The wound healing process. Fracture: Stages of Bone Regeneration, Middle Data and Healing Speed, Required Preparations

Anyone surgical intervention It is a forced measure associated with one or another degree of trauma of body tissues. From the time to restore the body after the operation and the speed of healing, the seams depends on how fast the patient can return to active life. Therefore, questions are so important about how quickly the seams will be lit and how to avoid postoperative complications. From the suture of the wound healing speed, the risk of complications and the appearance of the scar after operational intervention depends on the suture of the suture. Read more about seams Talk today in our article.

Types of suture materials and methods of imposing seams in modern medicine

The perfect suture material must have the following characteristics:

To be smooth, slide, without applying additional damage. Be elastic, stretching, without causing compression and necrosis of fabrics. To be durable, withstand loads. Reliably tiped into nodes. Have a biocompatibility with the tissues of the body, inertness (not to cause irritation of fabrics), have low allergicity. The material should not swell from moisture. The term of destruction (biodegradation) of resorption materials should coincide with the wound healing time.

Different qualities are inherent in different suture materials. Some of them are advantages, other disadvantages of the material. For example, smooth threads will be difficult to tighten into a solid node, and the use of natural materials, so appreciated in other areas, is often associated with an increased risk of developing infection or allergies. Therefore, the search for the ideal material continues, and while there are at least 30 variants of the threads whose choice depends on specific needs.

Suture materials are divided into synthetic and natural, absorbable and non-radiation. In addition, materials consisting of one thread or several are manufactured: monofilament or polyfilament, twisted, wicker having different coatings.

Unproductive materials:

Natural - silk, cotton. Silk is a relatively strong material, due to the plasticity ensures the reliability of the nodes. Silk refers to conditionally non-disseminating materials: over time, its strength decreases, and in about a year later, the material is absorbed. In addition, silk threads cause a pronounced immune response and can serve as a reservoir of infection in the wound. Cotton has low strength and is also able to cause intense inflammatory reactions. Stainless steel threads have durability and give minimal inflammatory reactions. Used in operations on abdominal cavity, when stitching sternum and tendons. Synthetic non-disseminating materials have better characteristics. They are more durable, their use causes minimal inflammation. Such threads are used to compare soft tissues, in cardio and neurosurgery, ophthalmology.

Remaining materials:

Natural Ketgut. The disadvantages of the material include a pronounced tissue reaction, the risk of infection, insufficient strength, inconvenience to use, the inability to predict the periods of resorption. Therefore, the material is currently practically not used. Synthetic absorbable materials. Produce from decomposing biopolymers. They are divided into mono and polyfilament. Much more reliable in comparison with Ketgut. Have a certain period of resorption, characterized in different materials, rather durable, do not cause substantial tissue reactions, do not glide in their hands. Not used in neuro and cardiac surgery, ophthalmology, in situations, when the constant strength of the seams is required (for crosslinking tendons, coronary vessels).

Seam imposition methods:

Ligatural seams - with their help tie up vessels to ensure hemostasis. Primary seams - allow you to compare the edges of the wound for healing by primary tension. Suts are continuous and nodal. According to the testimony, immersed, brine and subcutaneous seams can be superimposed. Secondary seams - this method is used to strengthen the primary seams, to re-closing the wound with a large amount of granulation, in order to strengthen the wound, healing the secondary tension. Such seds are called reitive and used to unload wounds and reduce tissue tension. If the primary seam was superimposed in a continuous manner, nodal seams use for the secondary, and vice versa.

How much seams are heal

Each surgeon seeks to achieve wound healing by primary tension. At the same time, the restoration of tissues passes in the shortest possible time, the swelling is minimal, there is no fitting, the amount of insignificant separated from the wound. Scarring with this healing minimum. The process passes 3 phases:

Inflammatory reaction (The first 5 days), when leukocytes and macrophages, destroying microbes, foreign particles, destroyed cells migrate into the wound area. During this period, the tissue compound did not reach sufficient strength, and they are held together at the expense of the seams. The migration and proliferation phase (on the 14th day), when collagen and fibrin are produced in the wound in fibrin. Due to this, the granulation tissue is formed from the 5th day, the strength of fixing the edges of the wound increases. Phase of ripening and restructuring (from the 14th day to full healing). In this phase, the synthesis of collagen and the formation of connective tissue continues. Gradually, a scar is formed on the site of the wound.

How long does the seams take off?

