home Audience 6 Induration around the wound. Periods and phases of healing of purulent wounds. Wound care during the early stages of healing

Induration around the wound. Periods and phases of healing of purulent wounds. Wound care during the early stages of healing

The farther from the head, the longer. Without primary surgical treatment the wound is healing secondary intention, through the process of suppuration. The time frame may vary from 2 to 3 weeks. Depending on the size of the wound surface.

The wound does not owe anything to anyone, and therefore for each person it heals exactly as long as it is allowed to local conditions- individual qualities of a person. Yes, I forgot, natural conditions also play a role. For example, everyone knows that in the coastal region, wounds heal longer and more painfully due to the high humidity of the climate. And the energy of the person himself can influence the healing of a wound. Once upon a time in the Soviet magazine "Around the World" I read about one either African or Australian aboriginal tribe, a representative of which demonstrated to Soviet scientists his abilities of this kind: he took a knife and slashed his hand, making a rather deep wound, which is usually treated doctor. But his blood very quickly coagulated and dried, and literally after a few minutes the bleeding stopped. And by evening, only a scar remained at the site of this wound, as if the wound had been inflicted a long time ago.

All about cuts

General information

blunt objects that leave wounds with ragged edges. Such wounds usually appear in the bone area ( on knees, fingers). The tissues around such wounds become very swollen and severely injured, scarring is more difficult, since their edges are uneven,
sharp objects that leave cut wounds. Such wounds can be quite deep and affect not only the upper layers of tissue, but also deeper ones,
thin and sharp objects that leave puncture wounds,
combined injuries that remain after exposure to sharp and blunt objects.

What symptoms should you look out for?

If the cut is on the face, the wound is long or deep enough, if its edges are not closed with an adhesive plaster, you need the help of a doctor. Deep wounds in the joint area, on the chest, neck, face, and palms are dangerous. You should also definitely show the wounds to a doctor if the victim is a baby, if the tissue around the wound turns red, swells and hurts. These are signs of infection. Attention should be paid if the tissue around the wound has lost sensitivity. If the bleeding does not stop, the victim has impaired motor skills of the limbs or fingers, or if he is in shock, an ambulance must be urgently called.

Complications

trauma to large veins and arteries,
cut infection ( the wound hurts, becomes covered with pus, turns red),
tetanus. This serious disease, striking nervous system. It is incurable. The pathogen develops in deep wounds ah without access to oxygen. To prevent the development of the disease, it is introduced antitetanus serum, operating for ten years.

Incised extensor tendon injury

Treatment and stopping bleeding

cleansing the wound,
blood stop,
sterile wound closure,
antiseptic treatment.

Cleansing the wound carried out using water and soap solution. Washing should be done with a piece of cotton wool or bandage. Quick rinse wound allows you to remove sources of infection and prevent wound suppuration. After soaping the wound, rinse the soap thoroughly clean water. This procedure must be done daily until the wound is completely scarred.

If the wound is very dirty, you can also use 3% hydrogen peroxide or an antiseptic solution.

If you have a cut on your lips or chin small child, you should not apply a bandage, as it will collect food and saliva.

A sterile dressing should not be changed frequently, unless the dressing is loose or dirty. But even in this case, you can not change the bandage, but only bandage it on top again with a clean bandage.

Most quick way- this is to press the cut on top with a clean bandage or cloth. The bandage must be pressed tightly enough and held until the bleeding stops ( sometimes up to a quarter of an hour). This procedure is ineffective only if the arteries are affected. To make the blood flow less intensely, you need to raise the wounded limb upward.

Aqueous solutions are used for treating wounds, as well as wetting tampons and napkins for sterile dressings. This treatment is completely painless and is often used to treat wounds in children.

What to do if your finger is injured?

Here's a little secret: how to put it on your finger so that it is convenient for them to operate, and so that the bandage does not move out. Regular bandaging of a finger most often only leads to the fact that the bandages slip off after a while. And sometimes they dry to the wound, and changing the dressing is then painful and unpleasant. To prevent all these troubles, you should wrap your finger at the cut site with a strip of paper that covers the entire phalanx. After which you can wrap a bandage or stick a patch. Such a paper wrapper will protect the wound, move its edges and help it heal faster.

This type of bandage is easier to remove because the paper will not stick to the wound. According to experienced people, it is best to use white stationery paper. Before application, it should be treated with hydrogen peroxide.

Ointment treatment

It is produced in the form of ointment, spray, cream and lotion. Contains vitamin B5, quickly heals wounds, restores tissue, and can be used to treat mucous membranes. Treat the affected area once a day.

Relieves inflammation, antiseptic, accelerates tissue restoration. Wounds are treated once a day.

Relieves inflammation, stops bleeding, accelerates tissue restoration. Prescribed if the cut does not heal for a long time. The affected surface is treated two or three times a day and a bandage is applied before bedtime.

Relieves inflammation, destroys microbes, accelerates tissue restoration. It is very indicated for long lasting cuts. Treatments are carried out several times a day.

Produced in the form of iodine solution and ointment. Strong antiseptic. May cause local skin irritation.

Inhibits the development of pathogenic microbes, relieves pain, and accelerates scarring. Treatment is carried out once or twice a day. Effective for purulent wounds.

Antiseptic, inhibits the development of microbes. Prescribed for the treatment of wounds, including very dirty ones ( washed first aqueous solution, then ointment is applied).

