The consequence of any operation is wounds and sutures, the care of which requires special attention. The speed of rehabilitation and the quality of tissue restoration depend on how carefully the patient follows the doctor’s recommendations. It is important to stick to the right drinking regime, get proper rest, take all prescribed pills for wound healing after surgery, visit the treatment room for timely dressing of wounds. Physiotherapeutic methods and traditional medicine will also help.

The process of wound formation and healing is complex cellular changes and general reactions of the body that ensure the process of recovery and healing. M.N. Kuzin created a classification in 1977 in which he describes the phases of healing postoperative wounds. They are as follows:

1. Inflammation phase. Consists of period vascular changes and cleaning the wound from necrosis products. At this time, a spasm of blood vessels occurs, which is replaced by their expansion. Blood flow becomes slower, the permeability of the vessel wall increases. This provokes traumatic swelling. On the one hand, edema is a way to cleanse the wound of dead tissue, on the other hand, it is the reason for the appearance of hypoxia and impaired microcirculation. The action of inflammatory products developing edema and tissue damage are the causes of pronounced pain syndrome. To make this period as easy as possible, you need to understand how to treat wounds after surgery.
2. Regeneration phase. Granulation tissue begins to develop. It consists largely of fibroblasts and capillaries, which form collagen fibers and connective tissue substances. It is important that initial stages tissue formation may be accompanied by necrosis. This is a reason to pay special attention to the healing process during this period. Later the conversion process begins granulation tissue into the connective scar.
3. Scarring and epithelization phase. At this stage, new granulations are not formed. The number of vessels and cell elements decreases, and granulation tissue is replaced by collagen fibers located horizontally. Cells in the basal layer of the skin produce epithelium. If you know how to treat the wound after removing the stitches, the scarring result will be very good.

Materials and processing methods

The success of wound healing depends on the functioning of the body. For some, the wound heals quickly after surgery, for others it bothers us even after the main healing process has passed. The main success depends on how attentive the patient is to his health and follows the doctor’s recommendations.

The healing time of a postoperative wound depends on:

• sterility of operations performed on the wound;
• the quality of materials used to treat the wound;
• regularity of processing postoperative suture.

Sterility is the first and most important requirement for wound treatment after surgery. Hands must be washed thoroughly before the procedure. It would be useful to use special disinfectants. It will be useful to know how to treat the wound after removing the stitches. Depending on the type of wound, the following can be used as an antiseptic:

• solution of potassium permanganate (do not get carried away with increasing the dosage, otherwise you may get burned);
• iodine (only in small quantities so as not to cause dry skin)4
• brilliant green;
• medical alcohol;
• fucorcin (extra caution should be exercised, since this wound healing agent after surgery is poorly washed off from surfaces);
• hydrogen peroxide (may cause a burning sensation);
• anti-inflammatory drugs, ointments, gels.

The use of these funds can be independent. When using some products, you need to consult a doctor.

Wound healing after surgery is not very good fast process. To ensure that it causes a minimum of inconvenience and complications do not arise, you should adhere to certain rules:

1. Disinfection. Hands and tools must be carefully handled.
2. Accuracy. You need to remove the stuck bandage very carefully. Before treating a wound after surgery, you can moisten it with hydrogen peroxide and wait a few seconds. Dry crusts and growths should absolutely not be removed from a wound. They must fall off on their own.
3. Safety. Each time at the time of dressing, the wound must be treated with an antiseptic using a cotton swab or swab. It would be a good idea to carefully examine the wound for inflammation. If you suspect it, you should consult a doctor. To avoid complications and the development of infection, the optimal frequency with which the wound should be treated after surgery is twice a day.
4. Protection. Each time after treatment, the wound must be closed by applying one or another type of bandage. Showers should be taken carefully. If the wound cannot yet be wetted, this requirement should be observed.

Wound healing methods

The first method used to heal a surgical wound is surgical. It includes such manipulations as surgical treatment of the postoperative wound and suturing. Along with it, surgeons resort to:

• antibacterial therapy;
• installation of drainage;
• use of narcotic drugs;
• the use of regeneration stimulants;
• immunotherapy;
• the use of vitamin-mineral complexes, hormonal drugs.

The answer to the question of how to speed up wound healing after surgery is simple. Physiotherapy is very effective in recovery. Its main tasks are this process the following:

• suppress the development of pathogenic organisms;
• prevent the appearance of unwanted inflammation;
• slow down the process of rejection of dead tissue;
• dock painful sensations;
• stimulate tissue regeneration;
• form scars, the size of which will be minimal.

