To establish the healing period of abrasions. Periods and phases of healing of purulent wounds Average time for healing of fractures in adults

There are several stages of tattoo healing, each of which is different. certain rules care for damaged skin. To ensure that your body design remains an effective and beautiful decoration for a long time, you should not neglect the advice of a tattoo artist. Strict adherence to his recommendations is the main guarantee that you will not need correction. What should you know to avoid tattoo deformation and maintain its longevity?

First stage

The quality of a tattoo depends half on proper care in the first days after the session. Applying a permanent pattern is a mechanical intervention in the human body, which cannot be painless and without leaving a trace. After the procedure, small microcracks remain on the body through which ichor is released. This begins the process of healing and cleansing the skin, which is launched by the lymphatic system.

At the first stage of healing, the area of the body with the tattoo swells and discharge appears in the form of a sticky liquid mixed with ink. Many people first of all think that the pattern simply spreads and washes off, but this is not so. This normal reaction body for such a procedure. Back in the salon, the tattooist treats the area of application with healing ointment and wraps it in protective film. It is not recommended to remove the film during the first 24 hours. At home, you need to take a warm (not hot!) shower, gently wash the wound with antibacterial soap and leave to dry. Under no circumstances should you rub the drawing with a washcloth or towel. After washing, apply a healing anti-inflammatory cream to the tattoo.

Second phase

On the second day of tattoo healing, the ichor disappears and the swelling goes away. Skin on at this stage shrinks, becomes dry and dehydrated. Why is this happening? The fact is that ink is perceived by the body as a foreign body. It takes time for them to take root and not be rejected. During this period, the drawing should be actively treated with healing ointments. It is recommended to avoid body contact with clothing, as friction does not promote tattoo healing. If you need to go outside, it is advisable to wrap the application area with protective or regular cling film. At home, during the second stage of healing, it is better to leave the tattoo open to allow the skin to breathe.

Third stage

Usually on the third day a crust forms on the tattoo. The skin begins to peel off, white or colored flakes appear. The fact is that the ink remains in the lower layer, the dermis, and the epidermis, that is, the upper layer, is renewed and restored after the procedure. This reaction of the body provokes severe itching And discomfort. Under no circumstances should you scratch the tattoo or tear off the scab. This will significantly damage the drawing and increase the healing time. You can lightly pat your body with your palm and continue to treat the area with ointment. Antiseptic solution Sinaflan will also help reduce itching. At this time, it is advisable not to visit the gym, solarium, limit time spent in the open sun and reduce physical exercise. Don't be alarmed if the tattoo fades a little and loses its brightness. This will go away after complete healing.

Healing time

The healing time of a tattoo varies from person to person and depends on the following factors.

Place of application

The buttocks, chest and abdomen heal the fastest. The recovery period takes from 4 to 7 days. Areas with a small number subcutaneous fat(back, ankle, neck) can take up to 2 weeks to heal.

Tattoo volume

Large tattoos are usually applied in several stages, so complete healing occurs within a month. This is especially true for portrait photos in the style of realism or blackwork tattoos, where a large amount of ink is used to completely shade the design. Small and medium tattoos recover faster because the body area is small.

Thickness and depth of lines

Thin, neat lines do not seriously injure the skin and are restored faster, deep, wide and thick lines take longer: 1-2 weeks.

You can determine whether a tattoo has healed by running your hand over it. If the pattern is uniform, without roughness or husks, the restoration process was successful.

Healing ointments

After the session, the tattoo needs proper care. Upon completion of the work, the tattooist treats the application site with an anti-inflammatory ointment, which relieves swelling. Further, a similar procedure must be done at home to speed up the regeneration process. The most effective and recommended drugs include the following.

Remember that during the period of regeneration of the damaged area (that is, during all three stages listed above), you should completely abandon cosmetic hand creams and even baby cream. The fact is that they contain additives, flavorings and essential oils, which do not promote healing, but on the contrary, injure the skin.

Video about tattoo care

A wound implies an injury in which the skin, muscles, tendons, internal organs, bones. Usually healing occurs in several stages, but not everyone knows what wound granulation is.

The wound healing process includes the stages of inflammation, granulation and epithelialization. In addition, healing can be with primary and secondary intention, as well as under the scab. How quickly the victim will recover depends on how complex the injury is and how all the phases proceed.

