How is healing wounds? Periods and phases of healing of purulent wounds

The wound involves the injury at which the skin, muscles, tendons, internal organs, bones are damaged. Usually healing occurs in several stages, but what is the wound granulation, not everyone knows.

The wound healing process includes the stages of inflammation, granulation and epithelialization. In addition, healing can be with primary and secondary tension, as well as under the lap. From how difficult damage and how all phases are passing, depends on how quickly the victim will cure.

Stages of healing Ran.

Healing, any wound passes several stages:

1. Inflammation. The body first reacts to the wound, producing substances that turn the blood. Blood clots are formed, clutching vessels. They prevent the development of strong bleeding. Next, cellular reactions occur, leading to an inflammatory process, the new fabric begins to grow - the granulation that is impossible without the participation of fibroblasts. In cases where the injury treatment requires the imposition of seams, they are removed in a week, but if there is a tension under the seam, it can lead to a discrepancy of the edges of the wound. It happens because the scar was formed on the edges of the wound, and not granulation. The inflammatory stage lasts an average of 5-7 days.
2. Granulation wounds. With a favorable flow of the healing process, after a week, the wound granulation stage begins. The damaged area for a month continues to be filled with a ripening granulation tissue, which includes inflammatory cells, connective tissue and re-vessels. Successful granulation is impossible without cytokines and a sufficient amount of oxygen. Closer to the end of this phase on the granulation tissue, new epithelial cells are growing, and the edges of the wound are connected by a bright red scar.

Granulation tissue has different look Depending on the stage of its development. Normal fabric originally has the appearance of a gentle fabric covered with a turbid, gray-greenish flare, juicy, rich in thin-walled vessels, which is easily bleeding. In later periods, the cloth becomes paler, denser, graininess disappears, turning into a whitish dense scar.

The granulation tissue consists of six, gradually passing into each other layers:

• surface leukocyte necrotic layer
• surface layer of vascular loops
• layer of vertical vessels
• ripening layer
• layer of horizontally located fibroblasts
• fibrous layer

1. Epithelization. This step of healing begins immediately after the granulation ended. It lasts this phase for almost a year. Epithelium and connective tissue completely fills the damage space. The scar brightens, because the vessels in it becomes much smaller than originally. As a result, the healed wound is covered with a scar, strength of approximately 85% compared with healthy skin.

All these wound healing stages are purely individual, their duration depends on many factors, including the general condition of the patient and damage care.

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Caring for the wound at the initial stage of healing

The optimal solution for the speedy recovery of damaged tissue looks like regular use of dressings. Disinfection here is carried out by solutions of potassium permanganate and hydrogen peroxide. These substances are applied in warm form for gauze tampon. Next, a neat impregnation of the wound is performed, at which the touch of damage to hand is eliminated - this can lead to the development of infections.

Treatment of injured plots in the granulation phase

Granulation tissue has a delicate, loose structure. It is easy to damage, touching or casually changing the bandage. When processing wounds should be as cautious as possible.

It is not allowed to wipe the surface of the damaged area with cotton discs, tampons.

It is permissible only irrigation of the wound with warm bactericidal solutions.

Several types of treatment of injured fabric are distinguished:

• Physiotherapeutic;
• Drug;
• Treatment at home;

When choosing a treatment method, it is necessary to take into account the nature of the wound, as well as the features of its healing.

Physiotherapy treatment method

Of the specific methods of accelerating regeneration, the method of ultraviolet irradiation should be highlighted. When using it, the surface of the damaged area from pathogenic microflora occurs, and the regeneration processes are significantly accelerated. Especially relevant such a method will be with slowly emerging, sluggishranulating tissue.

Indications for exposure:

• Infection of the wound;
• Abundant purulent discharge;
• Loose immunity and, as a result, violation of reparation mechanisms;

However, other methods of treatment are used for the speedy healing of damage. Most often resort to drug methods Wound surface treatment.

Application of drugs at the stage of granulation

Properly chosen medication facilitates faster wound epithelization. As a rule, with hyperelations, doctors recommend using gel forms of drugs. Whereas with an unnecessary fast drying of the surface of the damaged area use ointment.

Maintenance medicinal productsapplied at granulation stages

One of the most popular drugs appointed at this stage is soliccer. Granulation of seams, healing damaged sections after burns and other injuries skin cover accompanied by the appearances of non-psychic scars. Salcossuril contributes to the formation of more homogeneous connective tissuewhich looks much natural.

Home Treatment Wounds in Granulation Phase

In the presence of uncomplicated damage, in which only surface extreme epithelium layers are affected, you can resort to restoration people's Fashion Treatment. A good solution here looks like a gauze dressing impregnated with the oil of the Zverboard.

The presented method contributes to the speedy completion of the granulation phase and active tissue updates. To prepare the above tool, it is enough to take about 300 ml of vegetable refined oil and about 30-40 grams of dried hunter. Mixing the ingredients, the composition should be boiled on a slight heat for about an hour. The cold mass must be filtered through the gauze. Next, it can be applied to impose bandages.