The choice of physiotherapy method must be made taking into account the wound healing phase. If this is the beginning of the process, then an uninfected wound may become infected. To avoid this, prescribe physical methods treatment. They stimulate the immune system, limit the manifestations of swelling and inflammation. In the second phase, it is recommended to use methods that will stimulate vasoconstriction and accelerate regeneration. During the last stage of healing, the choice of method should be determined by the type of scar that is to be formed. In general, physiotherapy is not always used during the third stage of wound healing.

Most often, physiotherapy is prescribed starting from the second day of wound healing. After suturing, it should not take much time, because there is a need to cleanse the pus. It is important to know how to treat the wound after surgery. To do this, before the procedure physical treatment They use bactericidal drugs, as well as immunomodulators and necrolytics. If the wound is large and the pain is severe, you can use painkillers.

Basic rules for self-treatment

Treatment of wounds after surgery at home requires special attention. When attempting to heal a suture yourself, extreme caution should be exercised. Each type of wound requires treatment methods that are suitable only for it and medical supplies. Basic rules that must be followed in any case:

1. Under no circumstances should you stop bleeding on your own, especially if the postoperative wound is stab or cut. Bleeding is a way of clearing bacteria. If this does not happen, it may develop infectious inflammation. If the wound is deep, stopping the bleeding is still necessary.
2. Do not touch the wound with your hands. This is a way to introduce infection into it. The result will be long healing, suppuration, sepsis. In some cases, this can cost lives.
3. Treating the wound after removing the sutures requires the use of antiseptics. Even if the wound heals well on the outside, it needs to be disinfected.

What to do in case of complications

Often, with insufficient care, if recommendations are not followed, or due to a weakened immune system, the wound begins to bother. The process of inflammation of the suture is accompanied by the following symptoms:

• swelling;
• redness of the suture area;
• the appearance of a compaction that can be easily felt with your fingers;
• increased body temperature and, in some cases, increased blood pressure;
• muscle pain;
• general weakness.

Regardless of how many symptoms occur simultaneously, the reasons may be as follows:

• infection in the wound;
• injury to the subcutaneous tissue and, as a result, the formation of hematomas;
• increased tissue reaction to suture material;
• poor drainage in overweight patients;
• the patient does not know how to treat the wound after surgery;
• weak immunity.

In many cases, the factors that provoke inflammation of the postoperative suture can be combined. They can arise due to a surgeon’s mistake made during surgical treatment, due to the patient’s inattention or carelessness during the procedure. hygiene procedures, due to an infection not related to the wound, but affecting its healing.

In addition to these factors, the condition of the wound can be influenced by the patient’s weight, since healing in obese patients is a more complex and lengthy process. This is often associated with increased level blood sugar. Age is also important. The older a person gets, the slower the process of regeneration of body tissues occurs.

To ensure fast healing nutrition should be normalized. The body must receive sufficient amounts of protein and vitamins, because the lack of these substances negatively affects the recovery process.

If you still cannot avoid inflammation, you should not exercise. self-treatment. Seeing a doctor is a guarantee that the process can be stopped. If there are any disturbances in the process of tissue restoration, the specialist will do the following:

• remove the stitches and clean the wound;
• install a device for removing fluid and pus - drainage;
• will appoint additional funds external use.

Prevent occurrence serious complications When healing postoperative wounds, only the diligence of the patient himself can help. He should know how to treat the wound after surgery. If you take care of the suture carelessly, you can get septic blood poisoning or even gangrene. IN mandatory you need to treat the suture, do not wet it for the period specified by the doctor, take vitamins for wound healing after surgery, diversify your diet and change the bandages on time. If everything is done correctly, the wound will heal quickly and without complications.

Wound healing after surgery- video

Weeping wounds represent damage to soft tissue structures. The skin is the body's natural barrier and performs many functions.

The superficial skin is exposed to aggressive environmental influences.

Orthopedist-traumatologist: Azalia Solntseva ✓ Article checked by doctor

Treatment

There are different degrees of damage. Localization: skin, blood vessels, bones, sometimes internal organs.

When a wet injury does not heal, inflammation occurs. During the healing process, scars form. Treatment consists of regular dressings, antibiotics and disinfectants. medicines.

Ointments for drying

Treating with drying agents means using ointments and gels.

