Wound healing

everyone this is dr. Marjorie from team MDS conquer I'm going to discuss about the own healing in this video so here I'm going to discuss about the own healing and also the healing of the extraction wound and healing of the fractures also if you see this own is the discontinuity or break in the surface of the epithelium okay if it will be simple only the skin is involved and when it involves the underlying nerves or muscles and tendons it is called as a complex own so these are the list of types of wound a cute old a chronic owned the wound which is not healing even in the four weeks it is called as a chronic wound and the other classification includes the closed rooms and the open rooms closed until are contusion abrasion and hepatoma whereas open wounds includes inside stones lacerated penetrating and the crust owns so usually the healing will be taking place in two steps that is regeneration and the repair the regeneration occurs when healing takes place by the proliferation of parenchymal cells okay and whereas repair it is the replacement of the NGO testify the fibrous tissue and there are two processes which are involved in the repair here that is granulation tissue formation and the contraction of the owns if you take the granulation tissue formation it takes place in three phases that is phase of inflammation phase of clearance and phase of in phase of in growth of the granulation tissue so in phase of inflammation after the trauma blood clot will be seen at the site of injury and the there is acute inflammatory response within the 24 hours after the trauma at the site of the injury so this is the face of inflammation if you see the face of clearance the combination of the proteolytic enzymes find the auto lytic enzymes and the phagocytic activity of the macrophages all welcome mine and clear of the necrotic tissue debris sand the red blood cells which is seen in which is called as a phase of clearance and in the last in growth of granulation tissue it consists of two main processes the first one is I am geo Genesis angiogenesis means linear acceleration that means the new blood vessels are formed and this angiogenesis takes place under the influence of this following factors like vascular endothelial growth factor platelet derived growth factor or transforming growth factor basic fibroblast growth factor and surface integrals so if you take the next process that is called as v reno genesis okay in this fibrinogen a says that the newly formed blood vessels are present in amorphous in the ground substance okay then this fibroblast will have a combination of morphologic and functional characteristics of smooth muscle cells and this collagen fibers will appear by the sixth day after the own and then which finally formed formation takes place that is called as a cicatrization I mean there will be more and more of collagen formation then coming to contraction of the own it starts after four days and completed by the fourteenth day after the own and during this period the own will be reduced approximately 80% of its original size and this contracted own will result in a rapid healing so those are the steps you have to include in the faces of all healing ok those three steps then coming to the good healing can be may be healing can be takes place by the first inter and the second thing which we have to include other ways by which the own healing takes place okay the healing can be takes place with a primary union or a secondary union or a tertiary indention it is also called as a delayed primary cold closure so primary yuning can occur takes place when the only screen and unaffected surgically in size don'ts without much loss of cells and tissues and edges of the homes are approximated by this sutures okay again there are few sequences in this primary Union on the primary Union which takes place in a healing those sequence of five indirect initially there will be hemorrhage then acute inflammatory response epithelial changes and organization of the own so ml hammer initial hemorrhaging notes immediately following the injury okay then acute inflammatory response within 24 hours none of the epithelial changes were a basal cell of epidermis from both the cut margins start proliferating in the this phase and they're well approximated home discovered by a layer of with epithelium within 48 hours and by the fifth day multi-layered epithelium can be seen and organization by the third day fibroblasts also invade the own area and by the fifth day new collagen is formed and in the four weeks the scar tissue the scanty cellular and vascular even elements are formed with it completely apathy lies the surface so those are the four phases which are take place in the primary Union so if you take the secondary Union this secondary Union is taken takes place when the wound is infected when having extensive loss of cells and tissues and if the old is not approximated by surgical sutures so on these are the sequences which takes place in the secondary Union the initial three to three to four phases are the same and the last thing is the own contraction the presence of infection or extra in which you can see in the secondary Union so all these things initial hemorrhage is same inflammatory phase is also the same then even the epithelial tissue cells will migrate in the form of epithelial Spurs and until end I need to add a granulation tissue forms it does not cover surface fully okay the surface of the wound is not covered fully until a granulation tissue is formed so and the formation of granulation tissue here which is I mean which is a bulk of secondary healing is mainly because of this granulation tissue and the newly formed relation this week in the market with a deep red I have color which is granular and very fragile and une contraction and this wound contracts to 1/3 to 1/4 of its original size and if bacterial contamination of an open wound is there as it is in the secondary union the wound edges are not approximated with the suture on and which is which have a loss of more amount of epithelial cells the most prominent chances of bacterial infection is there so if bacterial contamination of open wound is that then it will delay the process of healing so those are the steps which includes the secondary Union ok then coming to the tertiary healing the stress-free healing is the secondary healing plus delayed the primary closure and this type of healing occurs following an injury or an operation when a tissue is excised and foreign material or in fact shiny is present so this is the tertiary healing so those we have done and regarding the phases of healing I know that is initial phase the secondary phase and tertiary phase now will go with the factors affecting the whole healing which includes the local factors and systemic factors so these are the list of local factors given here and this is the systemic factors which are given here which affects her own healing and if you take the hey age of the patient the healing will be more slow in the aged people and