Healing wounds at the granulation stage can also be with the help of a pine gulin. The latter is taken in its pure form, rinsed with water and, if necessary, softened with weak heating. After such preparation, the substance is superimposed on the damaged area of \u200b\u200bthe tissue and is fixed by the bandage.

Options for the further development of the granulation stage

If the first and second stage of wound healing passed without complications, the gradually damaged area is completely covered with a dense scar cloth and the regeneration process is successfully completed.

However, sometimes tissue recovery mechanisms are failed. For example, occurs necrotic closures adjacent to the wound.

Such a state is extremely dangerous for the patient and requires immediate surgical intervention.

Non-approaches are carried out - operation on excision of dead tissue. If the wound is infected with the pathogenic microflora, the process of its healing can be delayed for a long time. Antibiotics apply to restore normal tissue regeneration .

The granulation stage of healing of the damaged area is a complex adaptation mechanism aimed at the early separation of the internal environment of the organism from adverse external influences. It provides the formation of new layers of fabric in return damaged. Due to the granulation stage, the trummers of the injured area is restored and the protection of other, deeper tissues is protected.

Surgical intervention

When the granulation processes are delayed, the formation of deep wound strokes, in which the accumulation of purulent chambers is observed. In such cases, it is difficult to clean the wound due to the use of ointments and gels. The elimination of unpleasant complications is most often due to surgical intervention. In this case, the specialist performs incision, removes purulent clusters, disinfects the wound, after which the contraperture imposes.

Finally

So we figured out, the granulation of the wound - what is it? As practice shows, one of the defining conditions for accelerating the healing process is differentiated treatment. The value also has the correct selection of drugs. All this contributes to the speedy granulation of the damaged area and the formation of a new, healthy tissue.

The wound process is a set of consecutive changes occurring in the wound and associated reactions of the entire organism.

Conditionally wounded process can be divided into common reactions of the organism and the wound healing directly.

General reactions

The complex of biological reactions of the body in response to damage to the wound process can be considered as two consecutive stages.

First phase

For 1-4 days, from the moment of injury, the excitation of the sympathetic nervous system is noted, the discharge of the hormones of the brain layer of the adrenal glands, insulin, ACTH and glucocorticoids. As a result, life processes are increasing: the body temperature and the main exchange are increasing, the body weight is reduced, the disintegration of proteins, fats and glycogen is reduced, the permeability of cell membranes is reduced, protein synthesis and others are suppressed. The value of these reactions is to prepare the entire body to live in alteration.

In the first period, there is a moderate increase in body temperature, weakness, reduced performance.

In blood tests, the increase in leukocytes is revealed, sometimes a small shift leukocyte formula Left, in urine analyzes can appear protein. With abundant blood loss, there is a decrease in the number of erythrocytes, hemoglobin, hematocrit.

Second phase

Starting with 4-5 days, character common reactions It is determined by the prevailing influence of the parasympathetic nervous system.

The main importance is acquired somatotropic hormone, aldosterone, acetylcholine. In this phase, the mass of the body increases, the normalization of protein metabolism occurs, the reparation capabilities of the body are mobilized. With an uncomplicated flow to the 4-5th day, phenomena of inflammation and intoxication are stopped, the pain eats, fever ceases, normal blood and urine laboratory indicators.

Healing Ran.

Wound healing is the process of reparation of damaged tissues with the restoration of their integrity and functions.

For the closure of a defect formed during damage, three main processes occur in the wound:

The formation of collagen fibroblasts. When healing wounds, fibroblasts are activated by macrophages. They proliferate and migrate to the place of damage, binding to fibrillar structures through fibronectin. At the same time, fibroblasts are intensively synthesized by the substances of the extracellular matrix, including collagen. Collands provide the elimination of the tissue defect and the strength of the scar formed.

Epithelization of wounds occurs as the epithelium cells migrate from the edge of the wound onto its surface. Complete epithelization of the wound defect creates a barrier for microorganisms.

The effect of fabric turning, to a certain extent due to the reduction of myofibroblasts, provides a reduction in wound surfaces and closing the wounds.

These processes occur in a certain sequence, which is determined by the phases of wound healing (phases wound process).

Phases of healing wounds according to M.I. Kuzina (1977):

I phase - inflammation phase (1-5-e day);

II phase - regeneration phase (6-14th days);

III phase - the phase of education and the reorganization of the scar (from the 15th day from the moment of injury).

Phase inflammation

I Phase Healing Wounds - Inflammation Phase, flows into the first 5 days and combines two consecutive periods: vascular changes and purification of wounds from necrotic tissues. Vascular reactions and outowaded changes occurring in the wound are closely related.

Period of vascular changes. In response to the injury, a number of disorders affecting the microcirculatory channel develop. In addition to the immediate destruction of blood and lymphatic vessels, which contributes to the violation of blood outflow and lymph, a short-term spasm occurs, and then a resistant paretic expansion of the micrososud. Participation in the inflammatory reaction of biogenic amines (Bradykinin, histamine, serotonin), as well as the complement system leads to a resistant vasodilation and an increase in the permeability of the vascular wall.

