1. wound healing review

what are the 4 phases of wound healing?

1. hemostasis (mins to hrs)

2. inflammatory phase (~days 1-3)

   • early inflammation - neutrophils

   • late inflammation - macrophages

3. proliferative phase (~days 4-12)

   • angiogenesis

   • fibroblasts, granulation, ECM

   • contraction

   • epithelialization

4. maturation phase

what are local and systemic factors that affect wound healing?

• local

  • wound perfusion

  • tissue viability

  • wound fluid accumulation

  • wound infection

  • mechanical factors

  • envenomation

• systemic

  • conditions that impair immune function

  • age

primary closure

applies to suture wounds

delayed primary closure

surgical closure 2-5 days after wound initiation, before granulation tissue forms

secondary closure

wound closed after granulation tissue forms in wound bed

second intention healing

wounds that heal without suturing

what are the 4 “C’s” of wound management?

• clip: surgical margins

• clean: copious lavage

• culture: ALWAYS

• cover or close: depends on plan

when should primary closure be considered?

• freshly incised, non-contaminated wounds

• occurred within previous ~3-6 hrs

when is primary closure not appropriate?

• tension

• mobility

• substantial tissue trauma

• dirty wound (bite wounds!)

• dirty regions

• significant skin loss, dead space, or swelling

• result of dehiscence

• more than ~6hrs old

what is the function of the primary bandage layer?

• absorbs tissue fluid or allows it to pass through to secondary layer

• may be an adherent or non-adherent

what is the function of the secondary bandage layer?

• absorbs tissue fluid

• padding

• support or immobilization

• typically cast padding or roll cotton

what is the function of the tertiary bandage layer?

• holds primary & secondary layers in place

• provides pressure

• keeps inner layers protected from environment

• adhesive tape, elastic wraps, or impermeable barrier