Periods and phases of healing of purulent wounds. Wound healing after surgery, medications, nutrition rules

A burn is damage skin, which occurs when high temperatures, ultraviolet radiation, when exposed to radiation, hot liquids, steam, fire, explosive liquids and gases, chemicals or electricity.

A second-degree sunburn also takes about two weeks to heal. It is important not to cause an infection with the help of a cream, which cannot be used for a second-degree burn. The wound healing process can be accelerated by using disinfectant and eating healthy food, which will help tissues recover faster.

Electrical burns may not damage the skin, but they can cause damage to internal organs.

If the wound needs to be washed, then you can use hydrogen peroxide, furatsilin solution and others aqueous solutions antiseptics. When found inflamed area around the damage, you should immediately seek help from a doctor.

Pharmacy products

From pharmaceuticals For wound healing, preparations with provitamins or vitamins are most often used: for example, or retinol - provitamin B5. These drugs are available in the form of lotions, creams or ointments. They are perfect
Suitable for treating dry damage.

Products containing methyluracil have excellent anti-inflammatory effects. At the same time similar drugs actively stimulate cellular immunity. When using them, wounds heal quite quickly. These products are also suitable for treating dry wounds.

One of the universal pharmaceutical drugs is considered to be "Eplan". It heals wounds and has pronounced regenerative properties. "Eplan" is suitable for treatment radiation injuries, ulcers, burns, dermatitis, etc. This tool actively destroys microbes, clearing the wound of infections.

Folk remedies

Before using traditional medicine, you should consult your doctor.

The wound process is a set of sequential changes occurring in the wound and the associated reactions of the whole organism.

Conventionally, the wound process can be divided into general reactions of the body and direct wound healing.

General reactions

The complex of biological reactions of the body in response to damage during the wound process can be considered as two successive stages.

First phase

Within 1-4 days from the moment of injury, excitation of the sympathetic nervous system is noted, the release of adrenal medulla hormones, insulin, ACTH and glucocorticoids into the blood. As a result, vital processes intensify: body temperature and basal metabolism increase, body weight decreases, the breakdown of proteins, fats and glycogen increases, the permeability of cell membranes decreases, protein synthesis is suppressed, etc. The significance of these reactions is to prepare the whole organism for life in conditions of alteration.

In the first period, a moderate increase in body temperature, weakness, and decreased performance are observed.

Blood tests reveal an increase in the number of leukocytes, sometimes a slight shift leukocyte formula to the left, protein may appear in urine tests. With heavy blood loss, a decrease in the number of red blood cells, hemoglobin, and hematocrit occurs.

Second phase

Starting from 4-5 days, the character general reactions is caused by the predominant influence of the parasympathetic nervous system.

Somatotropic hormone, aldosterone, and acetylcholine become of primary importance. In this phase, body weight increases, protein metabolism normalizes, and the body’s reparative capabilities are mobilized. In an uncomplicated course, by the 4-5th day the symptoms of inflammation and intoxication are stopped, the pain subsides, the fever stops, and the symptoms return to normal. laboratory parameters blood and urine.

Wound healing

Wound healing is the process of repair of damaged tissues with restoration of their integrity and functions.

To close the defect formed due to damage, three main processes occur in the wound:

Formation of collagen by fibroblasts. During wound healing, fibroblasts are activated by macrophages. They proliferate and migrate to the site of injury, binding to fibrillar structures through fibronectin. At the same time, fibroblasts intensively synthesize extracellular matrix substances, including collagens. Collagens ensure the elimination of tissue defects and the strength of the formed scar.

Epithelization of the wound occurs as epithelial cells migrate from the edges of the wound to its surface. Completed epithelization of the wound defect creates a barrier to microorganisms.

The effect of tissue contraction, to a certain extent due to the contraction of myofibroblasts, ensures the reduction of wound surfaces and wound closure.

These processes occur in a certain sequence, which is determined by the phases of wound healing (phases of the wound process).

Phases of wound healing according to M.I. Kuzina (1977):

Phase I - inflammation phase (days 1-5);

Phase II - regeneration phase (6-14 days);

Phase III is the phase of scar formation and reorganization (from the 15th day from the moment of injury).

