by primary intention without sutures. This occurs due to the convergence of the edges under the influence of edema of the surrounding tissues, and they are subsequently held in place by the resulting “primary fibrin adhesive.”

With this healing method, there is no cavity between the edges and walls of the wound; the resulting tissue serves only to fix and strengthen the fused surfaces. Only wounds in which there is no infectious process heal by primary intention: aseptic surgical wounds or accidental wounds with minor infection if the microorganisms die within the first hours after injury.

Thus, in order for the wound to heal by primary intention, the following conditions must be met:

No infection in the wound;

Tight contact of wound edges;

2. Describe the phases of the wound process. What phase is the patient in?

3. What complication of the pathological process developed in sick K.?

Task 3.

Patient A., 29 years old, two days after the traumatic removal of the 6th tooth of the upper jaw on the right, the body temperature in the armpit increased to 39.9°C.

Objectively: in the area of the extracted tooth, the edges of the wound are swollen and painful, opening the mouth is also painful; The patient's skin is pale, dry and cold to the touch. The patient's condition is not satisfactory.

1. What pathological process has developed in the patient? List local and general signs of this process.

2. What phase of the wound process occurs in the patient?

3. What elements make up a wound?

4. List the complications of the wound process.

Task 4.

Patient P., 15 years old, is undergoing inpatient treatment in a clinical hospital for acute lymphadenitis of the right submandibular region, which occurred after acute hypothermia. The patient has a history of chronic tonsillitis and surgical treatment is recommended. The patient's condition is unsatisfactory. The head is tilted to the right. On the right, in the submandibular region, a dense infiltrate is palpated, painful on palpation. Body temperature in the armpit is 38.3ºС. Complement C-3 blood plasma - 2.3 g/l (normal 1.3-1.7 g/l), NST - test 40% (normal 15%), (nitroblue tetrazole reduction test reflects the degree of activation of oxygen-dependent mechanisms of bactericidal activity phagocytic cells). C - reactive protein in blood plasma (++), ESR - 35 mm/hour.

1. What pathological process is inherent in the identified changes?

2. What symptoms of the body’s general reactions to inflammation did you identify when analyzing the problem?

3. What local symptoms of the inflammatory reaction are given in the problem?

4. What outcomes of the inflammatory reaction do you know?

5. Give an example of a general blood test:

a) in acute inflammation;

b) chronic.

Task 5.

Patient B., 46 years old, was admitted to the dental department of a clinical hospital with complaints of fever (temperature up to 39°C), throbbing pain in the submandibular region on the right. The illness began after severe hypothermia four days ago. Objectively: in the submandibular region on the right there is a red-bluish infiltrate with a softening area in the center. In case of emergency, the abscess was opened. A laboratory study revealed a high content of neutrophilic leukocytes in the exudate. The hemogram revealed: nuclear shift to the left, acceleration of ESR. “Acute phase proteins” were detected in the blood plasma.

1. For which inflammation, acute or chronic, is this situation more typical?

2. What is meant by the term “acute phase proteins” in inflammation? What changes in the body are indicated by the presence of “acute phase proteins” in the blood and the dynamics of their changes in different stages of the disease, significance for prognosis.

3. How are wounds divided by origin and degree of microflora contamination?

4. What factors worsen and slow down the course of the wound process?

5. Reasons for the occurrence of a chronic process in the dental-maxillary area.

Main:

1. Pathophysiology (study for medical universities) / ed., M.: GEOTAR-MED -200p.

2.Atlas on pathophysiology / edited by MIA: Moscow

Additional:

1. Guide to the practical course of pathophysiologists: textbook / etc. // R-on-Don: Phoenix

2.Barsukov physiology. Lecture notes. - M.: EKSMO - 2007

3. Hormonal regulation of the basic physiological functions of the body and the mechanisms of its disturbance: textbook / ed. . - M.: VUNMC

4. Dolgikh pathophysiology: textbook. - R-on-Don: Phoenix

5.Pathological physiology: Interactive course of lectures /,. – M.: information agency”, 2007. – 672 p.

