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Contractures Scar contractures can cause severe functional, psychological and aesthetic problems ( Figure 3.19 ). Contractures across joints may restrict the range of movement, leading to deformity , - impairment and disability . Contractures may also result ...

Degloving Degloving is the avulsion of skin and subcutaneous fat from the underlying fascia, muscle or bone. A degloving injury may be open or closed. An example of an open degloving is a finger avulsion injury with loss of skin ( Figure 3.10 ). Closed deglo...

Haemostasis Disruption of the vascular endothelium following injury causes vasoconstriction and exposure of the subendothelial extracel lular matrix. This encourages platelets to adhere, activate and aggregate, resulting in a platelet plug, which also helps ...

INTRODUCTION Wound healing is a complex and dynamic biological process. In human adults, the normal response to injury across all organ systems typically results in fibrosis and scar formation. Fibrotic healing causes tissue dysfunction and its potential impact...

Inflammation In the early inflammatory phase (days 1–2), platelet activation causes an influx of inflammatory cells led by polymorpho - nuclear leukocytes, particularly neutrophils. The latter are important for minimising bacterial contamination of the wound....

Learning objectives To understand: Normal wound healing and how it can be adversely • affected Types of healing and how to classify wounds • Learning objectives To understand: Normal wound healing and how it can be adversely • affected Types of healing and how...

Leg ulcers 12 In developed countries, the most common chronic wounds It are leg ulcers. An ulcer can be defined as a break in the epithelial continuity . A prolonged inflammatory phase leads to overgrowth of granulation tissue and attempts to heal by scarring l...

NORMAL HEALING IN OTHER SPECIFIC TISSUES Bone Bone healing occurs in similar phases to those for skin but with some di ff erences ( Figure 3.3 ). Most fractures heal by callus formation, which involves intramembranous and endo - chondral ossifi cation. This is ...

NORMAL WOUND HEALING IN SKIN Classically , wound healing has been arbitrarily described in three overlapping but distinct stages, including inflammation, proliferation and remodelling ( Figure 3.1 ). An additional stage, haemostasis, is often described as the i...

Necrotising fasciitis This is a severe, rapidly progressing infection of the soft tissue and fascia associated with signifi cant morbidity and mortality ( Figure 3.14 ). Reported mortality rates vary widely but a Danish nationwide cohort study including over ...

Post exposure management for Tetanus Prone Wounds underappreciated and is not as simple as is often perceived. The end points of surgical debridement can sometimes be di ffi cult to determine. Healthy subcutaneous fat is yellow and soft. Muscle viability is jud...

Pressure ulcers Pressure ulcers occur over a bony prominence or under a medical or other device ( Figure 3.15 ) . A number of similar classifications exist. The US National Pressure Injury Advisory injury’ in its staging system ( Table 3.5 ) to provide a more a...

Principles Clinical judgement is crucial in managing wounds. Some general principles of wound management are summarised in Table 3.2 . Antibiotic prophylaxis is needed for clean–contam - inated, contaminated and dirty wounds. It may also be used in clean woun...

Proliferation The proliferative phase starts around day 3 and lasts for 2–4 weeks. It consists mainly of fibroblast activity with the production of ground substance (glycosaminoglycans and - proteoglycans), collagen, angiogenesis and re-epithelialisation of ...

REFERENCES 1 Berard F , Gandon J. Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg 1964; 160 (Suppl): 1–192. 2 Garner JS. CDC guideline for prevention of surgical wound infec tion...

Remodelling The remodelling phase begins 2–3 weeks after injury and lasts for a year or more. This phase is characterised by maturation of collagen. Type III collagen, which is prevalent during prolif eration, is replaced by stronger type I collagen until the...

SCAR MANAGEMENT Principles The remodelling and maturation phase of wound healing results in scar formation. The immature scar is at first pink, hard, raised and often itchy . As the collagen matures, the scar becomes almost acellular as the fibroblasts and bloo...

TYPES OF WOUND HEALING There are di ff erent types of healing ( Summary box 3.2 Primary healing is also known as healing by first intention. This occurs when there is direct approximation of the wound edges and is the aim of treatment. When there are no advers...