Stages of wound healing

When healing, any wound goes through several stages:

Inflammation. The body's first reaction to a wound is to produce substances that clot the blood. Blood clots form, blocking the blood vessels. They prevent the development of severe bleeding. Next, cellular reactions occur, leading to an inflammatory process, new tissue begins to grow - granulation, which is impossible without the participation of fibroblasts. In cases where treatment of a wound requires sutures, they are removed after a week, but if there is tension under the suture, this can lead to divergence of the edges of the wound. This happens because a scar has formed at the edges of the wound, not granulation. The inflammatory stage lasts on average 5-7 days.
Granulation wounds. If the healing process is favorable, a week after the wound the wound granulation stage begins. Over the course of a month, the damaged area continues to fill with maturing granulation tissue, which includes inflammatory cells, connective tissue and newly formed vessels. Successful granulation is impossible without cytokines and sufficient oxygen. Toward the end of this phase, new epithelial cells grow on the granulation tissue, and the edges of the wound are connected by a bright red scar.

Granulation tissue has different kind depending on the stage of its development. Normal tissue initially looks like soft-grained tissue, covered with a cloudy, gray-greenish coating, is juicy, rich in thin-walled vessels, which is why it bleeds easily. In later periods, the tissue becomes paler, denser, the granularity disappears, turning into a whitish dense scar.

Granulation tissue consists of six layers that gradually transform into each other:

superficial leukocyte-necrotic layer
superficial layer of vascular loops
layer of vertical vessels
maturing layer
layer of horizontal fibroblasts
fibrous layer

Epithelialization. This stage of healing begins immediately after granulation has completed. This phase lasts for almost a year. Epithelium and connective tissue completely fill the damaged space. The scar becomes lighter because there are much fewer vessels in it than initially. As a result, the healed wound becomes covered with a scar, the strength of which is approximately 85% compared to healthy skin.

All these stages of wound healing are purely individual, their duration depends on many factors, including general state patient and injury care.

The role of the granulation stage

Leukocytes will play an important role in wound granulation.

So, wound granulation is a complex process in which the following types of cells take part:

leukocytes;
mast cells;
plasmacytes;
histiocytes;
fibroblasts.

A special role is played by fibroblasts, which supply collagen after granulation reaches the edges of the wound. In the presence of extensive hematomas, with a large accumulation of exudate or necrotization of tissue in the area of the wound, the process of fibroblast movement to the edges of the damage is slowed down, which increases t the time necessary for healing.

Important! The most pronounced fibroblast activity is observed on the 6th day after the formation of the damage. And the granulation process itself continues for a month.

Granulations are temporary tissue, which, after performing its function, undergoes regression and is replaced by scar tissue. The morphological basis of granulation is the globules of newly formed vessels. The growing tissue in the process of healing damage envelops these vessels, increasing in volume. Externally, granulation looks like delicate pink fabric.

Granulations formed during the healing process also perform a sanitary function, separating non-viable tissues. Such ischemic tissue areas, as the wound heals, self-regulate by lysis. When treating a wound surgically, non-viable tissue is removed mechanically.

Wound care during the early stages of healing

The optimal solution for speedy restoration of damaged tissue is the regular use of dressings. Disinfection here is carried out with solutions of potassium permanganate and hydrogen peroxide. These substances are applied warm to a gauze swab. Next, the wound is carefully soaked, avoiding touching the wound with your hands - this can lead to the development of infections.

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 of 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 of drugs. Whereas if the surface of the damaged area dries too quickly, ointments are used.

Basic medicines, 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 skin accompanied by the appearance of unaesthetic scars. Solcoseryl promotes the formation of a more homogeneous connective tissue, which looks much more natural.

Home treatment of wounds in the granulation phase

In the presence of a simple injury, in which only the superficial outer layers of the epithelium are affected, you can resort to restoration folk methods treatment. Good decision Here is the application of gauze bandages soaked in St. John's wort oil.

The presented method promotes the speedy completion of the granulation phase and active tissue renewal. To prepare the above remedy, it is enough to take approximately 300 ml of herbal refined oil and about 30-40 grams of dried St. John's wort. After mixing the ingredients, the composition should be boiled over low heat for about an hour. The cooled mass must be filtered through gauze. It can then be used to apply bandages.

Wounds at the granulation stage can also be healed using pine resin. The latter is taken in pure form, rinsed with water and, if necessary, softened with low heat. After such preparation, the substance is applied to the damaged area of tissue and fixed with a bandage.

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 the 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 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.

Surgical intervention

When granulation processes are delayed, deep wound tracts may form, in which there is an accumulation of purulent leaks. In such cases, it is difficult to clean the wound due to the use of ointments and gels. Elimination of unpleasant complications most often occurs through surgery. IN in this case the specialist makes an incision, removes purulent accumulations, disinfects the wound, and then applies a counter-aperture.

Finally

So we figured it out, wound granulation - what is it? As practice shows, one of the determining conditions for accelerating the healing process is differentiated treatment. The correct selection of medications is also important. All this contributes to the rapid granulation of the damaged area and the formation of new, healthy tissue.