Special instructions for the use of certain medications

If the cut does not heal for a long time, you should take a course of vitamins B, C, E and A,
Treatment of wounds with iodine can provoke individual intolerance,
People who have impaired function thyroid gland, you should use iodine preparations only under the guidance of a doctor,
Solutions of boric acid cannot be used to treat large surfaces of the body, as the drug is absorbed into the blood and poisoning may develop. This is very dangerous for children. Signs of poisoning boric acid: nausea, rash, kidney failure, diarrhea,
Alcohol preparations should not be applied to the wound surface, using them only to lubricate the skin around the wound,
Since any alcohol preparations cause a burning sensation, they are not advisable to use in the treatment of wounds in children,
Deep cuts should not be treated with hydrogen peroxide, as air bubbles may clog the blood vessels.
Lifusol ointment creates a thin protective film on the surface of the wound, which protects the wound from germs. You can remove it by wiping the body with alcohol,
Lifusol is a flammable product. In addition, you should not give the tube of ointment to babies.

Antibiotics

What affects the speed of healing?

How to get rid of scars?

For the right choice method of removing a scar, you must first of all keep in mind the nature of the injury and its depth.

When should you definitely see a doctor?

blood spurts out of the wound; if the blood is scarlet, a blood vessel is probably cut,
blood flows profusely and does not stop,
the cut is in a visible place and the scar on it is undesirable,
the hands are affected - there are important tendons and nerves here,
symptoms of inflammation are present - redness covering the tissue more than 2 cm around the cut, swelling of the tissue,
increase in body temperature,
the wound is deep enough - in such cases it is necessary to apply a suture,
the wound is dirty, and the last tetanus shot was given more than five years ago,
soil and animal feces got into the wound ( for example, manure) – in such environments there is a lot of tetanus pathogen,
the wound does not heal long enough, exudate flows from it,
after injury, the victim vomits and feels sick - this is more true for head injuries in children.

Doctor's help

clean the wound from dirt and debris,
put stitches,
if nerves, tendons or blood vessels are damaged, send them to the hospital,
prescribe antibiotics if the wound is infected,
give an anti-tetanus injection.

First aid and treatment procedure for deep cuts on fingers

The fingers are most susceptible to various injuries. Cooking, working garden plot, car repairs, home repairs, as well as many other everyday activities involve working with your hands, and, therefore, can cause finger injuries, the most common of which are cuts to the thumb and index finger. Every person should know what to do if they cut their finger.

Types of cuts

There are several types of cuts:

Cuts caused by blunt objects are characterized by ragged edges of the wound and can be combined with bruises and flattening of soft tissues, which complicates treatment.
Wounds from sharp objects have smooth edges, which makes healing easier. However, sharp objects often cause deep cuts, which can affect, in addition to the skin with small capillaries, large vessels, ligaments and even bones.
Another type of injury is a puncture rather than a cut. They can also be applied with sharp, thin objects. Treatment of such cuts and punctures is complicated by the fact that the wound channel is usually narrow and deep. The finger quickly swells, but the blood does not stop, it soaks into the tissue around it, because of this, the wound quickly rots, and the finger begins to break out. Such cuts are characterized by blueness of the finger.
Often the finger is not just cut, but part of the flesh is cut off. In this case, it is extremely important to protect the wound from getting pathogenic microorganisms, since the open area is much larger than with a regular cut.

First aid for a deep cut

Deep cuts may be complicated by tendon cuts. This injury can easily occur if you cut your finger with a blender or other electrical appliance powerful enough to cut deep into the flesh. With such injuries, the sensitivity of the finger is lost. The patient cannot move it, bend or straighten it.

These symptoms are a direct indication to see a doctor.

In most cases it is necessary surgery- suturing tendons, stitching up a cut. Self-treatment may entail serious complications. But first you need to provide emergency assistance.

Initially, you need to determine the intensity of bleeding. If the blood pulsates or gushes in a constant stream, it means that a vessel much larger than the capillary has been affected. It is necessary to stop the bleeding as quickly as possible. To do this, apply a tourniquet or rubber band to the finger above the cut site. It drags on exactly until the blood stops, no more. It is better to record the time when the tourniquet was applied. Every minute it is necessary to loosen the tourniquet, in order to avoid the death of tissues to which blood access was limited.

The second step is to wash the wound. As a rule, 3 or 6 are used for this percentage solution hydrogen peroxide, which also has hemostatic properties. If you don’t have peroxide on hand, you can rinse the wound under running water. cold water. However, many doctors do not recommend doing this with tap water, because the quality of the pipes often leaves much to be desired, and there is a high risk of infection.

After the wound is washed, a moderately tight bandage of gauze or bandage is applied. You can also use any piece of clean cotton or linen fabric.

After this, the victim should be immediately taken to the hospital or an ambulance should be called. All this time, it is better to keep the wounded arm raised, at face level, this will help slow down or even stop the bleeding.

How to treat a cut on a finger

Treatment of cuts consists of 4 main stages: washing, stopping bleeding, treating the wound, dressing.

Washing

So, first of all, you need to examine the wound. If there are foreign objects, then they must be removed. It is convenient to use tweezers for this. To remove remaining dust, dirt, and possibly particles of the object that caused the injury, such as pieces of glass, from the wound, it must be washed and disinfected. A solution of hydrogen peroxide copes well with this task. It must be poured directly into the wound. There, the peroxide begins to foam, thereby pushing out everything unnecessary. She also shows antiseptic properties. In addition to peroxide, you can use an aqueous solution of furatsilin or a soap solution to wash the wound. It is important to thoroughly rinse the soap solution with cold running water after the procedure. A correctly performed procedure will keep the wound walls in their original position, which will promote speedy healing.

Stopping the bleeding

After the wound is washed, it is necessary to stop the bleeding.

Usually, with a shallow cut, the bleeding itself stops within minutes.