Reducing perfusion leads to a deterioration in the oxygenation of tissues in the wound region. Acidosis develops, the carbohydrate and protein exchange is disturbed. When the decay of cell proteins (proteolysis) from the destroyed cells, ions K + and H + are released, increasing the osmotic pressure in the tissues, the water is delayed, the tissue edema (hydration) develops, which is the main external manifestation of inflammation.

Active participation in this phase is adopted by prostaglandins - arachidonic acid metabolites, isolated from destroyed cell membranes.

The period of purification of the wound from necrotic tissues. In the purification of the wound, the uniform elements of blood and enzymes play the most significant role. Already from the first day in the cloth surrounding the wound and exudate, neutrophils appear, on 2-3 and days - lymphocytes and macrophages.

Phase regeneration

The II phase of wound healing - the phase of regeneration, proceeds from 6 to 14 days from the moment of injury.

Two main processes occur in the wound: collagenization and intensive growth of blood and lymphatic vessels. The number of neutrophils decreases and the fibroblasts are migrated - the cells of the connective tissue, which have the ability to synthesize and secrete the macromolecule of the extracellular matrix. An important role of fibroblasts in the healing of the wound is the synthesis of the components of the connective tissue and the construction of collagen and elastic fibers. The bulk of collagen is formed in the regeneration phase.

Simultaneously in the area of \u200b\u200bthe wound, the recanalization and growth of blood and lymphatic vessels begin, which contributes to the improvement of the perfusion of tissues and nutrition of fibroblasts in need of oxygen. Capillaries are concentrated around the capillaries that contribute to the proliferation of capillaries.

For biochemical processes in this phase, a decrease in acidity is characterized, an increase in the concentration of Ca2 + ions and a decrease in the concentration of ions to +, a decrease in exchange.

The III of the wound healing phase is the formation and reorganization of the scar, begins approximately from the 15th day and can occur until 6 months.

In this phase, the synthetic activity of fibroblasts and other cells is reduced and the main processes are reduced to strengthening the generated scar. The amount of collagen practically does not increase. It occurs its restructuring and the formation of cross-links between collagen fibers, due to which the strength of the scar is growing.

There is no clear boundary between the regeneration phase and the scarring. The ripening of the connective tissue begins in parallel with the epithelization of the wound.

Factors affecting wound healing:

The age of the patient;

Power condition and body weight;

The presence of secondary infection of the wound;

Immune status of the body;

The state of blood circulation in the area of \u200b\u200bdamage and the body as a whole;

Chronic concomitant diseases (diseases of cardiovascular and respiratory systems, diabetes, malignant tumors etc.).

Classic types of healing

With a possible variety of options for the flow of the wound process, depending on the nature of injury, the degree of development of microflora, the peculiarities of the imminent response, they can always be reduced to three classic healing types:

Healing primary tension;

Healing by secondary tension;

Healing under the lap.

The healing of the primary tension is the most economical and functionally advantageous, it occurs in a shorter time with the formation of a thin, relatively strong scar.

The primary tension is healing operational wounds when the edges of the wound come into contact with each other (connected by seams). The number of necrotic tissues in the wound is small, inflammation is negligible.

Only wounds are heal in the primary tension, in which there is no infectious process: aseptic operating or random wounds with minor infection if microorganisms dying during the first hours after damage.

Thus, in order for the wound to heal the primary tension, compliance with the following conditions:

Lack of infection in the wound;

Dense contact of the wound edges;

Lack of hematoma wound foreign languages and necrotic fabrics;

Satisfactory overall condition of the patient (the absence of common adverse factors).

The healing of the primary tension occurs in the shortest possible time practically does not lead to the development of complications and causes small functional changes. it best Type Healing wounds, to which you always need to strive to create the necessary conditions for it.

Healing by secondary tension is healing through the suppuration, through the development of granulation tissue. In this case, healing occurs after a pronounced inflammatory process, as a result of which the wound is cleared of necrosis.

The conditions of healing by secondary tension:

Significant microbial pollution of the wound;

Significant sizes of the defect of the skin;

The presence in the wound of foreign bodies, hematomas and necrotic tissues;

The adverse state of the organism of the patient.

When healing, the secondary tension is also present three phases, but they have non-smart differences.

Features of the inflammation phase

In the first phase of the phenomenon of inflammation, much more and the purification of the wound proceeds much more than more. At the border of penetration of microorganisms, a pronounced leukocytar shaft is formed. It contributes to the elimination of infected tissues from healthy, demarcation, lysis, sequestration and rejection of non-expendable tissues occur. The wound is gradually cleaned. As the areas of necrosis and the absorption of decomposition products are increasing the body intoxication increases. At the end of the first phase after lysis and rejection of necrotic tissues, a wound cavity is formed and the second phase occurs - the regeneration phase, the peculiarity of which is the emergence and development of granulation tissue.

Granulation tissue is a special type of connecting tissue, formed when healing wounds by secondary tension, promoting rapid closure of the wound defect. Normally, without damage, there is no granulation tissue in the body.

Healing under the Strap - healing of wounds under the lap occurs with small surface damage to the type of grazing, damage to the epidermis, pulp, burns, etc.

The healing process begins on the surface of the damage to the washed blood, lymphs and tissue fluid that dries up with the formation of a stamp.