Products that protect the skin from infection:

1. Levomekol. Disinfecting, drying ointment has an antibacterial effect and prevents the formation of pus. Improves the functioning of the immune system, actively combats pathogenic microorganisms. Usage: for weeping injuries, suppuration, the product is applied with a syringe directly to the lesion.
2. Solcoseryl. Regenerating, drying ointment composition. Promotes the production of new cell fibers, stops the process of fluid formation. Application: apply ointment to the affected area, no more than 2 times a day. Apply to semi-closed dressings. The course of treatment is 2 weeks. There are no contraindications.
3. Povidone-iodine. Gel medication with regenerating, anti-inflammatory, drying effects. The gel penetrates deep into the dermis, neutralizes the lesion, restores the skin structure, and prevents the formation of scars. Application: rubbed onto the wound surface, washed off after 25 minutes. Contraindications: renal pathology, allergic reactions for iodine is not recommended for children under six years of age.

The listed medications have antimicrobial and drying properties. Consult your doctor before use.

Healing products

When the dermis is traumatized, a person experiences pain and discomfort.

To avoid negative consequences and complications used wound healing agents, which prevent the development of pathogenic bacteria and accelerate skin regeneration:

1. Bepanten. Wound healing cream, effectively cares for damaged skin, which separates exudate. The components of the cream normalize tissue metabolism and enhance the healing process.
2. Eplan. A regenerating, wound-healing medicine, has an analgesic and bactericidal effect. Apply directly to the affected area several times a day. Can be used as a compress.
3. Argosulfan. Healing cream based on salt (silver). The drug heals the dermis and has an antibacterial effect. Used for the treatment of weeping wounds, purulent lesions, trophic ulcers, burns.

The choice will depend on the location, area and severity of the lesion.

Antibacterial drugs

When treating a weeping wound, sterile dressings are used.

• Furacilin solution;
• Sodium hypochloride;
• Miramistin;
• Okomistin.

Antiseptics reduce the release of exudate.

If the wound continues to get wet and does not heal for a long time, antibacterial drugs are prescribed.

Treatment is carried out:

• Streptocide ointment;
• Mafenide;
• Streptonitol;
• Fudisin (gel).

The products are applied to the wound surface, and a sterile bandage or tampon is applied on top. Often, Xeroform or Baneocin powder is used to treat the skin layers.

Healing process

If the injury oozes, does not heal long time, there is a possibility of secondary infection. As a result, a wet surface is formed.

The immune system tries to fight inflammation on its own, and the production of excess blood plasma increases.

On the leg

Damage to the skin on the leg with the release of fluid occurs as a result of injuries, varicose veins or erysipelas, thrombosis, thrombophlebitis, diabetes mellitus.

The main goal of treatment is to create a systematic outflow of fluid. In case of accumulation purulent fluid inflammation spreads to nearby tissues.

In a hospital setting:

• treatment with antibacterial solutions (Dioxidin);
• for painful symptoms, painkillers are used (lidocaine spray, Xylocaine);
• To cleanse necrotic masses, powdered medicine Trypsin is used (a napkin is moistened in the medicine and applied directly to the affected area).

For shallow, weeping injuries on the legs, therapy is carried out at home. Salicylic or Ichthyol ointment is used.

Streptocide (tablets or powder) is used as an antiseptic. Before applying ointment compositions, the skin is treated with hydrogen peroxide.

Reasons for long delays

Weeping wounds that do not heal for a long time indicate the presence of pathology in the body and the addition of an infection.

Why skin abrasions do not heal:

1. Improper treatment of wound surfaces.
2. Diabetes mellitus. When the disease occurs, the limbs swell, blood circulation is impaired, and the activity of the immune system decreases. Dermal cells lack nutrition.
3. Age criteria. The immune system of older people is weakened. Therefore, the body is not able to fight inflammatory processes on its own, and regeneration slows down.
4. Lack of vitamins in the body. The wound does not heal with vitamin deficiency.

Cell regeneration slows down in people diagnosed with cancer, obesity, exhaustion, HIV.

Liquid oozing

The fluid that oozes from the wound is lymph. Its discharge is normal, natural phenomenon. It removes salt impurities, proteins, toxins, and water from tissue structures. Then it returns them to the circulatory system.

If the ichor is not released abundantly, there is no cause for concern. It is recommended to carry out the prescribed course of treatment.

The abundant flow of lymph from the wound surface is affected by:

• Poor quality treatment of the dermis;
• polluted environment;
• alcoholic drinks and nicotine;
• the presence of vascular and dermatological pathologies;
• excessive physical activity.

Process and dry

Any wound, regardless of location or origin, needs treatment.

• provide free access to the damaged area of ​​skin;
• touching the wound surface is permitted with gloves or tweezers;
• should be cleaned of contamination, rinse the damaged area with clean water;
• apply an antiseptic (initially treat with hydrogen peroxide, then brilliant green or iodine);
• cover the area with sterile gauze;
• stop the bleeding (if any).

Prohibited independent use medicines (gels, ointments, powders). The doctor examines the injury. Then a course of treatment is prescribed.