Provided that the victim does not have impaired blood clotting for any reason. It is enough to keep your hand raised after washing. If the bleeding doesn't stop after specified deadlines, you need to press the cut with a bandage or cloth. When blood continues to bleed through the bandage, another tighter bandage should be applied over the old one. Do not remove the old bandage until the bleeding stops. Because there is a risk of removing already dried blood and provoking bleeding with renewed vigor.

Bleeding that cannot be stopped in this way within minutes can be dangerous and you should consult a doctor.

A tourniquet is used exclusively when injuring large vessels, as it severely restricts blood circulation. Improper use can lead to irreversible consequences.

Treatment of the wound

After the bleeding has stopped, it is necessary to remove the hemostatic bandage, if it was applied. It is better to moisten the dried bandage with a solution of furatsilin for painless removal. If necessary, wipe the wound with a swab moistened with the same solution to remove any remaining dressing. Then dry the cut with a piece of dry, clean cloth. Next, the wound is treated with an antiseptic to prevent infection and subsequent suppuration. The skin around the wound is treated alcohol solution iodine or brilliant green.

It is extremely important to ensure that these drugs do not get on the edges, much less directly into the wound, because there they can kill living tissue.

This will slow down tissue regeneration and make treatment more difficult. In addition, the alcohol solution will cause additional painful sensations, which is especially undesirable if a child has injured a finger. The wound itself is treated with ointments with antibiotics, such as levomekol, methyluracil, gentamicin ointment, levosin, tetracycline ointment. It is important to apply the ointment in moderate doses. Too much a large number of ointment causes the edges of the cut to soften, which complicates treatment. After treating the wound, it must be properly bandaged.

Dressing

To begin with, it is recommended to wrap your finger in a paper strip moistened with hydrogen peroxide, this will help avoid pain when changing the bandage. You should use clean paper, without text. Printer ink and paint contain harmful substances. In this case, the edges of the wound need to be moved together as much as possible, especially if the wound is deep, down to the meat. A bandage is placed on the finger over the paper. It should be tight enough to hold the edges of the wound together. At the same time, the bandage should not put too much pressure on the finger or block the blood flow. Blood supplies damaged tissues with oxygen. This promotes faster healing.

For a small cut, you can use a bactericidal patch.

The dressing is changed once a day.

At proper treatment small cuts heal completely in 4-5 days. Deeper cuts complicated by suppuration or damage to the ligaments take much longer to heal.

If the wound has festered, the treatment process may drag on for days.

Damaged ligaments are restored from 3-4 weeks to 3 months.

Factors influencing the rate of wound healing

Healing depends on many factors. The main ones are:

Blood supply. The tissues must be sufficiently supplied with oxygen, which is delivered by blood. The higher the oxygen concentration in tissues, the more active the immune system is, the faster blood vessels are restored and skin, the production of collagen, one of the most important proteins that plays a key role in the process of tissue regeneration in the human body, is accelerated.
Patient's diet. To produce collagen fibers, you need proteins, minerals, vitamins, and carbohydrates. A large number of these components contain meat, dairy products, and nuts.
High-quality isolation of the wound from the external environment. Microorganisms entering a wound not only cause purulent inflammation. They also absorb oxygen, which is so necessary for immune processes.

Possible complications

Even the smallest, seemingly insignificant cut can result in a number of complications.

The most common of them is inflammation with suppuration. The edges of the wound become red and swelling is noticeable. The patient is bothered by throbbing pain in the finger. This complication occurs especially often with cuts with a deep narrow channel. Dressings with Levomekol ointment, as well as its analogues, such as Ichthyol ointment and balsamic liniment according to Vishnevsky. They effectively cope with inflammation and draw out pus from the wound well.

Extremely dangerous complication is infection of a wound by bacteria tetanus-causing. This disease affects the nervous system. It's incurable! If the cut was caused by a dirty object such as glass or rusty nail. Be sure to thoroughly wash the cut and see a doctor to administer anti-tetanus serum.

Cutting fingers are very common domestic injuries. You can cut yourself with a knife in the kitchen, with a razor in the mirror, even with a sheet of office paper. The vast majority of finger cuts are not serious. They are easily treated at home. However, you should not neglect even the smallest cuts.

It is important to take it on time necessary measures on treatment.

Ignoring them threatens with the most unpleasant consequences.

Every home and every workplace should have a first aid kit with the essentials for first aid: cotton wool; bandage; bactericidal patch; tourniquet; hydrogen peroxide; Furacilin tablets; iodine or brilliant green; ointment containing an antibiotic.

First aid for cuts. What to do to help yourself or anyone else affected

How long does it take for a deep knife cut on a finger to heal?

How long does it take for a deep cut to heal?

It happens that at the most inopportune moment, we hurt ourselves. Sometimes these wounds are very deep. What to do in this case? How can I make a deep cut heal faster?

How to help a wound heal faster?

There are a few simple rules, following which the wound will heal much faster, and the trace from it will be almost invisible.

The area of skin around the wound should be kept moist at all times. That is, you must definitely use an antibiotic ointment, which not only helps ensure safety from infection, but also provides the skin with sufficient moisture. This is done because dry wounds heal more slowly. You need to apply this ointment every time you dress a wound.

Step 2. Do not pick or tear off the crust that has formed on the wound. It serves as a kind of protection for the wound from getting into it various foreign bodies and bacteria. Therefore, when a person removes it, the healing process slows down, and there is also a possibility of an inflammatory process.

The bandage from the wound must be removed slowly and carefully so as not to further injure the cut or tear off the protective crust. If the patch is difficult to remove, you can wet it, then it will come off easier.

You need to get a good night's sleep. Because it has long been proven that all healing processes occur best when a person is in a state of sleep.

How do wounds and abrasions heal?

We all experience injuries from time to time. How to speed up the healing process and avoid scars if possible, read our article.