Strip performs a protective function, is a kind of "biological bandage". Under the lap, the rapid regeneration of the epidermis occurs, and the Strop is discouraged. The whole process usually takes 3-7 days. In the healing under Strap, the biological features of the epithelium are mainly manifested - its ability to put the live fabric, eliminating it from the external environment.

The body is the most complex biological system that has a natural ability to regenerate. One of the indicative evidence of the existence of a self-healing mechanism is wound healing.

Each wound has a natural reparative potential, which is represented in the form of a clear, long-studied researchers, the stadium healing mechanism based on physiological processes. That is, if, in the treatment of wounds, measures and drugs will contribute to the physiological flow of the stadium wound process, the wound will heal in the shortest possible time. It is the record of the physiology of the wound process and is the most important condition effective treatment wounds

As is known, wound healing can be carried out by primary and secondary tension. In the first case, due to the adjacent of the edges of the wound, its linearity and the minimum area of \u200b\u200bthe wound surface of the wound, as a rule, heals quickly and without inflammation. Therefore, if possible, any wound is trying to expose surgical treatment The imposition of skin seam. Treatment of such a treated wound in the overwhelming majority of cases does not represent any particular difficulties.

In the case of extensive wounds, when the edges of the wound and the presence of sections of tissue necrosis, healing occurs by secondary tension. It is when conducting such wounds that heal the secondary tension should be extremely carefully taken into account the stage of the wound process, carrying out differentiated treatment.

Treatment of the Russian Academy of Sciences: Study of the Wound Process

Regardless of the type of wound and the degree of tissue damage, the wound process is three physiological healing stages in accordance with the morphological changes at the level of cells and tissues. N.I. Pies allocated 3 stages. Today, the approach of MI is most often used. Kuzina to the steadility of the wound process.

Stage 1. Stage of Exudation (Vascular Reaction and Inflammation)

The wound at the exudation stage is characterized by perifocal edema, minor hyperemia and a specific separated.

At the exudation stage, all physiological processes are aimed at separating damaged tissues that are no longer subject to recovery and can potentially become a source of infection and intoxication. In this way, inflammatory process At the exudation stage, it helps to remove dead tissue and wound cleansing. All processes in the wound at this stage are due to the activation of complex enzymatic and catalyst systems (Kallikrein-Kinin, the chageman factor, fibrinogen, C-jet protein, prostaglandins, biogenic amines, etc.)

The wounded discharge at the stage of exudation, as a rule, at first serous, serous-fibrinous, with blood clots. Then the separated becomes purulent, contains leukocytes and necrotic tissue cells.

If at any stages of the wound process, an infection is attached to become more, and it acquires the form, color and smell characteristic of a certain type of microorganisms.

Stage 2. Stage of Proliferation (Regeneration)

In ideal conditions, when healing the wound in the primary tension, the proliferation stage (in particular, the synthesis of collagen cells) begins on the second day.

When the wound healing by the secondary tension, at the regeneration stage, the cells of cell division are beginning to appear on the most cleared areas - granulation tissue. They are usually pale pink, wet, easily traumatized and therefore requiring protection from damaging factors.

As granulation progressing, a parallel decrease in the area (sizes) of the wound begins, due to its transition in the zone of the wounds in the third stage.

The scarest, serous-hemorrhagic separated from the wound at the regeneration stage, and with the slightest traumatization of granulation tissue, the separated becomes hemorrhagic.

Stage 3. Stage of Epithelization (Differentiation Stage)

Sometimes the stage of epithelization is called the stage of forming a scar or final healing, as well as the stage of education and the reorganization of the scar. The separated is already absent or practically absent, the wound is dry. The separated may occur in case of injury to the wound, as well as when the infection is attached.

Additionally, it should be borne in mind that the wound process in the same wound (especially if it has a large area) is almost always characterized by simultaneous polystandy. That is, stages are usually smoothly moving from one to another, and it is not always possible during such a transition to clearly say, at what stage is the wound. Indeed, sometimes on some parts of the wound is in one stage, and on others - to another.

Most often, epithelization begins on the edges of the wound or from the zone of so-called islets of epithelization. At the same time, the rest of the wound may be in the proliferation stage.

Also often cleansing the wound occurs simultaneously over the entire surface. In some cases, the edges of the wound are cleaned slower than the central part, if there are more damaged tissues around the edge. Therefore, the differentiated treatment of the wound should take into account the possibility of having several healing stages of one wound at once, and do not slow down progress.

RAS Treatment depending on the stage of the wound process: the choice of the drug in the optimal dosage form

To understand how medical support wounds can be the most physiological, stimulating the natural wound healing processes, it is necessary to submit the essence of changes occurring at different stages of the wound process.

So, although we are talking about the exudation stage as the first stage of wound healing, it is, in fact, is the stage of decay (necrosis) of tissues for which inflammation is characteristic.

What are the needs of wound at the stage of exudation?

• Warning of the surface of the wound surface.
• The possibility of free allocation of exudate.
• Improving wound trophies to prevent reinforced necrosis.
• Stimulation of the beginning of the formation of granulation tissue (transition to second stage).
• Mechanical assistance in removing necrotic tissues.
• Prevention of infection penetration inside the wound.

