Characteristics of wound process

Wound process - this is the complex of successive changes, which take plac wound, and connective reactions of all organism.

Conditionally, we may divide this into general reactions of the organism and ing of the wound.

General reaction

The complex of the biological reaction of the organism during the influen damage we may observe like 2 successive stages.

1). During 1 -4 days from the moment of trauma there is observed the excitation of sympathetic nervous system, the elimination of the hormones of adrenal glands - insu­lin, ACTE, and glucocorticoids, into the blood. According to this the process of life activity becomes stronger: increase the main change process; decrease the mass of the body; increase the destruction of the proteins, lipids, and glycogen, decrease the pen­etration of cellular membrane.

In the cavity of a wound there is some quantity of microorganisms and destroy tissues, which dissolve and phagocytes. According to this, all process, which is present in the surrounding tissue of the wound, causes the general reaction in the whole organ­ism. As a result, in the first period there is observed the increase of the body tempera­ture, weakness, decrease the workability.

The analyses of blood notes the increase of the leucocytes quantity, sometimes - a small shift of leukocyte formula to the left. In analysis of urine may be proteins. During the general bleeding there is observed the decrease of hematocrit, quantity of erythro­cytes, hemoglobin.

2). Starting from 4-5 days, the character of general reactions depends on parasym­pathetic nervous system. The main important components are mineral-corticoids, so-matotrophic hormone, aldosterone, and acetylcholine.

They observe the increase of the body mass, the normalization of proteins, the mobilizing of reparative abilities of the organism. In 4-5 days when the complications are absent; the intoxication, inflammation, pain are decreased. The analysis of blood and urine becomes normal.

Healing of the wound

The reparation of the wound - the reparative process of damage tissue with re­sumption it's integrity and firmness.

For closing of the tissue defect there can be 3 main processes.

The formation of the collagen by fibroblasts. During the reparation of the wounds fibroblasts activates by macrophages. They proliferate and migrate to the place of in­jury, and connect with fibril structures through the fibronectin. In one time fibro plates synthesize the substance of extra cellular matrix. Collagens provide the liquidation of tissue defect and firmness of the stitch formation.

Epithelization of the wounds becomes under the influence of migration of the epithelial cells from the border of wound to its surface. The end epithelization of wound defect causes the barrier for microorganisms. But the migration from the border cannot close the defect, which does necessary in some cases to carry out a dermal plasty.

The decrease of the wound surface provides effect of tissue tension (the contrac­tion of miofibroblasts).

Phases of wounds reparation

Rufanov differ 2 phases: hydration and dehydration.

Girgolav determined 3 period of wounds reparation:

1. preparing period.

2. the period of regeneration.

3. the period of stitch formation.

In present time the most popular classification is (Cusin, 1977 year):

1. The phase of inflammation (1-5 day). It has period of vessel's changes and period o purifying of the wound from necrosis.

2. The phase of regeneration (6-14 day).

3. The phase of formation and stitch reorganization (begin from 15-th day).

The factors, which have influence on healing of the wound:

• age of the patient;

• the condition of nutrition and body mass;

• the presence of secondary infection of the wound;

• he condition of blood circulation in zone of damage and organism in general;

• the presence of destroys of water-electrolytic balance;

• the immune status of the organism;

• chronic bypasses diseases;

• using anti-inflammatory medications.

The best reparative process has the child organism, it caused by presence in period of development anabolic processes. In such condition the reparation is shorter and is not so dangerous.

Classical types of reparation:

• reparation by primary tension;

• reparation by secondary tension;

• reparation under the crust.

TREATMENT OF WOUNDS

Despite many specific peculiarities of different wounds, main stages of their heal­ing are mostly the same. There are also common tasks, that surgeon face while treating any wound.

1. Dealing with early complications.

2. Prophylaxis and treatment of infection in the wound.

3. Reaching the healing in the closest time.

4. Full stabilization of function of damaged organs and tissues.

Dealing with these tasks should be started at the very beginning of providing the first aid.

First Aid

While giving the first aid one should:

• exclude early complications of the wound that are dangerous to life of the patient,

• prevent the following infection of the wound.

(1) Fighting against complications threatening the life

The hardest early complications of the wound are:

  bleeding,

 development of trau­ matic shock,

 injuring of life important organs.