There are such stages of wound healing - inflammation, proliferation, remodeling.

Stage of inflammation

This stage of wound healing is the first response to injury, hemostasis with the formation of a fibrin-platelet clot that traps red blood cells. Platelets degranulate, releasing platelet-derived growth factor, transforming growth factor b, chemokines, and other biologically active proteins. Complement is activated, fibronectin and fibrin form a matrix through which cells move.

Within 24 hours big number(many) circulating polymorphonuclear leukocytes (PMN) “stick” (fixed) to the capillary endothelium and then migrate into the wound cavity through damaged capillaries. These cells are attracted by growth factors, chemokines and the matrix itself, which enhances cell migration and proliferation through integrins and other cell surface receptors. PMNs begin to phagocytose the thrombus, releasing proteases. They also kill bacteria by producing free radicals, which is dependent on local oxygen levels. Although PMNs release cytokines that can regulate the inflammatory process, they do not release growth factors in quantities sufficient to support the wound healing cascade; modern classical studies have shown that blocking the entry of PMN into the wound cavity does not impair the effectiveness of its healing. Substantial evidence suggests that the number of PMNs is strictly regulated and their excess can significantly impair wound healing.

Within 48-72 hours, blood monocytes migrate through the capillary walls, differentiating into macrophages. They are activated to release a large number of growth factors, including PDGF, TGF-b, keratinocyte growth factor (KGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF). Macrophages support the wound healing cascade, quickly and dramatically complicating it. In this case, a relatively cell-free 2-3-day wound becomes an intensely proliferating wound with a large number of cells within 7 days.

PDGF and TGF-b in the wound are precursors to a large number of growth factors that stimulate cell migration, cell proliferation and matrix deposition. They also participate in autocrine feedback that stimulates additional production of growth factors by macrophages and other cells found in the wound cavity, such as endothelial cells, perivascular mesenchymal cells and fibroblasts. VEGF and other growth factors stimulate angiogenesis, an important and necessary component of the wound healing process.

The exposed collagen matrix on the wound surface shortly after its formation stimulates the migration of keratinocytes from the basal layer of the epithelium. KGF, produced by macrophages and fibroblasts, is a precursor to growth factor that stimulates the proliferation of keratinocytes and their migration into the wound. If the edges of the wound are well aligned, epithelization at the first stage of wound healing is practically completed within 24 hours. At the same time, the water barrier is restored. With continued cell proliferation over several days, the multilayered keratinized surface is restored. IN open wound this process, depending on the size of the wound, the remaining skin appendages and the condition of the underlying neodermis or granulation tissue, can last from several days to several months.

Proliferation stage

At this stage of wound healing, 72 hours after wound formation, fibroblasts migrate into a temporary matrix consisting of fibrin and fibronectin and proliferate there. They shape the wound structure by producing collagen, a protein responsible for wound strength; proteoglycans, as well as trace amounts of other matrix molecules.

Although there are at least 15 types of collagen, the predominant type in the body is collagen type I, which is the main structural protein of skin, bones, tendons and other soft tissues. This is the most important type of collagen in adult wounds. During wound healing, type III collagen is also formed, but it is more characteristic of fetal tissue. Proteoglycans (glycosaminoglycans), consisting of hyaluronic acid, are also found in large quantities in wound contents. The long hydrophilic polysaccharide chains they contain are capable of holding large amounts of water. They are responsible for the high water content in the healing wound and in the skin. Recent studies have established that proteoglycans and other matrix molecules interact with fibroblasts and other cells through cell membrane adhesion molecules. Such changes in the extracellular matrix can lead to changes in cell motility, protein synthesis, and cell proliferation.

Remodeling stage

The structure of a healing wound changes over time in its cellular composition and organization of matrix molecules. At the third stage of wound healing, during the 2nd and 3rd weeks after wound formation, the number of inflammatory cells increases and newly formed capillaries begin to grow into the damaged area. This process involves apoptosis, many of whose triggering signals still remain unknown.

During the 2nd and 3rd weeks, the total amount of collagen increases and its destruction by collagenases is observed. During this "remodeling" stage, which can last anywhere from many months to 2 years, the collagen fibers become significantly more organized and cross-linked. The strength of the scar at the third stage of wound healing increases to 70% of normal. Visible scars represent residual disorganized collagen.

The researchers observed that in the fetus, the stages of wound healing progress through regeneration, in which the structure of the skin after repair is indistinguishable from the structure of the surrounding skin. It was noted that there were no inflammatory cells in the wound and a predominance of hyaluronic acid. In ongoing research, scientists are trying to determine whether recapitulating some features of the embryonic stages of wound healing can reduce scar formation in adults.