Mechanical removal of necrotic tissues and prevention of infection penetration is achieved by primary surgical treatment of the wound and, in the future, frequent dressings using sterile dressing material and rinsing wounds and antiseptics. The remaining wound needs can be satisfied only by applying the most effective drug for this stage for local treatment wounds.

Requirements for the drug for local treatment of wounds on early stage Pretty simple. The drug must have a hydrophilic basis, to hold the moisture for a long time and be convenient to use. TO dosage formscorresponding to these requirements includes solutions and gels. Solutions, unfortunately, are not able to retain moisture for a long time, so when applying solutions it is necessary to dress every 1.5 tok. That is, they are not very comfortable in use.

Significantly promising in this sense gels. They are easy to use, better hold moisture, provide an outflow of exudate, do not create fatty films. Active substance The gel preparation for the treatment of wounds in the first stage should have a trophic effect, which will protect the wound from excessive necrosis and stimulates its transition to the second stage.

In the second stage (proliferation), as the wound purification, the formation of a new tissue begins, on the basis of which healing begins. This new, granulation, fabric is very sensitive to damage and trophic impaired. It can regress and even collapse. Therefore, when conducting the wound, it must be protected as much as possible. To do this, at the islands of granulation tissue and on the edges of the wound, where the most intensive processes of proliferation are also coming, a drug should be applied with the same trophic effect that stimulates the synthesis of collagen and cell division, but already on an ointment basis.

As the second stage of the wound process progressing, everything is big and most of The surface of the wound should be processed using ointments. And as a result, when the wound becomes dry and will significantly decrease in size due to the edge epithelialization, it is necessary to completely go to the use of ointments. Thanks to the creation of a fatty film on the surface of the epithelization sites, the ointment will protect young skin cells from drying out and provide them with greater resistance to external environmental factors.

In this stage, it is also important to stimulate the permitted motor activity of the patient: this tactic is justified by the fact that the activation of the patient also enhances the blood circulation in the area of \u200b\u200bthe wound, which improves the healing processes.

If the wound is large in the area, due to the rather slow mitosis of the epidermis cells of the edges of the wound will be difficult to achieve complete epithelialization. So, on average, the epidermis can grow 1mm per month. Therefore, with large clean wound surfaces in the second-third stage, it is often resorted to an auto-precious skin, which will allow you to get new, additional, sections of the epithelization of the wound and accelerate its full healing.

Treatment of the Russian Academy of Sciences: Differentiated application of wound-healing drugs for local treatment of non-infected wounds at different stages of the wound process

Sometimes the treatment of the Russian Academy of Sciences is a long process. The duration of healing (and, accordingly, the course of treatment) depends on the nature of the wound, its area, the state of the body, the infection of the wound and other factors. Therefore, when conducting wounds, the doctor must constantly analyze, at what stage of the wound process it is at the moment.

So, if regressing arises during the healing process, the use of ointments should be discontinued and again return to the appointment, admitting gel forms medicinal preparations And wait for the purification of the wound and the appearance of new granulations. With the appearance of dry sections, on the contrary, it is necessary to process them with ointments.

Differentiated treatment of the Russian Academy of Sciences is one of the main conditions for their healing. BUT right choice Preparations for the treatment of wounds directly ensures the speedy healing of the wound.

Treatment of the Russian Academy of Sciences: Differentiated application of wound-healing drugs for local treatment of non-infected wounds at different stages of the wound process

Note. In the treatment of non-infected wounds at the first two stages of the wound process before using local funds, the wound should be rushed aqueous solution One of the antiseptics for the prevention of infection. In addition, the skin around the wound at the beginning of each dressing is treated with an alcohol solution of antiseptics.

Fast healing of scars

Active substance:

Hemoderivat, ointment base.

Indications:

• Venous ulcers
• Burning
• Injuries
• Frostbite

Fast healing without scars

Active substance:

Hemoderivat, hydrophilic basis.

Indications:

• At the stage of mocking for the treatment of erosions, ulcers, various origins, including radiation
• Prolesidery, burns
• Trophic ulcers atherosclerotic and / or diabetic origin

The human body is very fragile, and it is amenable to practically any mechanical stress. Apply the wound or any other injury easily. The same can be said about animals. To cut down, for example, you can be very simple - one awkward movement of your hand, but the wound will be delayed for a long time. In several stages. The topic is very detailed, therefore, you should tell about it and separate attention affect the types of wound healing.

Definition

Start standing with terminology. The wound is mechanical damage The integrity of the skin, mucous membranes, internal organs and deeply lying fabrics. To speak a medical language, then the clinic of this kind of injury causes local and general signs. The first of the listed includes pain, bleeding and gaping. TO general signs There is infection, shock and acute anemia. Expressed in varying degrees - it all depends on general status The human and reactivity of the body.

So, the sharper was the tool, cutting the cloth, the more blemaculate the wound. However, it is worth knowing one nuance. Bleeding is far from always outdoor. Often it is internal. That is, the blood is poured into the cavity and in the fabric. Because of this, common hematomas are formed.