Injury is always a nuisance. Even the slightest scratch can cause a lot to a person discomfort: inflammation, pain, swelling. And if these consequences of injuries go away after some time, then the scars, alas, remain for many years. It is especially unpleasant if scars form on visible parts of the body, for example on the face, neck, hands. Appearance spoiled by scars often brings a lot of psychological problems, especially for women who care so much about their beauty.

Fortunately, everything is not as tragic as it seems at first glance. With a competent approach to the treatment of wounds and abrasions, you can significantly speed up the healing process and also avoid the formation of scars.

How do wounds heal?

First, let's figure out how wound healing occurs? Believe me, a deeper understanding of the processes only contributes to the correct treatment tactics. The wound healing process takes place in several stages:

inflammation phase. Immediately after the injury occurs, the body begins to fight the problem. Initially, a blood clot forms in the tissues to stop bleeding. On the other hand, the body needs to constantly fight microorganisms that can get into open wound. This whole process is accompanied by inflammation - a process in which immune cells are recruited to the site of injury, and swelling is also formed, which puts pressure on the nerve endings, thereby causing pain. The inflammation phase can last up to 7 days. Already on the 7th day, the wound begins to fill with granulation tissue - connective tissue, which is formed during wound healing;
proliferation phase. Approximately starts from the 7th day and can last up to 4 weeks. During the proliferation phase, the wound is actively filled with connective granulation tissue, which is based on collagen. The wound is also filled with capillaries and inflammatory cells. This is how a young scar is formed. At this stage, the scar stretches easily. Because of great content the scar has blood vessels in it bright red color, which makes it easily noticeable;
scar formation phase. A scar begins to form around the 4th week, and this process can last up to 1 year. The bright red scar formed during the proliferation stage begins to fade and the scar becomes less noticeable. As a result, the lesion site is finally filled with connective and epithelial tissue. Primary collagen is replaced by coarser collagen. Thus, a scar is formed, which takes on its final (completed) appearance.

Fast healing

In parallel, wound healing occurs in 2 stages: hydration and dehydration. The wound hydration stage is the period when the wound is still moist. Accordingly, the dehydration stage is the time when the wound remains dry. In this regard, to achieve speedy healing, it is important to use wound-healing drugs (D-panthenol, etc.) in a timely manner. It is worth keeping in mind that during the hydration stage the wound needs hydration and regular cleansing. And at the stage of dehydration, the wound needs protection and nutrition of the formed tissues. Therefore, it is very important to use wound-healing drugs already at the “wet” stage. This way the wound will close faster, and the risk of wound infection will be significantly reduced.

Sweat glands help heal wounds, burns and ulcers. Scientists from the University of Michigan came to this conclusion.

Besides, accelerated healing The wound usually does not result in scarring, or minor scarring may occur. Well, if scars do form, for example, with deep cuts, or burns, then there are remedies for this case too. You can buy it in pharmacies special means(ointments, gels) that prevent the appearance of scars. However, it is important to apply them immediately after the wound has healed. Thus, when treating scars you will achieve maximum effect.

How long does it take for a cut on a finger to heal?

In the section Diseases, Medicines to the question How long does it take for a deep cut on a finger with a knife to heal? The best answer given by the author Nadegda is The bandage will have to be removed. Otherwise, the blood and lymph under the patch form a breeding ground for microorganisms. treat with peroxide and brilliant green. Pull the edges together and apply a bandage. Do the dressing once a day. If the bandage sticks to the wound, soak it in peroxide or furatsilin. It will heal in about 4-5 days.

Sorry it's late, I was busy away from the computer. Technically, it looks like this: bend your finger slightly so that the skin is not stretched, then the edges of the wound will come together and apply a tight bandage. You need to bandage the entire finger, covering both joints (so that the finger does not bend) Something like this. Get well.

It's not the same for everyone. It depends on the body.

Pour streptocide (powder or crushed tablet) into the wound and everything will heal quickly (in 3 days), leaving a small invisible scar as a keepsake.

1) REMOVE the adhesive plaster, otherwise the wound will fester!

2) Treat the wound with hydrogen peroxide, the edges of the wound ( healthy skin) grease with brilliant green.

3) Sprinkle the wound with streptocide powder. Streptocide powder in 2 g bags can be bought at the pharmacy.

4) Apply a bandage to your finger.

If the wound begins to bleed profusely, sprinkle coarse salt onto the wound and apply pressure to the wound. The salt can be changed several times. (Salt will not hurt or cause irritation).

hello, I was opening a jar of pickles and the neck of the jar split, my hand slipped and cut my first and second fingers, hit a passing artery, lost a lot of blood, they put 12 stitches, but they couldn’t sew the tendon, now 2 fingers don’t work, the stitches were removed but the cut started it diverges, we covered it with streptocide, then dried it with brilliant green, the wound remains with blood discharge and so on, there is no pus. what can be done in this situation.

I have never wounded the skin so deeply that it reached the tendon, but it was still unpleasant, of course. In principle, Argosulfan cream is always available in the first aid kit for such cases. This antibacterial drug, providing protection against infection. Thanks to the silver ions in its composition, it has double action– antimicrobial and healing without the formation of a rough scar. It always helps, by the way!

I have the same forefinger left hand outer part. I cut myself about half a year ago, but the scar still remains as if I cut my finger 3 days ago.

Wound healing is a dynamic process consisting of three overlapping stages: inflammation, formation granulation tissue, maturation or restructuring of the skin. The contribution of each of these stages to the healing process depends on the depth of the injury.

Shallow wounds. Shallow wounds involve the epidermis and upper layers of the dermis. Skin appendages ( hair follicles, sweat and sebaceous glands) are retained. Thrombosis, inflammation and formation of granulation tissue are slightly expressed. The healing of shallow wounds is based on epithelization due to the preserved appendages of the skin and marginal epidermis, which ultimately leads to complete and rapid recovery skin with invisible scars or without them at all. Hyper- or hypopigmentation may remain at the wound site.