6. Robbins S. L., Kumor V., Abbas A. K. et al. Robbins and Cotran pathological basis of disease / Saunders/Elsevier, 2010. – 1450P.

Electronic resources:

1. Frolov pathophysiology: Electronic course on pathophysiology: textbook. - M.: MIA, 2006.

2.Electronic catalog of KrasSMU

3. Absotheue Digital Library

5.BD Medicine

6.BD Geniuses of Medicine

7. Internet resources

Wound process – the body's response to injury.

It includes 3 phases:

Inflammatory phase (alteration, exudation, necrolysis);
Proliferation phase (formation and maturation of granulation tissue);
Healing phase (scar formation, wound epithelization).

There are several types of healing:

Healing by primary intention;
Healing through the formation of infiltrate (per infiltrati);
Healing by secondary intention;
Non-healing of the wound (chronic long-term non-healing wounds).

Primary healing

Cut and puncture wounds heal by primary intention.

Conditions under which a wound heals by primary intention:

With these wounds the amount of dead tissue is minimal,
There is no infection in the wound or only a small amount,
The edges and walls of the wound are brought together (in contact). The wound is a narrow slit-like defect,
There are no foreign bodies in the wound

From the walls of the wound, adhesive substances (from lymphatic vessels and capillaries) and proteins are released. The wound sticks together, primary adhesion of the edges and walls of the wound occurs. The stage lasts tens of minutes.

Then the consolidation process occurs. From one edge of the wound, vessels grow into the other edge, in different directions and planes (growing towards each other). The stage lasts several hours.

The capillaries are covered with fibroblasts, so the lumen of the wound is filled with capillaries with fibroblasts. Fibroblasts synthesize collagen and elastin fibers. Fibrocytes are then formed from fibroblasts. That is, the walls and edges of the wound are stitched with fibers. The stage lasts several days. Scar tissue forms and matures.

On days 4-5 (face, neck), days 6-10 (rest of the body), epithelization of the wound occurs.

If one or more conditions are not met (see above), the wound heals by secondary intention.

Secondary healing

Torn, lacerated, bruised, crushed wounds heal by secondary intention. They clearly distinguish zones of necrosis, bruise and concussion.

Stage 1 – purification (hydration) stage.

Sources of enzymes in the wound: 1) Enzymes - autopsins contained in lysosomes (lysis process from the inside); 2) Enzymes of macrophages, monocytes, lymphocytes, platelets, erythrocytes, neutrophils, eosinophils that migrated from the vessels along the intercellular gaps to the necrosis zone. 3) Microorganisms present in the wound.

Liquefaction and loosening of tissues leads to the fact that dead tissue falls off in pieces (up to the bruise area).

The process of fusion of wound edges is the same: a capillary grows towards the bruised area. There is a loop-like growth of capillaries with fibroblasts. As a result, granulation tissue is formed. The next day - a new layer of capillaries. So the wound is gradually freed from the dead.

With the growth of granulations, the wound gradually decreases in size. As soon as the wound is completely filled with granulation tissue, the epithelium begins to creep in.

If the growth of the epithelium is slowed down for some reason, granulations come out from behind the edges of the wound and a keloid is formed.

Healing by primary intention is possible under a protective bandage in 6 to 8 days, “on its own.” The prerequisites are a small area of damage, close contact of the edges of the wound, the absence of foci of necrosis and hematoma, and relative asepticity of the wound (microbial contamination less than 10 5 per 1 g of tissue). The surface of the wound is covered with a thin scab; after the latter is rejected, a fresh scar covered with epithelium opens. Every aseptically applied surgical wound heals in this way. Signs of inflammation with this type of healing are minimal and can only be determined microscopically.

For very superficial wounds that do not penetrate all layers of the skin (abrasions), healing occurs under a scab consisting of fibrin, leukocytes and red blood cells. In the absence of infection, this healing occurs within a few days. In this case, the epithelium spreads over the entire surface of the wound. The formation of a crust during excoriation is highly desirable.