deviated people and if you take the nutrition also if more debris Asian the own healing will be delayed in high protein emia delay the appearance of fibroblasts if you take a vitamin C deficiency if vitamin C deficiency actually C play it plays an important role in the collagen formation and Oh Dean if the vitamin C deficiency is present you can see the formation of unstable collagen which is degraded by collagen eliza's hence the bone healing is very delayed and it results in the capillary fragility also then even the vitamin E is also a membrane stabilizer in vitamin A deficiency decreases the collagen synthesis zinc deficiency also inhibit the healing whereas widen b6 deficiency also you can see the poor reef repair and impaired circulation cross-linking corticosteroids if the patient is in corticosteroid it depresses the growth of granulation tissue my recommends like warfarin and apparently crease the formation of fibrin matrix okay and the depressed general assistance infection shock and malignancy all these things will decrease the own healing in even in the diameters these are the three reasons why there is a decreased own healing in the diabetes because of increased susceptibility infections hyperglycemia released results in the decreased activity of phagocytes and even in the insulin is required in the earlier stages for the collagen formation so these are the three type things where you can see why my wound healing is delayed in the diabetic people then other future netic disorders coagulation disorders and smoking also will cause the Delaine own healing so those are the reasons you have to ride with those the factors like local and semuc factors you have to mention in your exam then complications of the own healing include infection epidermal cysts pigmentation seroma which is a correction of fluid with limb for blood and hematoma okay these are the complications of the own healing and other complications include like scar formation incisional hernia neoplasia keloid this keloid is important and mostly seen in the African Asian population and this is like a xsu painful and ugly scar formation this is because of the excessive formation of the collagen material then coming to the hypertrophied scar this here the borders are confined to the initial wound and the non highly collagen fibers and fibroblasts is seen in this thing then excessive contraction proud flesh wound dehiscence so those are the complications of the whole healing if now will come the heat to the healing of the extraction own this after the extraction immediately blood fills the socket which correlates and ends of torn blood vessels in the periodontal ligament then within the first this can be divided into the stages that those are the sequence which happened immediately after the extraction now we'll see after 24 hours alteration in the vascular blood vasodilation occurs mobilization of the leukocytes surface of the clot covered by thick fibrin iron finally the clot retraction then fur in the first week of the own clot is replaced by the graduation tissue and a linear vultures the as teo clastic activity and edges of the own continue to exhibit the epithelium proliferation in the second week clot continues to organize fibrin mesh work is formed vo i Anzio tenses tuber trabeculae a first-year entered the socket osteoclast ik resorption and the remnants of PDL undergo degeneration in the third week mature granulation tissue is seen trabeculae of a state form around the old and crest of annular bone is rounded by osteoclast ik resorption in the fourth week it is a final stage of healing where the remodeling of the bone is seen and the radiographic evidence of bone formation does not become prominent that means it will become prominent only after the sixth or eighth week often to the extraction so if the tooth extraction on healing of tooth extraction is given you have to write let immediately what is with what happens in the sockets immediately after the 24 hours first week second week third week in the fourth week okay then the complications of the extraction oonh that is dry socket and the fibrous Union then coming to the healing of bone it can be healed by the indirect healing or secondary healing or direct healing or the primary healing so these are the primary intention healing which there are two types of healing that is gap healing and a contact to healing and here this gap healing this is small gap between the fractured bony fragments you seen whereas in areas with inter fragment the gap is zero we can expect the contact healing so you can note all these differences between this gap healing and a contact healing which is given in this slide then this is because in the secondary intention first there will be a midterm of formation callus formation bony this is fibrous can is bony carrots and the bone remodeling these are the steps in the secondary intention of the bone healing then complications of the fracture healing include fibrous Union non-union and the delayed Union so those are those are the things you have to write for the bone healing fracture heal bone healing of the fracture healing and nowadays we are using lasers so we'll see the lasers in their own healing so these skills can be write and you can write in the applied aspects so lasers will employ employ the low-level radiant energy and it will I mean this majority of the laser on healing has focused on the flourish proliferative phase in the literature and this low-level radiant energy of laser will answer eight the own healing reduces the pain and the enhance is the neural regeneration so these are the important points you have to write in the laces and all healing and the own care should be taken like you have to provide a nutritional support and monitor the nutritional sub-tree status and create maintain a clean moist environment with adequate circulation and oxygenation and you have to know about few points about the hyperbaric oxygen therapy also here the 100% oxygen it will be given at two to two point four atmospheres for one to two hours so this is the applied aspect you can write like lasers and moon care and hyper box hyperbaric oxygen therapy and advances in the own care we are using the growth factors so this is the list of exogenous application of growth factor directly on the own you can you wrote this points because these are the advancements and this is the delivery system that can be used to deliver the growth factors like we can do topically or a fibrin sealant or a glue use of a platelet-rich plasma and tissue-engineered equal ins so that's it so if a home healing answers the answer here has come you have to write all the healing of own phases than the complications of all healing than the extraction socket healing than the fracture healing are finally if you applied aspects like lasers and the advances in the own healing that we own care that we are using now growth factors directly on their own so these are the references which are included in this video for the own healing thank you have a great day