When the wound healed so much that no longer needs to be supported by non-disseminating seams, they are removed. The procedure is carried out under sterile conditions. At the first stage, it is treated with an antiseptic wound, hydrogen peroxide is used to remove crusts. Capturing the thread of a surgical tweezers, crosses it at the place of entry into the skin. Gently pull the thread from the opposite side.

Seam removal time depending on their localization:

Sew on the skin of the body and limbs should be left on the spot from 7 to 10 days. Seams on the face and neck are removed in 2-5 days. Retention seams are left for 2-6 weeks.

Factors affecting the healing process

The speed of healing of seams depends on many factors that can be divided into several groups:

Features and character of the wound. Definitely, wound healing after a small surgical intervention will be faster than after laparotomy. The process of recovery of fabrics is lengthened in the case of wounds after injury, when there was pollution, penetration foreign languagesLoading fabrics. The location of the wound. The best healing is in zones with good blood supply, with a small layer thick of subcutaneous fatty fiber. Factors caused by the character and quality of surgical assistance provided. At the same time, the nature of the cut, the quality of the intraperation hemostasis (bleeding stop), the type of suture materials used, the choice of the seams of the seams, compliance with the rules of asepsis and much more. The factors associated with the age of the patient, its weight, health status. Reparation fabrics faster in young age and people with normal body weight. Extend the healing process and can provoke the development of complications chronic diseases, in particular, diabetes and other endocrine disorders, oncopathology, vascular diseases. In the risk group there are patients with the presence of foci of chronic infection, with reduced immunity, smokers, HIV-infected. Causes related to care postoperative Wanna and seams, compliance with the power and drinking mode, physical activity of the patient in postoperative period, fulfilling the recommendations of the surgeon, the reception of medicines.

How to care for seams

If the patient is in the hospital, the seam care is carried out by a doctor or nurse. At home, the patient should comply with the recommendations of the doctor's care physician. It is necessary to keep the wound clean, process the antiseptic daily: a solution of iodine, mangalling, diamond greenery. If the bandage is applied, it should be consulted with a doctor before removing it. Special preparations can accelerate healing. One of these funds is the gel contractability containing onion extract, allantoin, heparin. You can apply it after the epithelization of the wound.

For the speedy healing of postpartum seams in required strict adherence to hygienic rules:

• careful hand washing before visiting the toilet;
• frequent change of gaskets;
• daily linen change and towels;
• during the month, the adoption of the bath should be replaced by a hygienic shower.

If there are outdoor seams on the crotch, in addition to thorough hygiene, you need to take care of the dryness of the wound, the first 2 weeks cannot be sitting on a solid surface, constipation should be avoided. It is recommended to lie on the side, sit on a circle or pillow. The doctor can recommend special exercises To improve the blood supply of tissues and wound healing.

Healing of seams after cesarean section

We will need wearing a postoperative bandage, compliance with hygiene, after discharge, it is recommended that the adoption of the shower and washing the skin in the seam area twice a day with soap. At the end of the second week, special ointments can be used to restore the skin.

Healing of seams after laparoscopy

Complications after laparoscopy are rarely observed. To protect yourself, one day after intervention should be observed. At first it is recommended to stick to the diet, abandon alcohol. For body hygiene, a shower is used, the seam area is treated with an antiseptic. The first 3 weeks limit physical activity.

Possible complications

The main complications in the healing of wounds are pain, suppuration and lack of seams (discrepancy). Binding may develop due to the penetration of bacteria, fungi or viruses into the wound. Most often infection is caused by bacteria. Therefore, often after surgery, the surgeon prescribes an antibiotic course with a prophylactic goal. Postoperative suppuration requires pathogen identification and determining its sensitivity to antibacterial agents. In addition to the appointment of antibiotics, it may be necessary to open and drain the wound.

What to do if seam broke up?

The lack of seams is more often observed in older and weakened patients. Most likely time complications - from 5 to 12 days after surgery. In such a situation, you need to immediately seek medical care. The doctor will decide on the further signation of the wound: leave it open or re-stake in the wound. With evisceration - penetration through the wound of the intestinal loop, urgent surgical intervention is required. Such a complication may arise due to the bloating, strong cough or vomiting

What to do if the seam hurts after the operation?