Inflammatory phase

Phase I of wound healing - the inflammation phase, occurs in the first 5 days and combines two successive periods: vascular changes and cleansing of the wound from necrotic tissue. Vascular reactions and extravascular changes occurring in the wound are closely related.

Period vascular changes. In response to injury, a number of disorders affecting the microvasculature develop. In addition to the direct destruction of blood vessels and lymphatic vessels, which contributes to the disruption of the outflow of blood and lymph, a short-term spasm occurs, and then a persistent paretic dilatation of microvessels. Participation in inflammatory reaction biogenic amines (bradykinin, histamine, serotonin), as well as the complement system, leads to persistent vasodilation and increased permeability of the vascular wall.

Reduced perfusion leads to deterioration of tissue oxygenation in the wound area. Acidosis develops, carbohydrate and protein metabolism. During the breakdown of cellular proteins (proteolysis), K+ and H+ ions are released from the destroyed cells, increasing osmotic pressure in tissues, water retention occurs, tissue edema (hydration) develops, which is the main external manifestation of inflammation.

Prostaglandins, metabolites of arachidonic acid released from destroyed cell membranes, take an active part in this phase.

The period of cleansing the wound from necrotic tissue. The most significant role in cleansing the wound is played by shaped elements blood and enzymes. From the first day, neutrophils appear in the tissues and exudate surrounding the wound, and on the 2-3rd day - lymphocytes and macrophages.

Regeneration phase

Phase II of wound healing - the regeneration phase, occurs in the period from 6 to 14 days from the moment of injury.

Two main processes occur in the wound: collagenization and intensive growth of blood and lymphatic vessels. The number of neutrophils decreases and fibroblasts - cells migrate to the wound area connective tissue, having the ability to synthesize and secrete macromolecules of the extracellular matrix. Important role fibroblasts during wound healing - synthesis of connective tissue components and construction of collagen and elastic fibers. The bulk of collagen is formed precisely in the regeneration phase.

At the same time, recanalization and growth of blood and lymphatic vessels begin in the wound area, which improves tissue perfusion and nutrition of fibroblasts that need oxygen. Concentrated around the capillaries mast cells, which promote the proliferation of capillaries.

Biochemical processes in this phase are characterized by a decrease in acidity, an increase in the concentration of Ca2+ ions and a decrease in the concentration of K+ ions, and a decrease in metabolism.

Phase III of wound healing - the formation and reorganization of a scar, begins approximately on the 15th day and can last up to 6 months.

In this phase, the synthetic activity of fibroblasts and other cells decreases and the main processes are reduced to strengthening the resulting scar. The amount of collagen practically does not increase. Its restructuring and the formation of cross-links between collagen fibers occur, due to which the strength of the scar increases.

There is no clear boundary between the regeneration phase and scarring. The maturation of connective tissue begins in parallel with epithelization of the wound.

Factors influencing wound healing:

Age of the patient;

Nutritional status and body weight;

Presence of secondary wound infection;

Immune status of the body;

The state of blood circulation in the affected area and the body as a whole;

Chronic concomitant diseases(diseases of the cardiovascular and respiratory systems, diabetes mellitus, malignant tumors, etc.).

Classic types of healing

With a possible variety of options for the course of the wound process, depending on the nature of the wound, the degree of development of the microflora, and the characteristics of the immune response, they can always be reduced to three classical types of healing:

Healing by primary intention;

Healing by secondary intention;

Healing under the scab.

Healing by primary intention is the most economical and functionally beneficial; it occurs in a shorter time with the formation of a thin, relatively durable scar.

Surgical wounds heal by primary intention when the edges of the wound come into contact with each other (connected with sutures). The amount of necrotic tissue in the wound is small, and inflammation is insignificant.

Only wounds in which there is no infectious process: aseptic surgical or accidental wounds with minor infection if microorganisms die within the first hours after injury.

Thus, in order for the wound to heal by primary intention, the following conditions must be met:

No infection in the wound;

Tight contact of wound edges;

Absence of hematomas in the wound, foreign bodies and necrotic tissues;

Satisfactory general condition of the patient (absence of general unfavorable factors).

Healing by primary intention occurs in the shortest possible time, practically does not lead to the development of complications and causes minor functional changes. This is the best type of wound healing, which you should always strive for and create the necessary conditions for it.