Deep wounds. Necessary stage in the healing of deep wounds - the formation of a blood clot to stop bleeding from relatively large vessels in the deep layers of the dermis. Inflammation and granulation tissue formation are important steps in healing, along with skin tension, which brings wound edges closer together to promote epithelialization. Since the skin appendages are damaged, epithelization of deep wounds occurs only due to the marginal epidermis and the lost tissue is replaced by scar tissue.

To understand the pathogenesis of scarring, it is necessary to know how wound healing occurs normally.

Stage of inflammation

The first thing that happens when a wound heals is the formation of a hematoma. This ensures the cessation of bleeding from damaged vessels and the creation of a barrier that prevents microorganisms from entering the wound. The thrombus is a temporary matrix into which inflammatory cells migrate. When platelets are destroyed, many growth factors are released, incl. transforming growth factor (TGF-β1), epidermal growth factor, insulin-like growth factor type 1 (IGF-1) and platelet-derived growth factor, which attract inflammatory cells, promote extracellular matrix synthesis and vascular sprouting.

A number of other signaling molecules, such as fibrinolysis products, attract neutrophils and monocytes to the wound. These cells come from the bloodstream by diapedesis through the endothelium of the capillaries adjacent to the wound. The main function of neutrophils is phagocytosis and destruction of microorganisms inside cells. In addition, neutrophils produce inflammatory mediators, under the influence of which keratinocytes and macrophages can be activated already at this stage of healing.

At the end of the acute inflammatory reaction (after 1-2 days), monocytes that migrated from the bloodstream become macrophages and destroy remaining microorganisms and dead cells. These macrophages also serve as a source of growth factors and inflammatory mediators, in particular platelet-derived growth factor, which attract fibroblasts to the site of injury.

Proliferation stage

Fresh granulation tissue is very rich in blood vessels and cells. Since epithelization alone is not enough to heal deep wounds, proliferation of fibroblasts in the areas of the dermis adjacent to the wound begins already in its first stages. Fibroblasts migrate into the wound, lining an extracellular matrix consisting of fibrin, fibronectin, vitronectin and glycosaminoglycans. Fresh granulation tissue has a high ratio of type III collagen to type I collagen.

In response to the action of growth factors in the wound, proliferation of keratinocytes and fibroblasts begins. As granulations form and excess collagen matrix appears, the number of cells decreases through apoptosis. What triggers apoptosis is unknown. Under the influence of substances that stimulate angiogenesis, which serve as inducers of endothelial growth factor, TGF-β1, angiotropin and thrombospondin, vessels begin to grow into the extracellular matrix.

Myofibroblasts help bring the edges of large wounds closer together, which reduces the amount of granulation tissue required to fill the wound cavity and reduces the area of epithelialization. Due to the contractile proteins actin and desmin, fibroblasts also help bring the edges of the wound closer together. The mechanical tension that occurs after the edges of the wound are closed signals the cessation of tension.

Epithelization begins within a few hours after the wound appears. Migrating keratinocytes activate tissue plasminogen activator and urokinase and increase the number of urokinase receptors, which in turn promotes fibrinolysis, an important step necessary for keratinocyte migration. To pass through the temporary matrix formed by the thrombus, keratinocytes form additional fibronectin and collagen receptors. Migration of keratinocytes and epithelization is facilitated by the tension of the wound edges.

Stage of maturation and restructuring (complete healing)

At the restructuring stage, excess collagen and temporary matrix are removed by tissue enzymes, and inflammatory cells leave the wound. When the scar matures, a balance arises between the processes of destruction of the temporary matrix and collagen synthesis.

On the one hand, fibroblasts synthesize collagen, contractile proteins and extracellular matrix, on the other hand, fibroblasts, mast cells, endothelial cells and macrophages secrete a number of enzymes (matrix metalloproteinases) necessary for destruction and restructuring. The balance between these proteinases and their tissue inhibitors plays a role important role in the restoration of damaged tissues.

Interferons produced by T-lymphocytes (interferon-γ), leukocytes (interferon-α) and fibroblasts (interferon-β) prevent the development of fibrosis and suppress the synthesis of collagen and fibronectin by fibroblasts.

The restructuring process lasts from 6 to 12 months, but can last for years. The strength and elasticity of a scar is usually only 70-80% of that of intact skin, making scars more susceptible to repeated trauma.

Factors influencing wound healing and scar formation

Age. Unlike adults, wounds on fetal skin heal quickly and without scarring. The mechanism of scarless healing is unclear, but it is known that inflammation is mild, a large amount of hyaluronic acid is present in the wound contents, and collagen fibers are arranged in a certain order.

The fetal body is significantly different from the adult body. The main difference is in the characteristics of tissue oxygenation: the oxygen content in them remains relatively low throughout the entire period of intrauterine development. Inflammation in fetal wounds is mild due to neutropenia. As the immune system fetus inflammatory reaction becomes more pronounced, and scars may form at the site of the wounds.

The fetal skin is constantly bathed in warm, sterile amniotic fluid, which contains many growth factors. But this alone does not explain scarless healing. In experiments on fetal lambs, isolating the wound from amniotic fluid using a silicone dressing did not prevent scarless healing; on the other hand, adult skin grafted onto the fetus healed with scar formation, despite contact with amniotic fluid.