Burn

Any weeping wound, including a burn, is accompanied by bacterial infection. Humidity appears when immune system unable to cope with inflammation.

Treatment of weeping burns consists of systematic dressings, taking antiseptics and wound healing drugs. .

They are the ones who are able to ensure the outflow of fluid, tissue regeneration, and prevent the development of inflammatory processes

Step-by-step therapy for weeping injuries:

1. Processing antiseptic. These include Miramistin, Furacilin.
2. An hygroscopic dressing is used, which is changed every 2-3 hours.
3. When changing the dressing material, the damage is treated with an antiseptic. Then it is superimposed antibacterial drug Betadine. It can dry out the skin.
4. If pain is present, painkillers (tablets, aerosols, injections) are used.
5. For purulent injuries, ointment compositions Levomekol and Levosin are applied under the bandage.

After eliminating inflammation, it is recommended to use a burn patch. At the stage of recovery and scarring of the skin, Solcoseryl ointment is applied under the bandage, at least 4–6 times a day. Vitamins A, C, and E are taken in combination with the main therapy.

Folk recipes

Together with pharmaceuticals used to treat weeping injuries traditional medicine that are prepared at home:

1. Potato juice. Fresh potatoes are grated using a grater. The juice is squeezed out. A sterile napkin is moistened in the liquid, applied to the wound, and bandaged. The compress is applied before bedtime. The medicine draws out bacterial exudate.
2. Onions. Vegetable (1 large head) is grated. The gruel is laid out on a gauze cloth and applied to the damage (20 - 30 minutes), 4 -5 times a day. The drug reduces swelling and cleans the surface.
3. St. John's wort oil. The leaf and inflorescence (100 grams) of St. John's wort are finely chopped, and the golden mustache (50 grams) is added. The mixture is poured olive oil(250 ml). The container with the medicine is covered with paper and infused for 15–20 days in a warm place. The product is filtered and stored in the refrigerator. The napkin is wetted in medicine and applied to the wound 2 - 3 times a day.

Folk remedies are used after consultation with your doctor.

Open purulent wound

Therapy is carried out:

• antibacterial drugs;
• detoxification measures (toxins are removed from the body);
• medications that stimulate the immune system.

The goal of treatment when a purulent focus forms is to clean the open wound, reduce inflammation, and eliminate pathogenic bacteria.


For accelerated process skin regeneration assigned:

• Vishnevsky ointment;
• Synthomycin liniment;
• Tetracycline ointment composition.

Medicines are applied to a bandage. Use once a day, preferably before bedtime. To eliminate pus from large wounds, drainage is installed.

What is prohibited

For effective treatment wet abrasions, it is recommended to observe certain rules processing. If the wound does not heal for a long time, you need to consult a surgeon.

What is prohibited to do in case of weeping injuries:

1. Interrupt treatment. Dressing is carried out every day, in some cases 2 - 3 times a day.
2. Treat injuries with contaminated materials. Bandages, gauze dressings, mesh for fastening must be sterile.
3. Do not perform dressing with clean hands. If there are no sterile gloves, the palms of the hands are washed with soap and treated with an antiseptic.
4. Remove dried bandages. They are soaked with water.
5. Use expired medications, violate the instructions.

If during therapy the amount of fluid discharge increases, the wound grows, throbbing pain, swelling or redness appears, all parts of the body ache, it is recommended that the injury be examined by an experienced surgeon.

Complications

With improper therapy, weeping ulcers and wounds spread, affecting large areas of the skin and nearby tissues.

Treatment and healing of weeping wounds

5 (100%) 6 votes

Wounds are damage to the skin and underlying tissues varying degrees depth and vastness. There is no way to guarantee protection from this type of injury; you can only influence the healing process. To help the recovery process go as quickly as possible, they help special drugs, enhancing tissue regeneration, as well as folk remedies and proper nutrition.

Stages of wound healing

Wounds of any origin go through three successive stages during the healing process:

• Inflammation. The duration of this phase is about 5 days from the moment of injury. It is characterized by swelling and increased temperature of adjacent tissues, resulting from vasodilation and infiltration, and pain. At this time, leukocytes migrate to the wound, which clean it of dead tissue. The defect begins to be filled with special granulation tissue with many capillaries,
• Regeneration. At this stage, lasting 1-2 weeks, special fibroblast cells actively synthesize elastin and collagen for healing. The swelling subsides, pain and temperature decrease. Granulation tissue fills the wound, and a layer of epithelium forms on top - the damage heals.
• Scar formation. This phase lasts at least six months, during which the primary scar thickens and reorganizes. This happens due to the transformation of granules into connective tissue.