The pain, in turn, can be in a varying degree intensive. Its force depends on how much the receptors and nerve trunks were damaged. And from the rate of injury. And how vividly pronounced pain, depends on the injured place. Person, handbrushes, crotch and genitals are the most sensitive places on the human body.

In principle, this general Information Enough in order to penetrate the meaning of the topic. Now you can also tell about the types and classification of damage.

Classification

If we talk about the nature of damage to the tissues, it is possible to highlight firearms, crusted, cutting, chopped, bruised, swollen, torn, branched, poisoned, mixed wounds, as well as abrasions and scratches. Each of them has its own characteristics. And it depends on what kinds of healing wounds are also different depending on the type of injury.

Firearms and crushed, for example, almost no bleming. And even on the eye it is difficult to determine their direction and depth. The special form of corpus wounds is those that arose due to the impact of a pin, a spear, the edge of the umbrella or sharpened stick. Rezanny and chopped wounds are characterized by abundant bleeding and surface defects. From biting subsequently, the pus appears. Absadina, though painful, but heal faster.

In general, the classification is very detailed, all types of listed for a long time. But one more nuance is worth noting. The fact is that the wounds are divided into belated and fresh. To the first one belongs to those with whom a person appealed to the doctor a day after receiving injury. Such cured more difficult, since infection and other microorganisms have already managed to penetrate inside. Fresh wound is considered over the next 24 hours after applying. The consequences of preventing it easier.

The specificity of the restoration of fabrics

Healing is a complex regenerative process, reflecting the physiological, as well as a biological response to the injured injection. It is important to know that the fabrics differ in various ability to restore. The higher their differentiation (i.e., the slower the new cells are formed), the longer they will be regenerated. It is well known that the CNS cells are harder. But in the tendons, bones, smooth muscles and in the epithelium, this process occurs quite quickly.

Telling about the types of healing of wounds, I must say that they are faster, if the nerves and large blood vessels remained intact. For a long time the process will last when foreign bodies and virulent microorganisms (infection) have come into them. Still badly heal wounds in people suffering from chronic inflammatory diseases, diabetes and the insufficiency of the heart and kidney.

Primary healing

It is necessary to tell about it first. After all, the types of healing wounds begin with primary. Next comes secondary. The latter is healing under the lap.

It is dragging when the edges are smooth, they come into contact as closely as possible and viable. Healing will be successful if hemorrhages and cavities are inside inside, and there are no foreign bodies. Therefore, it is important to rinse the wound. It helps to neutralize infection.

This type of healing is observed after the aisphetic operations and full-fledged surgical processing injury. This stage passes quickly - approximately 5-8 days.

Secondary healing

It can be observed when there is no one of the conditions for the primary. For example, if the edges of the fabric are non-visual. Or do not fit close to each other. Contribute to secondary healing Maybe cachexia and disadvantage in the body of the substances they need. And accompanied this species Recovery of tissues by the suppuration and the occurrence of granulations. What it is? The granulation is called such newly formed vascular girls. In fact, it is familiar to every person since childhood, because each of us fell and spread my knees. Everyone remembers that the wounds were then tightened with a crust. This is the granulation tissue.

In general, the types of wound healing and their characteristic - the topic is very interesting. Not everyone knows that the process of restoring the fabric occurs in three stages. First, the inflammatory healing phase (about 7 days), then granulation (7-28 days). The last stage is epithelization. That is, the wound is covered with new, alive skin.

What do you need to know?

In the process of restoring tissues different types Healing wounds. In addition to the inflammatory phase, they all last quite a long time. Although it depends on the depth of damage. But the longest stage is the formation of the epithelium. May last about a year.

The most important phase is the notorious granulation. It is she who contributes to the normal wound tightening. Granulation tissue protects other, deeper, preventing infection penetration. If it is damaged, bleeding will begin. And the healing process will begin again. Therefore, it is very important not to touch injury and protect it from direct contact with clothes and in general with any other subjects / things.

Interestingly, the types of wound healing in animals do not differ from us. But their process is harder. Animals are trying to cure their wound themselves - constantly lick, which can harm. That is why the cats after sterilization are put on a bandage or a cone - they can not get to the wound and spool it to an even worst condition.

Healing under Strap and Treatment

This is the last type of fabric restoration. Healing under the lap occurs if the damage is slightly. When a person appeared, for example, or loss. Just for some time after the formation of injury, a dense crust appears (that the most strip), and the new epidermis is quickly formed under it. Strup then disappears itself.

Naturally, all wounds need to be treated. And how to do it, the doctor explains. Self-medication will not help, especially in the case of open wounds. Since in this situation it is necessary to act in stages. The first phase of treatment - processing medical solutionswhich neutralize the infection. The second is to prevent inflammation and edema. To do this, we can register tablets, sprays, ointments and gels. At the third stage, a person must, following medical recommendations, care for granulation tissue, contributing to its transformation into a connecting one.

Shrama

Medical classification is known far from one type of scar. When healing the wound in the primary tension, any scar can actually form. It all depends not on how tissue is tightened. The type of scar is determined by the premises of the appearance of the wound itself. Suppose surgery. The man suffered her, and the incision made by the scalpel was sewn. This is primary healing, since the fabrics are tightly in contact, there are no infections. But it will still be called a surgical scar.