The high content of hyaluronic acid in the extracellular matrix increases cell mobility, enhances their proliferation, and hence the restoration of the damaged area. This allows us to consider hyaluronic acid as the main factor in scar-free healing. A glycoprotein absent in adult wounds was found in fetal wounds. This glycoprotein stimulates the synthesis of hyaluronic acid. In addition, it is assumed that its long-term presence in fruit wounds promotes the orderly deposition of collagen during their healing. During processing hyaluronic acid perforated eardrum Not only did the rats recover faster than the control animals, but there was also less scar tissue at the site of injury, and the collagen fibers were arranged in an orderly manner.

Rapid epithelization of wounds in the fetus may be due to the early accumulation of fibronectin and tenascin in the wound contents. Fetal and adult fibroblasts are different. Fetal fibroblasts at the beginning of fetal development produce more collagen types III and IV, while adult fibroblasts produce mainly type I collagen. In addition, fetal fibroblasts are capable of simultaneously proliferating and synthesizing collagen, while in the adult fibroblast proliferation precedes collagen synthesis. Thus, in adults, during wound healing, the appearance of collagen deposits is somewhat delayed, which leads to the formation of scars. Skin tension does not play a role in scarless healing, because Fetal wounds are virtually devoid of myofibroblasts.

Inflammation plays a key role in the restoration of damaged tissue and scar formation. In the fetus, in the absence of inflammation, wounds heal without scars. Wound healing is thought to decline with age. As the body ages, its inflammatory response decreases due to a weakening of the function of macrophages and T-lymphocytes, loss of reactivity and mobility of fibroblasts, a decrease in the number and other distribution of growth factors and their receptors, incl. TGF-β receptor. All this may explain the difference in the speed and quality of wound healing at different ages.

Although wounds in older adults heal more slowly, they have improved scar quality, which may be due to decreased levels of transforming growth factor (TGF-β) in damaged skin. It is also possible that fibroblasts of the fetal subtype appear in the wounds of elderly people, which leads to wound healing as in the fetus. Decreased levels of hormones, particularly estrogen, during menopause can also contribute to slower wound healing and reduced scarring.

Estrogens. In vitro studies have shown that sex hormones influence important stages of wound healing such as inflammation and proliferation. Estrogens regulate the production of TGF-β isoforms and the formation of their receptors, which plays a significant role in the development of fibrosis and scar formation. U healthy women In postmenopause, wound healing slows down, but scar quality increases, which is associated with a decrease in TGF-β1 levels in wounds.

Against the background of hormone replacement therapy, wounds begin to heal faster, which suggests direct or indirect regulation of healing by sex hormones. Studies have shown that in menopausal women, replacement hormone therapy within 3 months accelerates epithelization and collagen deposition in wounds.

The presence of estrogen receptors on the surface of fibroblasts indicates the possibility of direct regulation of the function of these cells by estrogens. In addition, estrogens increase TFP-β1 levels in vitro.

These data suggest the involvement of estrogens in the regulation of skin fibroblast production and TGF-β1. Finally, it is noted that systemic administration Estrogen antagonists inhibit wound healing in humans. A preliminary study of scars in women who received wounds while receiving the estrogen antagonist tamoxifen showed that these scars were best quality than the scars left after healing of the same wounds in women who were not given tamoxifen.

Heredity. There is evidence of the existence hereditary factor, which affects the wound healing process by activating abnormal (pathological) scarring, which leads to the appearance of hypertrophic and keloid scars. Both autosomal dominant and autosomal recessive patterns of inheritance of keloid scars have been reported. Often, keloid scars are also observed in relatives of the patient with similar scars. In addition, the prevalence of keloid scars is significantly higher among populations with dark skin, reaching 4.5 - 16% among Africans and Latin Americans. The frequency of keloid scars is high in carriers of HLA-β14 and HLA-BW16, in people with blood type A (II) and those suffering from Rubinstein-Taybi syndrome.

Unfortunately, we encounter wounds that are difficult to heal quite often, especially when it comes to burn wounds, trophic ulcers and wounds of the leg with severe venous insufficiency. We will learn how to cope with the difficult task of treating difficult-to-heal wounds in this article.

The main difficulty in treating difficult-to-heal wounds is that the problem has to be dealt with quite long time and most often you have to do it yourself. Since the main treatment of an uninfected wound consists mainly of regular dressings using special wound healing agents.

So, our task is to learn how to treat wounds correctly and effectively. Exactly for effective treatment we need to understand what kind of wound we are dealing with. Of course, firstly, with long-healing wounds, consultation with a surgeon is necessary. The doctor will find out the actual cause of the problem and give individual recommendations for treating the wound. In addition, the treatment process should be periodically monitored by a specialist in order to make changes to the treatment regimen if necessary.

Rules for treating wounds

Regularity. Treatment of the wound should be continuous until complete healing. Therefore, dressings should be done daily. In the very as a last resort, you can do dressings every other day, but only when there is little discharge from the wound and the wound is clean. In all other cases, the wound must be bandaged every day, and in some cases twice a day.

Clean and sterile. Only sterile instruments and dressings are used to treat the wound. Only the bandage and (or) mesh for fixing the dressing may not be sterile, but be sure to be clean. Before bandaging, hands should be washed well with soap and treated with an antiseptic. Ideally, dressings should be done with sterile gloves, especially if you touch the wound.

Accuracy. When dressing, you need to be extremely careful: you cannot tear anything away from the wound. If the bandage is stuck, soak it - do not tear it off, as this will cause pain and further injure the wound.

Knowledge. Wounds can be dry and weeping. You need to be able to distinguish between them, since the treatment of a dry and weeping wound differs. First of all, the choice of form depends on this medicine for wound treatment.