If the wound heals quickly and without complications, we're talking about about healing by primary intention.

When an infection occurs at the stage of inflammation and suppuration occurs, the wound heals by a longer secondary intention.

Factors influencing healing

The duration of each healing phase may differ significantly from the indicated time frames. In this case, the difference can be both decreasing and increasing. It depends on many factors.

Accelerating healing

The following factors contribute to rapid recovery:

• Age. The younger the patient, the faster tissue healing occurs. In childhood and youth, the ability of tissues to regenerate is maximum.
• No wound infection. Any inflammatory process increases regeneration time.
• Proper nutrition ensures strong immunity and the availability of all necessary nutrients for the recovery process.
• High quality and timely first aid. If the wound was immediately washed and treated with an antiseptic, the likelihood of it suppurating is minimal.
• Careful care. Regular dressings and maintenance drug therapy promote healing.

In addition, damage that is not too extensive and deep heals faster.

Slow healing

Factors such as:

• Old age. Over the years, metabolism and, accordingly, the regenerative capabilities of the body slow down.
• Availability chronic inflammatory diseases, diabetes mellitus, immunodeficiency conditions (HIV, AIDS and others), skin diseases.
• Wound infection pathogenic bacteria, which leads to suppuration and significantly delays the healing process.
• Incorrect first aid and improper wound care subsequently contributes to infection.

Pay attention! Typically deep and extensive wounds heal longer, even if the victim was provided with high-quality medical care and all medical prescriptions were followed.

How to speed up wound healing

The course and duration of treatment has a great influence.

Correct Actions– washing, disinfection and sterile dressing – prevent complications and promote quick recovery. The faster you treat the wound, the more thoroughly you clean it, the less chance there is of avoiding infection.

When applying sutures, to speed up healing, it is necessary to treat the wound with brilliant green, iodine, or simply alcohol.

Photo 2. Iodine can only be applied to abrasions and shallow cuts, as well as to the edge of the wound. Source: Flickr (kenga86)

Should bandage the wound 1-2 times a day. It is important to maintain sterility and clean instruments with alcohol, wash your hands thoroughly and dry your hands, using only a clean towel and sterile dressing material.

Pay attention! Before each dressing, the wound must be cleaned. It is recommended to wash it with antiseptics - hydrogen peroxide, Miramistin, Chlorhexidine.

The choice of healing agents depends on the type of damage. Wet and dry wounds are treated with various means.

Do not use on wet wounds, since the film that forms on its surface in this case stops the outflow of fluid, and healing will be delayed. Treat the wound with means for accelerated healing It is possible only if there is no inflammation.

As soon as the wound begins to dry out, you need to change the product. It is better if another form of the same drug is used, for example, the gel is replaced with an ointment. In this case, the use of the bandage can already be canceled, or it can be applied a couple of hours after treating the wound.

Medicines

Used for treatment pharmaceutical drugs For local application in various dosage forms:

• Methyluracil ointment. An anti-inflammatory drug that increases local immunity and stimulates regeneration. It is used at the stages of inflammation and recovery for wounds of any type, including purulent ones (in combination with antibiotics). Apply under a bandage thin layer twice a day, course of treatment - from 2 to 16 weeks.
• Dexpanthenol and other products based on it in the form of gels, sprays and creams. They have wound healing properties. Used from the moment of injury (after its disinfection). Aerosols can be applied without a bandage to dry wounds; for wet wounds, gels and creams are used (under a bandage). Frequency and duration of use – at least 2 times a day until complete healing.
• Solcoseryl or Actovegin. These ointments promote collagen production, accelerate cellular metabolism and oxygen exchange in tissues. Intended for dry wounds, applied 1-2 times daily (with or without a bandage) until an elastic scar is formed.
• Curiosin. Drops and cream contain a zinc compound with hyaluronic acid, which provide an antibacterial effect and activate skin cell division. Suitable for any wounds, applied twice a day: the gel is applied without a bandage, lotions are made with the solution. The duration of treatment is not limited (until healing).
• Contractubex. The ointment should be used during the regeneration stage, as it inhibits cell development connective tissue from which a rough scar is formed. Not suitable for purulent and wet wounds. The course of treatment is 4 weeks, during which a thin layer of ointment is applied 2-3 times daily (under a bandage).

Folk remedies

Used as additional therapy.

To speed up regeneration you can do lotions made from decoctions of calendula, chamomile or oak bark.

Usually take a tablespoon of raw material in a glass of water, boil for 15 minutes and use after cooling and straining several times a day.

Apply compresses from juice or cut leaf aloe.

