Wound_Healing - Wound Healing Vic V. Vernenkar, D.O. St....

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Wound Healing Vic V. Vernenkar, D.O. St. Barnabas Hospital Dept. of Surgery
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Introduction Over the ages, many agents have been placed on wounds to improve healing. To date nothing has been identified that can accelerate healing in a normal individual. Many hinder the healing process. A surgeon’s goal in wound management is to create an environment where the healing process can proceed optimally.
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Early Wound Healing Events
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Stages of Wound Healing
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Wounding Blood vessels are disrupted, resulting in bleeding. Hemostasis is the first goal achieved in the healing process. Cellular damage occurs, this initiates an inflammatory response. The inflammatory response triggers events that have implications for the entire healing process. Step one then is hemostasis, resulting in Fibrin.
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Early Events Fibrin and fibronectin form a lattice that provides scaffold for migration of inflammatory, endothelial, and mesenchymal cells. Fibronectin is produced by fibroblasts, has a dozen or so binding sites. Binds cytokines Its breakdown products stimulate angiogenesis.
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Signs of Inflammation Erythema Edema Pain Heat
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Signs of Inflammation Immediately after injury, intense vasoconstriction leads to blanching, a process mediated by epinephrine, NE, and prostaglandins released by injured cells. Vasoconstriction reversed after 10min, by vasodilatation. Now redness and warmth. Vasodilatation mediated by histamine, linins, prostaglandins.
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Inflammation As microvenules dilate, gaps form between the endothelial cells,resulting in vascular permeability. Plasma leaks out into extravascular space. Leukocytes now migrate into the wound by diapedesis, adhere to endothelial cells, to wounded tissues. Alteration in pH from breakdown products of tissue and bacteria, along with swelling causes the pain.
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Neutrophils, macrophages and lymphocytes come into wound. Neutrophils first on scene, engulf and clean up. Macrophages then eat them or they die releasing O2 radicals and destructive enzymes into wound. Monocytes migrate into extravascular space and turn into macrophages. Macrophages very important in normal wound
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Wound_Healing - Wound Healing Vic V. Vernenkar, D.O. St....

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