What to prepare for dressing a wound

To treat a wound at home, you need to prepare in advance:

A clean oilcloth on which everything necessary for dressing will be laid out
Hand sanitizer
Hand soap
Clean hand towel
An alcohol-containing antiseptic for treating the skin around the wound (an alcohol solution of iodine, brilliant green, calendula tincture or salicylic alcohol are quite suitable)
An aqueous antiseptic solution (furacillin solution, 3% hydrogen peroxide solution, miramistin)
Tweezers and scissors treated with alcohol antiseptic (they must be treated before and after each dressing)
Medicine for treating a wound
Sterile dressing(bandage, gauze pads)
Non-sterile, clean dressing material for fixation bandage.

Rules for dressing and treating wounds

Before starting the dressing, you must thoroughly wash your hands with soap and dry them with a clean towel. After this, lay out everything that is needed for dressing. Next step: remove the previously applied external bandage.

Then we wash our hands again or treat them with a disinfectant solution, or put on sterile gloves.

It's time to remove the tissue directly covering the wound from the wound. If the napkin sticks, moisten it with an aqueous antiseptic solution (in this case it is better to use a 3% hydrogen peroxide solution) and wait until the napkin gets wet. We remind you that you cannot tear off the napkin.

After removing the napkin, treat the skin around the wound with an alcohol-based antiseptic solution and inspect the wound without touching it.

Inspection task assess the condition of the wound: is it dry or weeping (wet).

A wound with a wet, pink, easily injured surface and a significant amount of discharge is considered a weeping wound. If the surface of the wound is dry, with crusts and cracks, this wound is dry.

Also, with each dressing change, it is necessary to evaluate how the healing process is progressing. Will help evaluate the healing process following criteria: size of the wound (a healing wound, albeit slowly, but decreases in size), a dry wound or a weeping one (the transition from a weeping wound to a dry one indicates successful treatment wounds), wound depth (with successful treatment, the wound becomes more and more superficial).

Caution - danger!

If upon examination you see that the amount of discharge from the wound has increased, or it has acquired a different smell (no matter whether it is unpleasant or even pleasant, for example, sweetish) and color (primarily yellow, greenish, gray).
If the wound does not decrease in size, but, on the contrary, increases, especially if it deepens.
If the pain in the wound increases every day or has sharply intensified.
If there is a tugging and (or) throbbing pain in the wound area.
If treatment of the wound does not produce any positive results.
If there is swelling and redness of the skin around the wound.
If the body temperature has increased, chills have appeared, and there are no other reasons for this condition.
In all of the above cases, you should urgently show the wound to a surgeon!

After examination, the wound is washed with an aqueous antiseptic solution using sterile wipes. They are moistened with an antiseptic solution and the wound is carefully treated. Then the wound is dried with a dry sterile cloth.

The next step is to apply a wound healing agent. Very important point: ointments are used to treat dry wounds, and jelly or gels for weeping wounds. The difference is explained by the fact that a dry wound requires protection in the form of a film, under which it will soften. Ointment is not suitable for a weeping wound, as it will create an environment that will prevent the release of fluid and the entry of oxygen, which will slow down the healing of the wound. Therefore on weeping wound apply products that protect the wound from drying out and possible infection, and will not allow the wound to suffer from lack of oxygen. When the wound is completely dry, you should change the form of the drug so as not to dry it out.

Today, Solcoseryl® is rightfully considered one of the most effective modern wound healing agents. This drug is a deproteinized hemodialysate of the blood of dairy calves, which contains substances responsible for trophism, oxygen supply and restoration of damaged tissues. Solcoseryl® is available in the form of a gel and ointment, so choosing the form of the drug suitable for treating a specific wound (wet or dry) is quite easy. Solcoseryl® gel is used on initial stage treatment of a wound (wetting wound) until it dries out and granulations form - the drug is applied in a thin layer to the surface of the wound 2-3 times a day. After the disappearance of exudate and the appearance of granulations, it is necessary to switch to the use of Solcoseryl® ointment. The ointment is applied to the wound 1-2 times a day, creates a protective film, accelerates the final stages of wound healing, creates conditions for epithelization and the formation of an elastic scar.

The process of treating difficult-to-heal wounds can be quite lengthy, so be patient and remember that by following all the above recommendations, you will solve the problem - the wound will heal, and the experience of treating the wound will remain with you forever. Take care of your health!

We all experience injuries from time to time. How to speed up the healing process and avoid scars if possible, read our article.

Injury- it's always a nuisance. Even the slightest scratch can cause a person a lot of unpleasant sensations: inflammation, pain, swelling. And if these consequences of injuries go away after some time, then the scars, alas, remain for many years. It is especially unpleasant if scars form on visible parts of the body, for example on the face, neck, hands. Appearance spoiled by scars often brings a lot of psychological problems, especially for women who care so much about their beauty.

How do wounds heal?

inflammation phase. Immediately after the injury occurs, the body begins to fight the problem. Initially, a blood clot forms in the tissues to stop bleeding. On the other hand, the body needs to constantly fight microorganisms that can get into an open wound. This whole process is accompanied by inflammation - a process in which immune cells are recruited to the site of injury, and swelling is also formed, which puts pressure on the nerve endings, thereby causing pain. The inflammation phase can last up to 7 days. Already on the 7th day, the wound begins to fill with granulation tissue - connective tissue that forms during wound healing;
proliferation phase. Approximately starts from the 7th day and can last up to 4 weeks. During the proliferation phase, the wound is actively filled with connective granulation tissue, which is based on collagen. The wound is also filled with capillaries and inflammatory cells. This is how a young scar is formed. At this stage, the scar stretches easily. Due to the high content of blood vessels, the scar has a bright red color, which makes it easily noticeable;
scar formation phase. A scar begins to form around the 4th week, and this process can last up to 1 year. The bright red scar formed during the proliferation stage begins to fade and the scar becomes less noticeable. As a result, the lesion site is finally filled with connective and epithelial tissue. Primary collagen is replaced by coarser collagen. Thus, a scar is formed, which takes on its final (completed) appearance.