Healing by secondary intention. Granulation tissue and its biological significance.

The reason for wound healing by secondary intention is a large area of tissue damage and gaping wound edges, the presence of non-viable tissue, hematomas, and the development of wound infection. First, the surface of the wound is covered with a layer of blood cells mixed with fibrin, which protects the wound purely mechanically. After 3-6 days, the formation of fibroblasts and capillaries becomes so pronounced that the latter represent a vascular tree penetrating the fibrin layer. As a result, granulation tissue is formed, which creates a biological defense for the wound against infection and toxins. Epithelization begins only after the wound has been completely cleansed of necrotic masses and the entire wound defect has been filled with granulations. In order to shorten the time for wound healing by secondary intention, a suture is used on a granulating wound or a free skin graft. Granulations act as a protective wall and form a demarcation line at the border with healthy tissues. At the same time, granulation tissue secretes a wound secretion, which has a bactericidal effect (enzymatic necrolysis) and mechanically cleans the surface of the wound. Foreign bodies (metal, silk, heterogeneous bones) are encapsulated by granulation tissue, and the inflammation initiated by the foreign bodies stops. Foreign bodies such as catgut and hemostatic sponge are resorbed. Foreign bodies infected with virulent microorganisms are first surrounded by granulation tissue, but then suppuration occurs around the foreign body with the formation of a fistula or abscess.

General reactions of the body.

Factors influencing wound healing.

The most well-known general reaction of the body to injury is an increase in body temperature due to irritation of thermoregulation centers during the resorption of pyogenic protein breakdown products. This aseptic resorption increase in temperature is not accompanied by chills and does not exceed 38.5 0 C. The pulse rate almost does not increase. In response to injury, leukocytosis usually develops with a shift to the left; the albumin/globulin ratio in the blood plasma changes, the amount of total protein decreases. Severe trauma causes disorders of the basal and carbohydrate metabolism (traumatic hyperglycemia).

Catabolic phase usually lasts 2–4 days and is manifested by tissue necrosis, proteolysis and exudation. The breakdown of body proteins is easily detected by the increasing excretion of nitrogen in the urine. In cases of severe injury and infection, nitrogen excretion reaches 15–20 g per day, which corresponds to the breakdown and loss of 70 g of protein or 350 g of muscle tissue. It should be noted that plasma protein levels do not reflect these changes. Protein breakdown can be reduced by the administration of high-calorie drugs for parenteral and enteral nutrition.

Intermediate, transition phase takes 1 – 2 days, is not clinically expressed. Anabolic phase characterized by increased protein synthesis and takes from 2 to 5 weeks. Clinically manifested by the cleansing of the wound from necrotic tissue, the development of granulation tissue, and epithelization.

Among the factors influencing wound healing, the following should be highlighted:

Age. Younger patients heal faster than older patients.

Body mass. In obese patients, wound suturing is significantly more difficult; fatty tissue is more susceptible to traumatic injury and infection due to a relatively weak blood supply.

Nutritional status. In patients with low nutrition, there is a deficiency of energy and plastic material, which inhibits reparative processes in the wound.

Dehydration. Severe intoxication leads to fluid deficiency, electrolyte imbalance, which negatively affects the functions of the heart and kidneys, and intracellular metabolism.

State of blood supply. Wounds in areas with good blood supply (face) heal faster.

Immune status. Immunodeficiency of any kind worsens the prognosis of surgical treatment (courses of chemotherapy, glucocorticosteroids, radiation therapy, etc.).

Chronic diseases. Endocrine disorders and diabetes mellitus always lead to a slowdown in repair processes and the development of postoperative complications.

Tissue oxygenation. Any process that prevents the access of oxygen or other nutrients impairs healing (hypoxemia, hypotension, vascular insufficiency, tissue ischemia, etc.).

Anti-inflammatory drugs. The use of steroids and nonspecific anti-inflammatory drugs slows down the healing process.

Secondary infection and suppuration - is one of the most common causes of wound deterioration. It should be noted that in 95% of cases the source of bacterial contamination is endogenous bacterial flora.