Order of cell arrival in wound

Platelet → PMN 0-2 days → macrophages 3-4 days → lymphocytes → fibroblast 5 days and on

• Hemostasis
• Inflammation day 1-3
• Proliferative day 4-3 weeks
• Remodeling 3 weeks (actually starts around 5d) - 1 year
• IL, Factors, A&P

Cartilage – contains no blood vessels. Get nutrients and oxygen from diffusion

Scars – Contain a lot of proteoglycans, hyaluronic acid, and water

• Scar revision – wait for one year to allow maturation
• Infants heal with little or no scarring

Essential for wound healing  → Want transcutaneous oxygen measurement > 25 mmHg

RF for wound dehiscence - Deep wound infection #1, poor nutrition, COPD, DM, coughers.

Peripheral nerves regenerate 1 mm/day

Accelerated wound healing - reopening a wound, results in quicker healing the 2nd time (since healing cells already present)

Epithelial integrity

• epithelialization after primary closure starts around 24-48 hrs
• Most important factor in healing open wounds with secondary intention
• Migration from hair follicles #1 site, wound edges, sweat glands
• Dependent on granulation tissues in wound

Zinc needed for wound healing

Vit A → stimulation of fibroplasia, collagen cross-linking, epithelialization

• Reverse inhibitory effects of glucocorticoids on the inflammatory phase of wound healing
• Give Vit A for pts on chronic steroids***

All facial lacerations can be primarily closed if < 24 hours. Use non-absorbable suture, interrupted fashion. Allows drainage

All other lacerations can be primarily closed if < 18 hours

Suture removal - Face → 7 days. Other area 2 weeks

Diseases associated with abnormal wound healing

Osteogenesis imperfecta - Type I collagen defect

Ehlers-Danlos – Collagen disorder

Marfan’s – fibrillin defect (connective tissue protein)

Epidermolysis bullosa - excessive fibroblasts Tx: phenytoin

Pyoderma gangrenosum - tx steroids, gets better with colectomy in UC. Associated with hidradenitis

Ulcers

Leg ulcers – 90% from venous insufficiency

Tx: Compression and wrap

Diabetic foot ulcers - Usually at charcot’s joint (2nd MTP) and HEEL 2/2 to neuropathy

• Pressure sores: (pressure ulcers)

Wound vac – Increases wound contraction, promotes granulation, increases blood flow and removes edema

Denervation – has no effect on wound healing