Surability in the field of seams during the week after surgery can be considered a normal phenomenon. The first days of the surgeon may recommend the reception of an anesthetics. Reduce pain will help compliance with the recommendations of the doctor: restriction of physical activity, wound care, wound hygiene. If the pain is intense or persisted for a long time, it is necessary to consult a doctor, since the pain may be a symptom of complications: inflammation, infection, adhesion formation, hernia.

You can accelerate wound healing using folk remedies. For this, phytosborids are used in the form of infusions, extracts, decoctions and local appliqués, phytomazy, wipes. Here are some of the folk remedies:

Pain and itching in the area of \u200b\u200bthe seams can be removed using brave of herbs: chamomiles, calendula, sage. Wound treatment with vegetable oils - sea buckthorn, tea tree, olive. Multiplicity of processing - twice a day. Lussing scar with cream containing calendula extract. Applying to the wound of the cabbage sheet. The procedure has anti-inflammatory and healing effect. The cabbage sheet should be clean, it must be quiet.

Before applying phytopreparats, it is necessary to consult a surgeon. It will help to choose individual treatment and will give the necessary recommendations.

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Clinical course and morphology of wound healing

Wound healing is a deterministic biological process that lasts about a year and ends with the formation of a mature scar. However, in the subsequent tissue, forming a scar, continue to change, although in the minimum.

From a practical point of view, in this biological process can be conditionally allocated for several periods, during which two main indicators are significantly changed, the most significant and for the surgeon, and for the patient:
1) strength and external characteristics of the skin scar;
2) the possibilities of elongation and restructuring of welded scarring under the action of moving tissues (muscle movement, tendons, etc.).

Table 12.1.1. Clinical and morphological characteristics of the stages of uncomplicated healing of the surgical wound

Stage 1 - Postoperative inflammation and epithelization of the wound (7-10 days). In the course of this period, the processes of postoperative (post-traumatic) inflammation occur in the wound, after the resolution of which the edema decreases and under certain conditions (uncomplicated flow and comparison of the skin of the skin) occurs epithelization of the skin wound.

A distinctive feature of this stage of the wound process is the fact that the edges of the wound are connected to each other very fragile granulation tissue, not a scar. Therefore, after removing the seams on the 7-10th day of the edge of the wound can easily dispense with even a small load. To obtain a minimum in the width of the skin scar, the edges of the wound should be kept for seams for a significantly longer period of time.

It is very important that during this stage, moving structures involved in the process of healing of the Rape (tendon, muscles, ligaments) remain mobile, but their uncontrolled movements can strengthen the process of postoperative inflammation and thereby worsening the quality of future deep scars.

Stage 2 - Active fibrillogenesis and education durable scar (10 - 30th day after surgery). In the course of this period in a young granulation tissue, located between the edges of the wound, the active formation of collagen and elastic fibers begins, the number of which is rapidly increasing. This cloth quickly matures, which is accompanied by a decrease in the number of vessels and cellular "elements, on the one hand, and an increase in the number of fibers - on the other. After completion of this stage, the wound is already connected by the scar, which remains stretchable and noticeable for others.

Deep scars during this period are still able to rebuild as much as possible when moving the sliding structures involved in reparative processes. Therefore, it is at this time that surgeons begin to use special techniques aimed at restoring the mobility of tendons, muscles and joints. From this point of view, this period is key to restoring the functions of tendons having a significant amplitude of movements and arranged in channels with dense walls (the tendons of the flexor and extensors of the fingers of the brush in the respective zones, the capsule and bust of the joints).

Finally, this phase is characterized by the fact that the tissues participating in the reparative processes are still sensitive to any additional injury, including those who are not controlled by the volume of movement.

Stage 3 - the formation of a solid scar (30-90s). This stage lasts during the 2nd and 3 months after injury (operation). During this period, the number of fibrous structures in the RubE increases significantly, and their bundles acquire a certain orientation in accordance with the dominant direction of load on the scar. Accordingly, the number of cellular elements and blood vessels in the scar tissue significantly decreases, which is manifested by an important clinical tendency - the transformation of a bright and noticeable scar into a less bright and less noticeable. It should be noted that under adverse starting conditions, it is at this stage that the hypertrophic growth of the scar tissue begins.

At the 3rd stage, the internal scars are significantly strengthened, which gradually lose the ability to restructure and elongate. It should be noted that the formation of deep scars in the conditions of full 3-month immobilization of the limbs often does not leave the patient any chances of restoring the function of stitched tendons, especially if they have a significant amplitude of movements and are surrounded by dense tissues (for example, finger bent tendons). Loses its extensibility and a joint capsule, especially after damage to its elements and the surrounding bond. Under these conditions, effective rehabilitation implies relevant surgical operations.