Another situation. A man chopped tomatoes with a sharp knife and accidentally fell a blade on his finger. Household Accident, you can say. And the type of healing is the same, primary. However, this will be called a scar resulting from an accident.

There is still keloids, normatrophic, atrophic and however, they are not related to the topic. It is enough just to know about these types of scars.

Causes of violation of wound healing

Finally, it is worth saying a few words about why sometimes tissues are restored so slowly. The first reason is the man himself. But violations appear and without his participation. It should be addressed to the doctor if it changed the pus or increased the severity of the wound. It is abnormal, infection is possible. By the way, so that it does not appear, it is important to rinse the wound constantly.

Also need to know that the skin of an adult heals slower than adolescents, for example. And even so that the wound is tightened faster, it is necessary to maintain a normal level of humidity in the tissues. Dry skin heals badly.

But if the wound is serious and some violations are observed, you need to contact the doctor, and not engage in self-medication.

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

Shallow wounds. Shallow wounds capture the epidermis and the upper layers of the dermis. Skin appendages (hair follicles, sweat and sebaceous glands) It is saved. Thromb formation, inflammation and formation of granulation tissue are expressed slightly. The healing of the shallow wounds is based on the epithelialization due to the preserved appendages of the skin and the regional epidermis, which ultimately leads to a complete and rapid restoration of the skin with imperceptible scars or at all. In place of the wound can remain hyper- or hypopigmentation.

Deep wounds. The required stage in the healing of deep wounds is the formation of a thrombus to stop bleeding from relatively large vessels of deep layers of dermis. Inflammation and formation of granulation tissue are important stages of healing along with skin tension, which ensures rapprochement of the edges of the wound, contributing to epithelization. Since skin's appendages are damaged, the epithelization of deep wounds occurs only due to the edge of the epidermis and lost tissues are replaced by the scars.

To understand the pathogenesis of scarring, it is necessary to know how wounds are healing in the norm.

Stage of inflammation

The first thing happens during wound healing is the formation of hematoma. This ensures cessation of bleeding from damaged vessels and the creation of a barrier impeding the injection of microorganisms. Thromb is a temporary matrix in which inflammatory cells migrate. In the destruction of platelets, many growth factors are distinguished, incl. Transforming growth factor (TFR-β1), an epidermal growth factor, an insulin-like growth factor of type 1 (IFR-1) and a thrombocyte growth factor, which attract inflammation cells, contribute to the synthesis of extracellular matrix and spacing the vessels.

A number of other signal molecules, such as fibrinolysis products, attracts neutrophil and monocytes to the wound. These cells come from blood flow by diapelling through endotheliums adjacent to the wound of capillaries. The main function of neutrophils is phagocytosis and the destruction of microorganisms inside the cells. In addition, neutrophils produce inflammation mediators, under the action of which keratinocytes and macrophages can be activated at this healing.

At the end of the acute inflammatory response (after 1-2 days), the monocytes migrated from the blood flow become macrophages and destroy the remaining microorganisms and dead cells. These macrophages also serve as a source of growth factors and inflammation mediators, in particular the platelet growth factor, which attract fibroblasts to the place of damage.

Stage of Proliferation

Fresh granulation tissue is very rich in vessels and cells. Since the healing of deep wounds is not enough single epithelization, already at the first stages begins the proliferation of fibroblasts adjacent to the wound areas of the dermis. Fibroblasts migrate into the wound, the subtle extracellular matrix, consisting of fibrin, fibronectin, vitrenectin and glycosaminoglycans. In the fresh granulation tissue, the collagen III ratio to the type I collagen.

In response to the action of growth factors, the proliferation of keratinocytes and fibroblasts begins in the wound. As the granulation and the appearance of excess collagen matrix appearance, the number of cells decreases by apoptosis. Due to what apoptosis is included - unknown. Under the action of substances that stimulate angiogenesis, which serve as inductors of the endothelium growth factor, TFR-β1, angiotropine and thrombopondin, vessels begin to grow into extracellular matrix.

Myofibroblasts contribute to the rapprochement of the edges of extensive wounds, which reduces the amount of granulation tissue necessary to fill the wound cavity, and reduces the area of \u200b\u200bepithelization. Due to the contracting proteins of actin and desphams, the fibroblasts contribute to the edges of the edges of the wound. The mechanical voltage arising after the edges of the wound closed, gives a signal to cease tension.

Epithelialization begins after a few hours after the wound appears. Migratory keratinocytes activate the plasminogen tissue activator and the urogase and increase the number of receptors to the urchinase, which, in turn, contributes to the fibrinolysis - an important stage required for migration of keratinocytes. To go through the temporary matrix formed by trombum, keratinocytes form additional Fibronctin and Collagen receptors. Migration of keratinocytes and epithelials contributes to the tension of the edges of the wound.

Stage of ripening and restructuring (full healing)

At the rearrangement stage of the collagen surplus and temporary matrix are removed by tissue enzymes, inflammation cells leave the wound. During the ripening of the scar, an equilibrium between the processes of destruction of the time matrix and the collagen synthesis are occurred.