Propolis in the form of a homemade alcohol tincture(1 part of propolis is infused in 10 parts of alcohol for 10 days) to lubricate wounds and promote healing.

Mumiyo: 0.2 g of the substance is dissolved in a glass of water, the resulting solution is drunk daily at night, and is also used for washing wounds and compresses.

Nutrition to support the body

An organism that receives from food essential microelements and vitamins, is able to recover faster.

In order for wounds to heal faster, the menu must have a lot vitamins(vegetables and fruits in fresh) and protein foods. Namely lean meat, fish and poultry, dairy products. Protein necessary for the synthesis of elastin and collagen fibers, due to which healing occurs.

Vitamin complexes

Maintenance therapy in the form of vitamins is mandatory at all stages of wound healing.

You can take regular multivitamin complexes or vitamin preparations With increased content necessary components. Particularly important antioxidants C, E, and also B vitamins. They increase the body's ability to heal itself.

During the wound process, three main periods are distinguished.

First period characterized by the melting of necrotic tissues, their sequestration during external environment and cleansing of wound detritus. The duration of this period is determined by the volume of damage, the degree of infection of the wound, the characteristics of the body and averages 3-4 days.

The initial reaction of the body to injury is a spasm of blood vessels in the area of ​​the wound defect, followed by their paralytic expansion, increased permeability of the vascular wall and rapidly increasing edema, which is called traumatic. Acidosis that develops as a result of metabolic disorders and changes in the state of colloids contribute to the progression of traumatic edema.

Vasodilation is accompanied by a violation of their permeability and is associated with the release of predominantly histamine and partially serotonin. In response to damage and exposure to microbes, leukocytes migrate from the blood vessels into the wound in large numbers. This applies mainly to neutrophils capable of phagocytosis. Along with other enzymes, they secrete leukoprotease, which is used to destroy cell debris and phagocytosed microorganisms. In addition, a large number of histiocytes, macrophages, lymphocytes and plasma cells accumulate in the tissues. Along with this, normal plasma contains oxins that facilitate phagocytosis, agglutinins that help glue and destroy bacteria, and a factor that stimulates an increase in the release of leukocytes from the blood.

Regarding the mechanism of lysis of non-viable tissue and wound cleansing, the role of the microbial factor in this process should also be emphasized.

The inflammatory reaction can grow rapidly and within the first day a so-called leukocyte wall is formed, which develops at the border of viable and dead tissue, being a demarcation zone. All these processes lead to the preparation of damaged tissues for the healing process. In particular, fibrin deposited in the wound undergoes local fibrinolysis of plasmin, which appears due to activation of plasmin by kinase. This leads to the unblocking of lymphatic gaps and vessels, and inflammatory swelling disappears. Starting from the third day, along with the previously predominant catabolic processes, anabolic ones come into play, the synthesis of the main substance and collagen fibers by fibroblasts increases and capillaries are formed.

An increase in blood supply to the area of ​​injury causes a decrease in local acidosis.

Second period - the period of regeneration, fibroplasia, begins 3-4 days after injury. The shorter it is, the less cells and tissue were injured when injured. A distinctive feature of this period is the development of granulation tissue, which gradually fills the wound defect. At the same time, the number of leukocytes sharply decreases. Macrophages continue to play an important role, but capillary endothelium and fibroblasts become of great importance during the regeneration period.

Granulation tissue begins to form in the form of separate foci at the bottom of the wound. These lesions are characterized by intense new formation of capillaries as a result of the secretion of biologically active substances by mast cells. Granulation tissue, due to its richness in blood vessels and cells, looks juicy, bleeds easily and has a pinkish-red color. Based on the appearance of granulations, one can judge the state of wound healing. Typically, healthy granulations have a granular appearance, a bright red color, and their surface is moist and shiny. Pathological granulations are characterized by a smoother surface; they look pale, flaccid, glassy-edematous, and covered with a layer of fibrin. Their cyanotic tint indicates a deterioration in venous outflow, which determines this color. In sepsis, granulations are dark red and appear dry.

The causes of poor granulation formation can be both general and local. After their elimination, the appearance of granulations quickly changes and the process of filling the wound with scar tissue is restored.

Thanks to the large number of fibroblasts that form collagen fibers and interstitial matter, the wound cavity is filled and at the same time the epithelium begins to creep from the edges due to the migration of cells to the newly formed granulations. The second fibroplastic period lasts from 2 to 4 weeks, depending on the location and size of the wound.