On the other hand, at the end of the 3rd stage, almost complete load on crosslined tendons and ligaments can be resolved.

It is important that at the 3rd stage of wound healing, the intensity of the processes of reparative regeneration of tissues changes significantly: from relatively high to very low. We also note that during this stage, a significant impact on the characteristics of the resulting scar has an impact on it for the strength of stretching. So, with longitudinal oatastic, the scar occurs additional education Collagen and elastic fibers in the zone of this permanent force, and at the greater the greater the stronger stretching. If the patients in the patients fibrillegenesis were initially reinforced, then the result of the early exposure to the scar in the phase of active fibrillegenesis is the formation of hypertrophic and even keloid scars.

Stage 4 - the final transformation of the scar (4-12 months). This stage is characterized by further increasingly slow ripening of catholic tissue with a practically complete disappearance of small blood vessels from it with further systematization of fibrous structures in accordance with the forces acting on this zone.

The result of a decrease in the number of vessels is a gradual change in the color of the scar: from bright pink to pale and less noticeable. Under adverse conditions, the formation of hypertrophic and keloid scars is completed, which sometimes significantly limit the function of tissues and worsen the appearance of the patient. It is important to note that in most cases it is in the middle of the 4th stage that the skin scars can be finally evaluated and determine the possibility of their correction. During this period, the formation of internal scars is also ends, and they are only a small extent to the influence of the load.

Types of wounds and types of their healing. Main types Ran.

The wound is a violation of the anatomical intake of tissue, accompanied by the formation of the wound space (cavity) or the wound surface. Several major types of wounds can be distinguished: traumatic, surgical, trophic, thermal, etc. (scheme 12.2.1).

Scheme 12.2.1. The main types of wounds and the options for their healing.

Traumatic wounds constitute the bulk of the Russian Academy of Sciences and may have the most different character (from cut to gunshot). These wounds can be heated independently or after surgical treatment when the wound from traumatic is translated into surgical.

Surgical wounds are distinguished by the fact that in the absolute majority of cases are applied with a sharp scalpel. This determines their cutting nature and more favorable conditions for healing. A special kind of surgical wounds are traumatic wounds treated with surgeon. Their scope, the location and condition of the walls of the wound cavity are often determined not so much by the surgeon as the character of primary damage.

Trophic wounds occur in violation of venous outflow and (or) arterial inflow, as well as in some endocrine and other disorders. Their main feature is a gradual occurrence as a result of the slow death of fabrics due to the violation of their nutrition.

Thermal lesions (burns and frostbite) have specific features, since the wound surface can be formed simultaneously (burning a flame) or gradually (when frosting), in the process of forming a line of demarcation and rejection of dead tissues.

Other wounds. Sometimes more encountered rare species wounds These include wounds formed after independent opening of unts, deep scuffs, breakdowns, etc.

Types of healing Ran.

Traumatic and surgical wounds are of the greatest importance for clinical practice. Their healing occurs two fundamentally different paths: primary tension (primary healing) and secondary tension (secondary healing).

The healing of the wounds in the primary tension occurs in cases where the edges of the wound will be removed from each other by no more than 5 mm. Then, as a result of edema and reducing the fishery bunch, the edges of the wound can occur. Most often, this situation occurs when the edges of the wound of the wound surgical seams.

The second most important condition for the primary healing of wounds is the lack of suppuration. This occurs if the edges of the wound are quite brought closer and viable, the intravenous hematoma is small, and the bacterial contamination of the wound surface is insignificant.

The initial healing of the wound has three important investigations for the practice.

First, it occurs as a short time, which, as a rule, means the minimum deadlines for the patient's inpatient treatment, its faster rehabilitation and return to work.

Secondly, the lack of suppuration in the fulfillment of reconstructive operations creates favorable conditions in the wound for the subsequent functioning of the structures reduced by surgeons (in the area of \u200b\u200bthe tendon seam, seam of vessels and nerves, osteosynthesis zone, etc.).

Thirdly, with primary healing, as a rule, a skin scar is formed with more favorable characteristics: it is much more thin and less often requires correction.