On the one hand, fibroblasts are synthesized collagen, contractile proteins and extracellular matrix, on the other - fibroblasts, fat cells, endothelium cells and macrophages allocate a number of enzymes (matrix metalloproteinases) necessary for destruction and restructuring. The equilibrium between these proteinases and their tissue inhibitors plays an 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 fibroblasts.

The rearrangement process continues from 6 to 12 months, but can stretch for years. The strength and elasticity of the scar is usually only 70 - 80% of those intact skin, so the scars are more susceptible to repeat injury.

Factors affecting wound healing and scar education

Age. Unlike adult people, the wounds on the skin of the fetus are healing quickly and without the formation of scars. The mechanism of Crabless healing is unclear, however, it is known that inflammation is expressed weakly, in the wound content there is a large amount of hyaluronic acid, the collagen fibers are stacked in a certain order.

The organism of the fetus is significantly different from the adult organism. The main difference is in the peculiarities of tissue oxygenation: the oxygen content remains relatively low the entire period of intrauterine development. Inflammation in the wounds of the fetus is taller due to neutropenia. As the immune system The fetal inflammatory response becomes more pronounced, and on the site of wounds can form scars.

The fetal skin is constantly washed by warm sterile amniotic fluid, which contains many growth factors. But one of these Crabless healing is not explained. In experiments on the fruits, wound isolation from amniotic fluid With the help of silicone bandage, it did not prevent Crabless healing; On the other hand, the skin of an adult leaned with the formation of a scar, despite contact with amniotic fluid.

The high content of hyaluronic acid in the extracellular matrix increases the mobility of cells, enhances their proliferation, and therefore restoring the damaged area. This allows you to consider hyaluronic acid by the main factor of Cubbar Healing. In the wounds of fruits, a glycoprotein was found, absent in the wounds of adults. This glycoprotein stimulates the synthesis of hyaluronic acid. In addition, it is assumed that the long-term presence in the wounds of fruits contributes to the ordered collagen deposition when healing them. When processing hyaluronic acid perforated eardrum The rats not only restored faster than that of control animals, but also the scar tissue in the place of damage was less, and the fibers of collagen were arranged ordered.

Fast epithelization of wounds in the fetal may be due to the early accumulation of fibronectin and tenscine in the wound content. Fiber fibroblasts and adults are different. Fiber fibroblasts at the beginning of the intrauterine development produce more collagen III and IV types, while adult fibroblasts are mainly type I collagen. In addition, fiber fibroblasts are capable of simultaneously proliferate and synthesize collagen, and in an adult proliferation of fibroblasts precedes collagen synthesis. Thus, in adults in the healing of the Russian Academy of Sciences, the appearance of collagen deposits is somewhat late, which leads to the formation of scars. Tension of the skin in Crabless healing role does not play, because Full wounds are practically deprived of myofibroblasts.

A key role in the restoration of damaged tissues and the formation of scars belongs to inflammation. The fetus in the absence of inflammation wounds are healing without scars. It is believed that with age healing wounds deteriorates. As the body agrees, the inflammatory reaction is reduced by the weakening of the macrophage function and T-lymphocytes, the loss of reactivity and the mobility of fibroblasts, reducing the number and other distribution of growth factors and their receptors, incl. TFR-β receptor. All this can serve as an explanation of the speed difference and the quality of wound healing at different ages.

Although wounds in older persons heal slower, they increase the quality of the scars, which may be due to a decrease in the level of transforming growth factor (TFR-β) in damaged skin. It is also possible that fibroblasts of the fetal subtype appear in the wounds of the elderly, which leads to healing of wounds, like the fetus. Reducing the level of hormones, in particular estrogen, in menopause also can also contribute to a slower healing of wounds and reduce the scarring.

Estrogens. In vitro studies have shown that sex hormones have an impact on such important stages of wound healing as inflammation and proliferation. Estrogens regulate the production of TFR-β isoforms and the formation of their receptors, which plays a prominent role in the development of fibrosis and the formation of scars. In healthy women in postmenopausus, wound healing slows down, but the quality of scars increases, which is associated with a decrease in the level of TFR-β1 in the wounds.

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

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

These data suggest the participation of estrogen in the regulation of the production of fibroblasts of the skin and TFR-β1. Finally, it was noted that the systemic administration of estrogen antagonists inhibits healing of wounds in humans. Preliminary study of the scars in women who received wounds against the background of the introduction of the Estrogen antagonist Tamoxifen showed that these scars were better qualitythan scars left after healing of the same wounds in women who have not been injected with tamoxifen.

Heredity. There are data on the existence of a hereditary factor that affects the process of wound healing, activating an abnormal (pathological) scarring, which leads to the emergence of hypertrophic and keloid scars. It was reported both about autosomal dominant and on an autosomal-recessive type of inheritance of keloid scars. Often, the keloid scars are also observed in relatives of the patient with similar scars. In addition, the prevalence of keloid scars is significantly higher among the population with dark skin, reaching 4.5% of Africans and Latin Americans. The frequency of keloid scars in the HLA-β14 and HLA-BW16 carriers, in persons with a group of blood A (II) and suffering from Rubinstein-Teyby syndrome.