Third period- the period of scar reorganization and epithelization begins without any transition on the 12-30th day from the moment of injury and is characterized by a progressive decrease in the number of vessels, they become empty. the number of macrophages and mast cells of fibroblasts decreases. In parallel with the maturation of granulation tissue, epithelization of the wound occurs. Excessively formed scar tissue rich in collagen fibers undergoes restructuring. These processes are characteristic of all tissues; they differ only in time. For example, skin heals much faster than fascia and tendons, which take 3-6 months to heal. At the same time, restoration of the skin begins after 24-48 hours and is determined by the migration, division and differentiation of epithelial cells. During primary wound healing, epithelization occurs on days 4-6.

Phases of wound healing (according to M.I. Kuzin, 1977) The first phase is inflammation. The initial period of this phase in the wound is characterized by vasodilation, exudation, hydration and migration of leukocytes. Then phagocytosis and autolysis increase, which helps cleanse the wound of necrotic tissue. The duration of this phase is 1-5 days. In this phase, the wound experiences pain, increased temperature, infiltration and swelling.

The second phase is regeneration. During this period, recovery processes predominate in the wound. Tissue exudation decreases. The synthesis of collagen and elastic fibers increases, which fill the tissue defect. The wound is cleaned and granulation tissue appears in it. Signs of local inflammation are reduced - pain, temperature, infiltration. The duration of this phase is about a week (from 6 to 14 days from the onset of injury).

The third phase is the formation and reorganization of the scar. There is no clear boundary between the second and third phases. During this period, the scar thickens and contracts. The duration of this phase is up to 6 months.

Each anatomical region has its own characteristics of wounds. This determines the tactics of performing surgical operations, pain relief, etc.

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, subsequently, the tissues that form the scar continue to change, although to a minimal extent.

From a practical point of view, in this biological process we can conditionally distinguish several periods, during which two main indicators, the most significant for both the surgeon and the patient, change significantly:
1) strength and external characteristics skin scar;
2) the possibility of lengthening and restructuring deep scars under the influence of tissue movement (movement of muscles, tendons, etc.).

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

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

A distinctive feature of this stage of the wound process is the fact that the edges of the wound are connected to each other by very fragile granulation tissue, and not by a scar. Therefore, after removing the sutures on the 7-10th day, the edges of the wound can easily separate under the influence of even a small load. To obtain a minimal skin scar in the future, the edges of the wound must be held in place with sutures for significantly more long period time.

It is also very important that during this stage the sliding structures involved in the healing process of the wound (tendons, muscles, ligaments) remain mobile, however, their uncontrolled movements can intensify the process of postoperative inflammation and thereby worsen the quality of future deep scars.

Stage 2 - active fibrillogenesis and the formation of a fragile scar (10 - 30 days after surgery). During this period, active formation of collagen and elastic fibers begins in the young granulation tissue located between the edges of the wound, the number of which rapidly increases. This tissue 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 this stage is completed, the edges of the wound are connected by a scar, which still remains extensible and noticeable to others.

During this period, deep scars are still capable of maximum restructuring when moving sliding structures involved in reparative processes. Therefore, it was at this time that surgeons began to use special techniques, aimed at restoring the mobility of tendons, muscles and joints. From this point of view, this period is key in restoring the function of tendons that have a significant amplitude of movement and are located in canals with dense walls (flexor and extensor tendons of the fingers in the corresponding zones, capsule and ligaments of joints).

Finally, this phase is different in that the tissues involved in the reparative processes still remain sensitive to any additional injury, including that caused by uncontrolled movements.

Stage 3 - formation of a durable scar (30-90 days). This stage lasts for the 2nd and 3rd months after the injury (surgery). During this period, the number of fibrous structures in the rumen increases significantly, and their bundles acquire a certain orientation in accordance with the dominant direction of load on the rumen. Accordingly, the number of cellular elements and vessels in the scar tissue decreases significantly, which is manifested by an important clinical trend - the transformation of a bright and noticeable scar into a less bright and less noticeable one. It should be noted that under unfavorable initial conditions, it is at this stage that the hypertrophic growth of scar tissue begins.

At the 3rd stage, internal scars also become significantly stronger, which gradually lose their ability to restructure and lengthen. Note that the formation of deep scars in conditions of complete 3-month immobilization of the limbs often does not leave patients any chance of restoring the function of the stitched tendons, especially if they have a significant amplitude of movement and are surrounded by dense tissues (for example, finger flexor tendons). The joint capsule also loses its extensibility, especially after damage to its elements and the surrounding ligamentous apparatus. Under these conditions effective rehabilitation involves performing appropriate surgical operations.

On the other hand, upon completion of stage 3, almost full weight bearing on the sutured tendons and ligaments may be allowed.