The healing of wounds by the secondary tension is characterized by a significantly slower course of the wound process, when the bonding of the edges of the wound can occur due to its large sizes. The most important features of this type of healing are the suppuration of the wound and its subsequent cleansing, which ultimately leads to the gradual epithelization of the wound in the direction of the periphery to the center. Note that peripheral epithelialization is quickly depleted and can lead to spontaneous wound healing, only if the size of the latter is not too large (up to 2 cm in diameter). In other cases, the wound granulates a long time and turns into a non-healing.

Healing of wounds by secondary tension is unfavorable in all respects.

First, this process lasts a few weeks and even months. Treatment of the patient requires not only constant dressings, but also additional operations (the imposition of secondary seams, skin plastic, etc.). This increases the duration of the patient's stay in hospital and economic costs.

Secondly, when the wound supplies, the outcomes of reconstructive operations deteriorate sharply (including those performed during open injuries). So, the wound suppuration when the tendon seam is applied at best leads to the blockade of the tendon with more pronounced scars, and at worst - to the necrosis of the tendon.

The development of coarse scars can block the regeneration of axons in the seam area or the plastic of the nerve, and the suppuration in the osteosynthesis zone usually ends with osteomyelitis. This creates new, often very complex problems whose surgical solution may require several months, and sometimes years, and the effectiveness of the activities carried out is often low. Finally, after the injection of the wound, as a rule, a wide scar with a gross violation of the skin surface is formed. There are often cases when the wound suppuration leads to disability and even creates a real threat to the patient's life.

IN AND. Arkhangelsky, V.F. Kirillov

Each of us has injuries from time to time. How to speed up the healing process and, if possible, avoid scars, read in our article.

Injury - It is always a nuisance. Even the slightest scratch can deliver a lot of unpleasant sensations to a person: inflammation, pain, swelling. And if the indicated effects of injuries pass after a while, then scars, alas, remain for many years. It is especially unpleasant if the scars are formed on visible parts of the body, for example, on the face, neck, hands. The appearance, spoiled by the scars, often brings a lot of psychological problems, especially women, so follows for their beauty.

Fortunately, everything is not so tragic, as it seems at first glance. With a competent approach to the treatment of wounds and abrasion, it is possible to significantly speed up the healing process, as well as avoid the formation of scars.

How to heal wounds?

First, let's figure it out, how does wound healing? Believe me, the deepening understanding of the processes only contribute to the right tactics of treatment. The wound healing process takes place in several stages:

• phase inflammation. Immediately after applying injuries, the body begins to fight the problem. Initially, a tomb is formed in the tissues to stop bleeding. On the other hand, the body must constantly fight microorganisms that may fall into open wound. This whole process is accompanied by inflammation - the process in which the injury is involved immune cellsAnd the swelling is formed, which presses on the nervous endings, thereby paining pain. Phase inflammation can last up to 7 days. Already on the 7th day, the wound begins to fill with granulation tissue - connective tissuewhich is formed when healing wounds;
• phase proliferation. It approximately starts from the 7th day and can last up to 4 weeks. In the proliferation phase, the wound is actively filled with a connecting granulation tissue, which is based on collagen. Also, the wound is filled with capillaries and cells of inflammation. So the young scar is formed. At this stage, the scar is easily stretched. Because of the large content in it vessels, the scar has a bright red color, which makes it easily noticeable;
• scar formation phase. The scar starts to form about the 4th week, and this process can last up to 1 year. The bright red scar formed at the proliferation stage starts pale, and the scar becomes less noticeable. As a result, the place of the lesion is finally filled with the connective and epithelial cloth. Primary collagen is replaced by a coarse collagen. Thus, a scar is formed, which takes the final (completed) view.

Fast healing

Parallel wound healing takes place in 2 stages: hydration and dehydration. The wound hydration phase is the period when the wound remains wet. Accordingly, the stage of dehydration is the time when the wound remains dry. In this regard, in order to achieve early healing, it is important to use wound-healing drugs (D-Panthenol, etc.). It should be borne in mind that at the hydration stage, the wound is necessary moistening and regular cleansing. And at the stage of dehydration, the wound requires protection and nutrition of the formed tissues. Therefore, it is very important to use invalid drugs already on the "wet" stage. So the wound will close faster, in addition, the risk of infection of the wound will significantly reduce.

In addition, accelerated wound healingAs a rule, does not lead to the formation of scars, either minor scars may form. Well, if the scars still formed, for example, with deep cuts, or burns, then for this case there are funds. In pharmacies, you can purchase special funds (ointments, gels), preventing the appearance of scars. However, it is important to apply them immediately after the wound will heal. Thus, in the treatment of scars, you will achieve the maximum effect.