Healing by secondary intention - healing through suppuration, through development granulation tissue. In this case, healing occurs after a pronounced inflammatory process, as a result of which the wound is cleared of necrosis.

Conditions for healing by secondary intention:

Significant microbial contamination of the wound;

Significantly sized skin defect;

The presence of foreign bodies, hematomas and necrotic tissue in the wound;

Unfavorable condition of the patient's body.

When healing by secondary intention, three phases are also present, but they have some differences.

Features of the inflammation phase

In the first phase, inflammation is much more pronounced and wound cleansing takes much longer. At the border of penetration of microorganisms, a pronounced leukocyte shaft is formed. It helps to separate infected tissues from healthy ones; demarcation, lysis, sequestration and rejection of non-viable tissues occur. The wound is gradually clearing. As areas of necrosis melt and decay products are absorbed, intoxication of the body increases. At the end of the first phase, after lysis and rejection of necrotic tissue, a wound cavity is formed and the second phase begins - the regeneration phase, the peculiarity of which is the emergence and development of granulation tissue.

Granulation tissue is a special type of connective tissue formed during wound healing by secondary intention, promoting rapid closure of the wound defect. Normally, without damage, there is no granulation tissue in the body.

Healing under a scab - Healing of a wound under a scab occurs with minor superficial injuries such as abrasions, damage to the epidermis, abrasions, burns, etc.

The healing process begins with the coagulation of spilled blood, lymph and tissue fluid on the surface of the injury, which dry out to form a scab.

Stroop performs protective function, is a kind of “biological dressing”. Rapid regeneration of the epidermis occurs under the scab, and the scab is rejected. The whole process usually takes 3-7 days. In healing under a scab, the biological characteristics of the epithelium are mainly manifested - its ability to line living tissue, delimiting it from external environment.

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 the patient’s appearance. 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 there are more rare species wound These include wounds formed after self-opening of ulcers, deep abrasions, scratching, etc.

Types of wound healing

Greatest value for clinical practice have traumatic and surgical wounds. Their healing occurs in two fundamentally 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 with surgical sutures.

The second most important condition for 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 in the shortest possible time, which, as a rule, 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

In response to injury to body tissue, it starts extremely complex mechanism restoration of the previous functioning and integrity of organ systems. This process is called tissue regeneration. There are three stages in the development of this mechanism. Their duration is individual for each person and directly depends on his age and the state of the immune system.

The prognosis for the healing time of a particular injury is also made based on observations of the nature of the injury and depends on the degree of its severity. All types of wounds are divided into two types according to the depth of damage:

Simple – the integrity of the skin, adipose tissue, and the structure of adjacent muscles is compromised.
Complex wounds are characterized by damage internal organs, large veins and arteries, bone fractures.

The stages of regeneration are the same for any damage, regardless of its origin and type.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

All human organ systems have the ability to restore structure. However, their regeneration rates vary. In case of damage, the skin is restored especially quickly. Reparative changes in other systems take much longer.

Interesting fact! Until recently, scientists were sure that nerve endings did not have the ability to recover. But modern research proved that the central nervous system forms new neurons, albeit extremely slowly.

The following phases of reparative regeneration of damaged tissues are distinguished:

Inflammatory stage;
Granulation stage;
Stage of scar formation;

Each of these phases has pronounced external manifestations, gradually replacing each other as the wound heals.

Features of the inflammation stage

Immediately after tissue integrity is damaged, a complex enzymatic mechanism, leading to blood clotting and stopping bleeding. There are two stages to this process:

Primary hemostasis characterized by a sharp narrowing of blood vessels in the damaged area and mechanical clogging of the torn capillary walls by platelet aggregates, which form a kind of plug. The average time for this phase is 3 minutes.
Secondary hemostasis occurs with the participation of the fibrin protein, which forms blood clots and thickens the blood. As a result of its formation, the blood will change its consistency, becoming cheesy and losing its fluidity. The process of formation of a fibrin clot takes 10-12 minutes.

Depending on the depth of the damage and the nature of the bleeding, I put stitches on the wound or use a bandage. If the injured area has not been infected with pathogenic microflora, after the bleeding stops, gradual tissue regeneration begins.