Fast healing

In addition, accelerated wound healing, as a rule, does not lead to the formation of scars, or minor scars may form. Well, if scars do form, for example, due to deep cuts or burns, then there are remedies for this case too. In pharmacies you can purchase special products (ointments, gels) that prevent the appearance of scars. However, it is important to apply them immediately after the wound has healed. Thus, when treating scars you will achieve maximum effect.

During the wound process, three main periods are distinguished.

First period characterized by the melting of necrotic tissues, their sequestration during external environment and cleansing of wound detritus. The duration of this period is determined by the volume of damage, the degree of infection of the wound, the characteristics of the body and averages 3-4 days.

The initial reaction of the body to injury is a spasm of blood vessels in the area of the wound defect, followed by their paralytic expansion, increased permeability of the vascular wall and rapidly increasing edema, which is called traumatic. Acidosis that develops as a result of metabolic disorders and changes in the state of colloids contribute to the progression of traumatic edema.

Vasodilation is accompanied by a violation of their permeability and is associated with the release of predominantly histamine and partially serotonin. In response to damage and exposure to microbes, leukocytes migrate from the blood vessels into the wound in large numbers. This applies mainly to neutrophils capable of phagocytosis. Along with other enzymes, they secrete leukoprotease, which is used to destroy cell debris and phagocytosed microorganisms. In addition, a large number of histiocytes, macrophages, lymphocytes and plasma cells accumulate in the tissues. Along with this, normal plasma contains oxins that facilitate phagocytosis, agglutinins that help glue and destroy bacteria, and a factor that stimulates an increase in the release of leukocytes from the blood.

Regarding the mechanism of lysis of non-viable tissue and wound cleansing, the role of the microbial factor in this process should also be emphasized.

The inflammatory reaction can grow rapidly and within the first day a so-called leukocyte wall is formed, which develops at the border of viable and dead tissue, being a demarcation zone. All these processes lead to the preparation of damaged tissues for the healing process. In particular, fibrin deposited in the wound undergoes local fibrinolysis of plasmin, which appears due to activation of plasmin by kinase. This leads to the unblocking of lymphatic gaps and vessels, and inflammatory swelling disappears. Starting from the third day, along with the previously predominant catabolic processes, anabolic ones come into play, the synthesis of the main substance and collagen fibers by fibroblasts increases and capillaries are formed.

An increase in blood supply to the area of injury causes a decrease in local acidosis.

Second period - the period of regeneration, fibroplasia, begins 3-4 days after injury. The shorter it is, the less cells and tissue were injured when injured. A distinctive feature of this period is the development of granulation tissue, which gradually fills the wound defect. At the same time, the number of leukocytes sharply decreases. Macrophages continue to play an important role, but great importance During the regeneration period, capillary endothelium and fibroblasts are acquired.

Granulation tissue begins to form in the form of separate foci at the bottom of the wound. These lesions are characterized by intense new formation of capillaries as a result of the secretion of biologically active substances by mast cells. Granulation tissue, due to its richness in blood vessels and cells, looks juicy, bleeds easily and has a pinkish-red color. Based on appearance granulations can be judged about the state of wound healing. Typically, healthy granulations have a granular appearance, a bright red color, and their surface is moist and shiny. Pathological granulations are characterized by a smoother surface; they look pale, flaccid, glassy-edematous, and covered with a layer of fibrin. Their cyanotic tint indicates a deterioration in venous outflow, which determines this color. In sepsis, granulations are dark red and appear dry.

The causes of poor granulation formation can be both general and local. After their elimination, the appearance of granulations quickly changes and the process of filling the wound with scar tissue is restored.

Thanks to the large number of fibroblasts that form collagen fibers and interstitial matter, the wound cavity is filled and at the same time the epithelium begins to creep from the edges due to the migration of cells to the newly formed granulations. The second fibroplastic period lasts from 2 to 4 weeks, depending on the location and size of the wound.

Third period- the period of scar reorganization and epithelization begins without any transition on the 12-30th day from the moment of injury and is characterized by a progressive decrease in the number of vessels, they become empty. the number of macrophages and mast cells of fibroblasts decreases. In parallel with the maturation of granulation tissue, epithelization of the wound occurs. Excessively formed scar tissue rich in collagen fibers undergoes restructuring. These processes are characteristic of all tissues; they differ only in time. For example, skin heals much faster than fascia and tendons, which take 3-6 months to heal. At the same time, restoration of the skin begins after 24-48 hours and is determined by the migration, division and differentiation of epithelial cells. During primary wound healing, epithelization occurs on days 4-6.

Phases of wound healing (according to M.I. Kuzin, 1977) The first phase is inflammation. The initial period of this phase in the wound is characterized by vasodilation, exudation, hydration and migration of leukocytes. Then phagocytosis and autolysis increase, which helps cleanse the wound of necrotic tissue. The duration of this phase is 1-5 days. In this phase, the wound experiences pain, increased temperature, infiltration and swelling.

The second phase is regeneration. During this period, recovery processes predominate in the wound. Tissue exudation decreases. The synthesis of collagen and elastic fibers increases, which fill the tissue defect. The wound is cleaned and granulation tissue appears in it. Signs of local inflammation are reduced - pain, temperature, infiltration. The duration of this phase is about a week (from 6 to 14 days from the onset of injury).

The third phase is the formation and reorganization of the scar. There is no clear boundary between the second and third phases. During this period, the scar thickens and contracts. The duration of this phase is up to 6 months.

Each anatomical region has its own characteristics of wounds. This determines the tactics of performing surgical operations, pain relief, etc.