It is important that at the 3rd stage of wound healing, the intensity of the processes of reparative tissue regeneration changes significantly: from relatively high to very low. We also note that during this stage, tensile forces exert a significant influence on the characteristics of the resulting scar. Thus, with longitudinal tightening of the scar, additional education collagen and elastic fibers in this area are constantly acting force, and to a greater extent, the stronger the stretching. If in patients the processes of fibrillogenesis are initially enhanced, then the result of early exposure to the scar in the phase of active fibrillogenesis is the formation of hypertrophic and even keloid scars.

Stage 4 - final transformation of the scar (4-12th month). This stage is characterized by further and slower maturation of scar tissue with the almost complete disappearance of small blood vessels with further systematization of fibrous structures in accordance with the forces acting on a given 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 unfavorable conditions, the formation of hypertrophic and keloid scars is completed, which sometimes significantly limit tissue function and worsen appearance patient. It is important to note that in most cases, it is in the middle of the 4th stage that skin scars can be finally assessed and the possibility of their correction can be determined. During this period, the formation of internal scars also ends, and they are only slightly affected by the load.

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

A wound is a violation of the anatomical integrity of tissues, accompanied by the formation of a wound space (cavity) or wound surface. Several main types of wounds can be distinguished: traumatic, surgical, trophic, thermal, etc. (Diagram 12.2.1).

Scheme 12.2.1. Main types of wounds and options for their healing.

Traumatic wounds make up the bulk of wounds and can have the most different character(from cut to gunshot). These wounds can heal on their own or after surgical treatment, when the wound is transferred from traumatic to surgical.

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

Trophic wounds occur when venous outflow and/or arterial inflow are disrupted, as well as from certain endocrine and other disorders. Their main feature is their gradual occurrence as a result of the slow death of tissues due to disruption of their nutrition.

Thermal injuries (burns and frostbite) have specific features, since the wound surface can be formed simultaneously (flame burn) or gradually (with frostbite), in the process of forming a line of demarcation and rejection of dead tissue.

Other wounds. Sometimes rarer types of wounds occur. These include wounds formed after self-opening of ulcers, deep abrasions, scratching, etc.

Types of wound healing

Highest value For clinical practice have traumatic and surgical wounds. Their healing occurs in two ways: in different ways: primary intention (primary healing) and secondary intention (secondary healing).

Wound healing by primary intention occurs in cases where the edges of the wound are no more than 5 mm apart from each other. Then, due to swelling and contraction of the fibrin clot, gluing of the wound edges may occur. Most often this situation occurs when the edges of the wound are brought together by surgical sutures.

Second the most important condition Primary wound healing is the absence of suppuration. This occurs if the edges of the wound are sufficiently close and viable, the intrawound hematoma is small, and bacterial contamination of the wound surface is insignificant.

Primary wound healing has three practical implications.

Firstly, it occurs as quickly as possible short term, which usually means minimum terms inpatient treatment the patient, his more quick rehabilitation and return to work.

Secondly, the absence of suppuration when performing reconstructive operations creates favorable conditions in the wound for the subsequent functioning of structures restored by surgeons (in the area of ​​the tendon suture, suture of blood vessels and nerves, osteosynthesis area, etc.).

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

Wound healing by secondary intention is characterized by a much slower course of the wound process, when gluing of the wound edges cannot occur due to its large sizes. Key Features This type of healing involves suppuration of the wound and its subsequent cleansing, which ultimately leads to gradual epithelization of the wound in the direction from the periphery to the center. Note that peripheral epithelization is quickly depleted and can lead to spontaneous wound healing only if the size of the wound is not too large (up to 2 cm in diameter). In other cases, the wound granulates for a long time and becomes non-healing.

Wound healing by secondary intention is unfavorable in all respects.

Firstly, this process lasts several weeks and even months. Treatment of the patient requires not only constant dressings, but also additional operations (secondary sutures, skin grafting, etc.). This increases the length of the patient's hospital stay and economic costs.

Secondly, when the wound suppurates, the outcomes of reconstructive operations (including those performed with open injuries). Thus, suppuration of a wound when a tendon suture is applied in best case scenario leads to blockage of the tendon with more pronounced scars, and in the worst case, to tendon necrosis.

The development of rough scars can block the regeneration of axons in the area of ​​suture or nerve repair, and suppuration in the area of ​​osteosynthesis usually ends in osteomyelitis. This creates new, often very complex problems, surgical solution which may require several months and sometimes years, and the effectiveness of the measures taken is often low. Finally, after the wound suppurates, a wide scar with gross violation skin surface relief. There are often cases when wound suppuration leads to disability and even creates real threat patient's life.

V.I. Arkhangelsky, V.F. Kirillov