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Timing is important to wound healing. Critically, the timing of wound re-epithelialization can decide the outcome of the healing. [11] If the epithelization of tissue over a denuded area is slow, a scar will form over many weeks, or months; [12] [13] If the epithelization of a wounded area is fast, the healing will result in regeneration.
There are several small variations in the reconstructive ladder [2] [3] in the scientific literature, but the principles remains the same: Healing by secondary intention; Primary closure; Delayed primary closure; Split thickness graft; Full thickness skin graft; Tissue expansion; Random flap; Axial flap; Free flap
It is the first stage of wound healing. Hemostasis involves three major steps: vasoconstriction; temporary blockage of a hole in a damaged blood vessel by a platelet plug; blood coagulation (formation of fibrin clots) Coagulation, the changing of blood from a liquid to a gel which forms the fibrin clots, is essential to hemostasis.
A week after the injury, the edges of the wound are pulled together by contraction. Contraction is an important part of the healing process when damage has been extensive, and involves shrinking in size of underlying contractile connective tissue, which brings the wound margins toward one another. [1]
Wound assessment is a vital first step in the precision management process. The purpose of wound assessment is: To identify: the origin of the wound, the effects of the wound on the individual, the effects of the individual on the wound. To determine: if healing is taking place, the most appropriate management of the wound. To gather data:
The end goal of wound management is closure of the wound which can be achieved by primary closure, delayed primary closure, or healing by secondary intention, each of which is discussed below. Pain control is a mainstay of wound management, as wound evaluation, wound cleansing, and dressing changes can be a painful process.
The wound can be allowed to close by secondary intention. Alternatively, if the infection is cleared and healthy granulation tissue is evident at the base of the wound, the edges of the incision may be reapproximated, such as by using butterfly stitches, staples or sutures. [4]
In 2011, the scientific literature highlighted stress shielding a fresh wound through the wound healing process, brings significant scar improvement and smaller scars. [ 18 ] [ 35 ] By 2016, skin had been regenerated in vivo and in vitro . and scar-free healing had been operationalized and induced by four main regeneration techniques: by ...