External manifestations of the inflammation stage:

Swelling. It occurs due to increased release of plasma from destroyed cells into the intercellular space.
Local temperature increase. Tissue injury leads to a sharp disruption of blood circulation, which leads to a change in temperature balance.
Redness of the damaged area. This phenomenon is also explained by changes in microcirculation and an increase in the permeability of capillary walls.

Typically, the inflammation phase lasts for 5-7 days.

All applied sutures are removed after its completion, if missing purulent discharge and there are clear signs of healing of the injured area. Gradually, the formation of new tissue begins, and the restoration process flows into the granulation stage.

Characteristics of the granulation stage

The inflammatory reaction characteristic of the damaged area is replaced by processes of wound cleansing and exfoliation of dead cells. At the same time, granulation tissue is formed. Its formation begins at the periphery of the wound, and only then the neoplasm reaches the center of the injured area.

In young tissue, restoration processes are actively underway, primarily the growth of new capillaries. They reach the wound surface and then, forming loops, return deep into the tissue. The damaged surface becomes granular and bright red. Due to its appearance tissue is called granulation tissue.

The appearance of the granulation tissue may vary depending on the location of the injury. On the skin and mucous membranes, it looks like a soft-grained, red area, the surface of which is often covered with plaque. In the thickness of the internal organs, granulation tissue is easily recognizable by its rich color and larger structure.

The newly formed tissue is very delicate; if you touch it carelessly, you can easily cause bleeding due to large quantity forming capillaries.

Interesting! There are no nerve endings in the thickness of the granulation formation, so touching it does not cause pain.

The granulation tissue lining the wound consists of six distinct layers:

Leukocyte-necrotic layer. Formed from exfoliated cells. Covers the wound for a long time until the scar is completely formed.
Layer of vessels and capillaries. If wound healing is delayed, thick collagen fibers are formed in this layer, which are parallel to the surface of the damaged area.
Layer of vertical vessels. The capillaries of this layer are surrounded by amorphous tissue. It actively synthesizes fibroblasts - cells that form connective tissue fibers.
Maturation layer. The cells that form the basis of the surface layers develop in it. Here the fibroblasts formed in the deep layers take their final form.
The layer of horizontal fibroblasts increases as the wound heals. Consists of young fibroblasts and a large number of collagen fibers.
The fibrous layer is a barrier that protects the internal environment of the body from external factors. It has pronounced bactericidal properties and blocks the effects of pathogenic microorganisms.

The main role in the formation of granulation formation belongs to fibroblasts - cells involved in the synthesis of collagen. With sufficient accumulation of it, the granulation stage moves into a new phase - scar formation.

Stages of wound healing. A visual picture. Daily photo report for two weeks

Stage of scar formation

The longest phase of the wound healing process.

It takes about a year for a dense scar to form.

Initially it retains a deep red color, but then takes on the color of the skin. This is explained by a decrease in the number of blood vessels in the connective tissue after the wound granulation stage is completed.

Interesting! The density of scar tissue is very high. It makes up more than 80% of the density of healthy skin.

However, the newly formed tissue does not have the ability to stretch. Once formed on the skin in the joint area, it can interfere with the normal flexion of the limbs, leading to limited mobility of the individual.

The timing of each healing phase depends on many factors. The age of the patient has the greatest influence. Observations have shown that the stage of formation of the scar phase passes much faster in pre-pubertal children.

Infection of the wound leads to an increase in healing time. Weak immunity, diseases of patients also have a negative impact on the regeneration process.

The importance of the granulation phase for tissue repair

The granulation stage of the formation of new tissue is a complex process in which several groups of cells take part. It includes:

Plasmocytes are cells that synthesize antibodies, which, in turn, are responsible for the body’s immune response.
Histiocytes. They perform a protective function by inactivating foreign objects that enter the newly formed layer of tissue.
Fibroblasts responsible for secreting the precursor protein collagen.
Leukocytes - protect the body from any pathogenic agents.
Mast cells are one of the components of formed connective tissue.

The entire maturation cycle of granulation tissue takes 20-30 days.

