lecture: surgical wound healing

Wound healing

Upper Chesapeake Medical Center

Spine Conference

9/5/14

Skin function

ProtectSensationThermoregulateEvaporateStorage and synthesizeAbsorbWater/osmosis resistance

Langer LinesCarl Langer Vienna Anatomist 1819-1887; impaled the skin of cadavers with a circular ice pick and noticed skin defect created was ellipsoid. He then connected the longitudinal axis of the defects. These lines correspond to the alignment of collagen within the dermis.

CleanClean contaminatedContaminateddirty

One year

Three months 2nd lower area

Note wide scar

Collagentensile strength is directly proportionate to amount of collagentensile strength increases with covalent cross links of organized collagen80% of strength is obtained at 6 weeks, but skin is normal at 6 monthsmost abundant protein in mammals 30% of all protein

[Greek kolla, glue + -gen.]

Inflammation/clot

Granulation

Beefy redEndothelial cell divisionNew capillariesfibroplasia

Epithelialization: keratinocytes at the margin change, cells migrate over

wound

NutritionHypoalbuminemia

Vitamin C: scurvy, wound healing arrested during fibroplasia, fibroblasts do not produce enough collagen, collagen not transported out of cells and collagen fibrils are not cross linked

Vitamin A, B6, B1 thiamine, B2 riboflavin

Chronic venous insufficiency

infection

Tissue trauma

Foreign body

Wound tension

stress

MRSA screen

Wet to dry

thanks