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 at an early stage are quite simple. The drug must have a hydrophilic basis, to hold the moisture for a long time and be convenient to use. Drug forms corresponding to these requirements include 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. The active ingredient of 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, the whole large and most of the wound surface should be processed using ointment. 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. And the right choice of drugs 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

Medicinal connection	At what stage of the wound process is applied	Form release	Ease of use	Features
1. Acerbin	1, 2, 3	Solution	-	Universality
		Ointment	+
2. Hemoderivat of the blood of milk calves	1, 2, 3	Gel, Ointment	+	Universality
3. Hyaluronate Zinc	2	Solution	-
		Gel	+
4.Decantenol	1, 3	Ointment, cream, aerosol	+	Application limited to the wound stage
5.Spantenol with Miramistin	1	Gel	+	Application limited to the wound stage
6.Dectentenol with chlorhexidine Bigluconat	2	Cream	+	Application limited to the wound stage
7. Caripzim	2	EX Tempore Solution Powder	-	Application limited to the wound stage
8. Eberman	2, 3	Ointment	+	Application limited to the wound stage

Note. In the treatment of non-infected wounds at the first two stages of the wound process, the wound should be washed with an aqueous solution of one of the antiseptics to prevent 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

bibliographic Description:
To establishing the term of the healing of Absadin / Kononenko V.I. // Forensic-medical examination. - M., 1959. - №1. - P. 19-22.

hTML code:
/ Kononenko V.I. // Forensic-medical examination. - M., 1959. - №1. - P. 19-22.

code for insertion on the forum:
To establishing the term of the healing of Absadin / Kononenko V.I. // Forensic-medical examination. - M., 1959. - №1. - P. 19-22.

wiki:
/ Kononenko V.I. // Forensic-medical examination. - M., 1959. - №1. - P. 19-22.

In the place of the formation of an abrasion on the body of a living person, the healing processes are pretty quickly, which during the examination can serve as a basis for the approximate definition of the occurrence of abrasion. These literature on this issue are dissected.

The first signs of accompanying abrasion, the redness and swelling, noted by the slack, who, in his opinion, can persist within 8-10 days. However, other authors (A. Shauncen, A. S. Ignatovsky, A. F. Thaik) indicate other terms for the disappearance of redness and swelling.

Data on the timing of the formation and disappearance of the crust in the place of abrasions, cited in the literature, also diverge.

The most detailed examined question about Absadin A.F. Thai, which has 4 healing stages: the first - when the surface of the abrasion is below the level of the surrounding skin (up to day or more); The second is the formation of a crust, towering over the level of intact skin - from 1 to 3-4 days; The third is the epithelization process, occurring under the crust, the detachment of which begins with the edges and ends on the 7-9 days; The fourth-disappearance of traces after throwing a crust on the site of the former abrasion (9-12 days).

As you know, there is no scars on the place of Absadin, and the pale pink plot disappearing over time. Literary data on the timing of preservation of this site is even more dissected (N.S. Bocarius, Grozhivo-Dombrovsky, Y. Brother, E.R. Gofman, V. Neegebauer, K.I. Tatiev, A.F. Taik et al.) .

As can be seen from the above, in determining the timing of the formation and disappearance of the crust, and in general, the healing of abrasions, neither the size, nor depth nor the localization of them nor the age of the testimony and the overall condition of its organism was not taken into account. Only A. F. Thaik indicates the need to take into account the state of the central nervous system And he speaks of its oppression in mortal injuries that influence the process of the healing of abrasion.

It seems to us that with the division of the process of healing abrasion at the stage, proposed by A.F. Thai, it is impossible to agree. The healing process itself proceeds and develops gradually and cannot be limited to the framework of the stages listed. In addition, the division in the stage vits the experts of the difficulty in establishing the expiration date of Absadin.

Our observations have shown that when healing abrasions in them continuously, changes occur, especially in the initial period of healing, and these changes may be based on the establishment of the timing of their education.

The observation has undergone 24 abrasions in people aged 11 to 56 years (mainly 11, 25, 30 and 56 years old). On the first day, the observation was carried out 4 times, in the second and third - 2 times, in the rest - 1 time every day. Localization of Absadin was different: the shin, thigh, forearm, brushes, neck area and chest.