It should be remembered that this is a temporary formation that will be replaced by dense scar tissue. Most of it consists of newly formed capillaries. Over time, the thin walls of the vessels are covered with new cells, which continue to divide, forming a dense layer that covers the site of damage.

Treatment of injured areas in the granulation phase

Granulation tissue has a delicate, loose structure. It can be easily damaged by carelessly touching it or carelessly changing the bandage. When treating a wound, you should be as careful as possible.

It is not allowed to wipe the surface of the damaged area with cotton pads or swabs.

It is only permissible to irrigate the wound with warm bactericidal solutions. There are several types of treatment for injured tissue:

Physiotherapeutic;
Medication;
Treatment at home;

When choosing a treatment method, it is necessary to take into account the nature of the wound, as well as the characteristics of its healing.

Physiotherapeutic method of treatment

Among the specific methods of accelerating regeneration, the following method should be highlighted: ultraviolet irradiation. When used, the surface of the damaged area is cleansed from pathogenic microflora, and regeneration processes are significantly accelerated. This method will be especially relevant for slowly forming, flaccid granulating tissue. Indications for the use of irradiation:

Wound infection;
Copious purulent discharge;
Weakened immunity and, as a result, disruption of repair mechanisms;

However, other treatment methods are also used to speed up the healing of the damage. Most often they resort to medicinal methods treatment of the wound surface.

Use of drugs at the granulation stage

Correctly selected medicine promotes faster epithelization of the wound. As a rule, for hypergranulation, doctors recommend using gel forms drugs. Whereas if the surface of the damaged area dries too quickly, ointments are used.

The main drugs used at the granulation stage:

One of the most popular drugs, prescribed at this stage, is Solcoseryl. Granulation of sutures, healing of damaged areas after burns and other injuries to the skin are accompanied by the appearance of unaesthetic scars. Solcoseryl promotes the formation of more uniform connective tissue, which looks much more natural.

Home treatment of wounds in the granulation phase

TO folk methods Treatment of injuries should only be used for minor injuries to the skin (minor cuts on the fingers, first-degree burns, mild frostbite).

Most known means St. John's wort oil has long been known to promote cell regeneration.

To prepare the oil, mix 300 ml of sunflower oil with 30-50 grams of dried St. John's wort herb. The resulting mixture is boiled in a water bath for no more than 30 minutes.

Gauze bandages are soaked in cooled St. John's wort oil and applied to the damaged area.

Options for further development of the granulation stage

If the first and second stages of wound healing have passed without complications, then gradually the damaged area is completely covered with dense scar tissue and the regeneration process is successfully completed.

However, sometimes tissue repair mechanisms fail. For example, necrosis occurs in areas adjacent to the wound.

This condition is extremely dangerous for the patient and requires immediate surgical intervention.

A necroectomy is performed - an operation to remove dead tissue.

If the wound is infected with pathogenic microflora, the healing process may take a long time. Antibiotics are used to restore normal tissue regeneration.

The granulation stage of healing of a damaged area is a complex adaptation mechanism aimed at quickly separating the internal environment of the body from unfavorable ones. external influences. It ensures the formation of new layers of tissue to replace damaged ones. Thanks to the granulation stage, the trophism of the injured area is restored and the protection of other, deeper tissues is ensured.

Our body's wound healing system. The most important stage granulation.

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 various degrees defeats. 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.

Ointments for drying

Treating with drying agents means using ointments and gels.

Products that protect the skin from infection:

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.
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.
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 pathogenic bacteria and accelerate skin regeneration:

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.
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.
Argosulfan. Therapeutic 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. When purulent fluid accumulates, 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:

Improper treatment of wound surfaces.
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.
Age criteria. The immune system of older people is weakened. Therefore, the body is not able to fight on its own inflammatory processes, regeneration slows down.
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:

Antiseptic treatment. These include Miramistin, Furacilin.
An hygroscopic dressing is used, which is changed every 2-3 hours.
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.
If pain is present, painkillers (tablets, aerosols, injections) are used.
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:

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.
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.
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 moistened with the 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 extensive 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:

Interrupt treatment. Dressing is carried out every day, in some cases 2 - 3 times a day.
Treat injuries with contaminated materials. Bandages, gauze dressings, mesh for fastening must be sterile.
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.
Remove dried bandages. They are soaked with water.
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.