Lecture: surgical wound healing
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Transcript of Lecture: surgical wound healing
Wound healing
Upper Chesapeake Medical Center
Spine Conference
9/5/14
Skin function
ProtectSensationThermoregulateEvaporateStorage and synthesizeAbsorbWater/osmosis resistance
Langer LinesCarl Langer Vienna Anatomist 1819-1887; impaled the skin of cadavers with a circular ice pick and noticed skin defect created was ellipsoid. He then connected the longitudinal axis of the defects. These lines correspond to the alignment of collagen within the dermis.
CleanClean contaminatedContaminateddirty
One year
Three months 2nd lower area
Note wide scar
Collagentensile strength is directly proportionate to amount of collagentensile strength increases with covalent cross links of organized collagen80% of strength is obtained at 6 weeks, but skin is normal at 6 monthsmost abundant protein in mammals 30% of all protein
[Greek kolla, glue + -gen.]
Inflammation/clot
Granulation
Beefy redEndothelial cell divisionNew capillariesfibroplasia
Epithelialization: keratinocytes at the margin change, cells migrate over
wound
NutritionHypoalbuminemia
Vitamin C: scurvy, wound healing arrested during fibroplasia, fibroblasts do not produce enough collagen, collagen not transported out of cells and collagen fibrils are not cross linked
Vitamin A, B6, B1 thiamine, B2 riboflavin
Chronic venous insufficiency
infection
Tissue trauma
Foreign body
Wound tension
stress
MRSA screen
Wet to dry
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