The table below shows the signs of various lifetimes of the lifetime healing of abrasions. Fresh grain in 3/4 of all cases lies below the level of the surrounding skin, but sometimes at the level with the surrounding skin. The surface of its wet, soft to the touch, in most cases pinkish-red, but there are changes in shades from pale pink, brown to dark tones. During the first day there is a minor soreness and the influence of infection may be observed.

On the second day in 3/4 of all cases, the precipitated surface is located on the same level with the surrounding skin, but sometimes it is already beginning to rise, and only single abrasions are below the skin level.

On the third day, almost all abrasions are covered with a rising crust of the brown-red color, but the shades of pink-red color can also be observed, sometimes dark, brown and yellowish color.

After 4 days, the crust is usually above the level of the skin and only in those rare cases when the body's reactivity is weakened or depressed as a result of an extensive injury: (severe injuries), it does not rise above the surrounding skin. By the end of the 8-11 days, the crust is easily separated, but its depression is possible and earlier, especially in cases where Absadin was first lubricated with iodine or diamond greenery, as well as in cases of superficial abnormal sizes and during the localization of them on the neck.

Symptoms detected in the healing process	From the moment of the formation of abrasions
The surface of the grain is basically pink-red, wet, below the level of the surrounding skin, around is observed	1 hour
Surface dries, redness and swelling around the abrasion of about 0.5 cm wide	6-12 hours
The surface is compacted, swelling disappears. The disappearance of the existing soreness is noted	24-36 "
The surface is more often a brown-red color, tight to the touch mainly at the level of intact skin. The infectious principle effect decreases	2 days
The abrasion is almost always covered with a crust, towering above the skin level. Dark, brown, yellowish shades prevail. Noticeably wrinkling, decrease in size	3 "
Crust, as a rule, towers above the skin level	four "
Crust with bodied edges, coloring it is more often red-brown, abrasions are reduced by half	5 days
The same phenomena are expressed more dramatically, leather peeling is observed around the abrasion.	6-7 "
Reducing the initial size of the abrasion 4 times	eight "
Cork deposit (rejection of it is possible before), there remains a pale pink plot	9-11 "
Reducing the size of the specified, plot, in coloring it is dominated by pinkish-reddish shades	15-16 days and more
Gradual non-traced disappearance of the specified area	20-30 days

Of course, it is impossible to think that the signs and deadlines given in the table and the terms are absolutes for all cases (sometimes crusts disappear on the 6th day), but this does not exclude the possibility of using these data in the practical activity of the judicial nuclear expert.

The duration of healing depends on the size of the abrasion. It should be noted such a pattern: the surface abrasion is 0.5 × 0.3 cm with a size of 0.5 × 0.3 cm, with other things being equal, the crusts were separated on the 6th day, and at a size of 2 × 1 cm to the 8th day. Localization is also important: at the arrangement of the abrasion on the neck of the cortex separation is reduced. So, with abrasions of 6 × 1 cm in the neck, the crust was dropped on the 8th day.

Significant effect on the healing process is infected with abrasion. In one case, with the size of the abrasion 2 × 1 cm when the infection is attached to the 4th day (suppuration), the crust was separated only on the 15th day.

The judicial american expert in determining the limitation of abrasion should take into account such moments as the leatization of the abrasion, the depth of the semitching of the skin (superficial or deep abrasion), the dimensions, the addition of infection, the lubrication with iodine, the diamond greenery of the oxadin surface, as well as the individual properties of the victim.

We have studied acts of examination in the Kharkiv judicial disguise for the 1st half of 1957, in which there was a description of 1270 abrasion. At the same time, it turned out that the expert in 75% of cases sees Absadin on the 2nd day of its formation. In 81.4% of these cases, the abrasions were located on the same level with the surrounding skin, in 66.5% they were a brown-red color, at 31.2%-red, in 2.3% - yellowish-red, in all cases there were Redness of the skin around the abrasion. On the 3rd day, the abrasions were studied in 14.6% of cases, and on the 4th day - at 7.2%, etc. The dimensions of the abrasion were different: the color of the crust on the 3rd day was mostly red-drone ( 71.9%) and only in 18.1% of cases - brown-red.

A comparison of our data on the healing of Absadin with those of the practice of the Kharkov judicial commentary ambulance showed a coincidence of detected signs during healing.

Thus, the data provided, as it seems to us, can be used to judge the deadlines for the formation of abrasion in the practical activity of the judicial nuclear expert.