Fortunately, most wounds heal with minimal scarring that does not have significant functional or cosmetic consequences. However, in some cases, the inflammatory process is pathologically prolonged and the stages of wound healing are disrupted. PMNs and macrophages constantly present in the wound release growth factors and inflammatory cytokines that stimulate collagen synthesis and cell proliferation. This increased activity can lead to the formation of hypertrophic scars or, in in some cases, keloid scars. Hypertrophic scars develop within the original wound. The formation of keloid scars has a genetic component. It is more often observed on pigmented skin. Keloid behaves like benign tumor and can spread beyond the original boundaries of the damage.

The article was prepared and edited by: surgeon

No matter how careful and experienced the surgeon is, no matter what modern suture materials he uses, a scar inevitably remains at the site of any surgical incision - a special structure made of connective (fibrous) tissue. The process of its formation is divided into 4 successively replacing each other stages, and significant internal changes after fusion of the wound edges, the wounds continue for at least another year, and sometimes much longer - up to 5 years.

What happens at this time in our body? How to speed up healing, and what needs to be done at each stage to ensure that the scar remains as thin and invisible as possible?TecRussia.ru explains in detail and gives useful recommendations:

Stage 1: epithelization of the skin wound

It begins immediately as soon as the damage is received (in our case, a surgical incision) and continues for 7-10 days.

Immediately after injury, inflammation and swelling occurs. Macrophages emerge from adjacent vessels into the tissue - “eaters”, which absorb damaged cells and clean the edges of the wound. A blood clot is formed - in the future it will become the basis for scarring.
On day 2-3, fibroblasts are activated and begin to multiply - special cells that “grow” new collagen and elastin fibers, and also synthesize the intercellular matrix - a kind of gel that fills the intradermal cavities.

At the same time, vascular cells begin to divide, forming numerous new capillaries in the damaged area. Our blood always contains protective proteins - antibodies, the main function of which is to fight foreign agents, so a developed vascular network becomes an additional barrier to possible infection.
As a result of these changes, granulation tissue grows on the injured surface. It is not very strong and does not connect the edges of the wound tightly enough. With any, even slight force, they can separate - even though the top of the cut is already covered with epithelium.

At this stage, the work of the surgeon is very important - how smoothly the skin flaps are aligned when applying a suture, and whether there is excessive tension or “tucking” in them. Also, careful hemostasis (stopping bleeding) and, if necessary, drainage (removing excess fluid) are important for the formation of a proper scar.

Excessive swelling, hematoma, and infection disrupt normal scarring and increase the risk of developing rough scars. Another threat during this period is an individual reaction to the suture material, which usually manifests itself in the form of local edema.
All necessary treatment of the surgical wound at this stage is done by a doctor or nurse under his supervision. You can’t do anything on your own, and it doesn’t make sense to interfere with the natural healing process yet. The maximum that a specialist can recommend after removing the stitches is to fix the edges with a silicone patch.

Stage 2: “young” scar or active fibrillogenesis

Occurs between 10 and 30 days after surgery:

Granulation tissue matures. At this time, fibroblasts are actively synthesizing collagen and elastin, the number of fibers is growing rapidly - hence the name of this phase ( Latin word“fibril” means “fiber”) - they are located chaotically, due to which the scar looks quite voluminous.
But there are fewer capillaries: as the wound heals, the need for an additional protective barrier disappears. But, despite the fact that the number of vessels in general decreases, there are still relatively many of them, so the developing scar will always be bright pink. It is easily stretchable and can be injured under excessive loads.

The main danger at this stage is that the already fused sutures may still come apart if the patient is overly active. Therefore, it is so important to carefully follow all postoperative recommendations, including those related to lifestyle, physical activity, and medication - many of them are aimed precisely at providing conditions for normal, uncomplicated scarring.

As prescribed by your doctor, you can start using external creams or ointments to treat the developing seam. As a rule, these are agents that accelerate healing: Actovegin, Bepanten and the like.
In addition, hardware and physical procedures aimed at reducing swelling and preventing hypertrophy give good results. fibrous tissue: Darsonval, electrophoresis, phonophoresis, magnetic therapy, lymphatic drainage, microcurrents, etc.

Stage 3: formation of a durable scar - “maturation”

During this period - 30 - 90 days after surgery - appearance the scar gradually returns to normal:

If at earlier stages the collagen and elastin fibers were arranged randomly, then during the third phase they begin to rearrange, oriented in the direction of greatest stretching of the edges of the incision. There are fewer fibroblasts, and the number of blood vessels decreases. The scar thickens, decreases in size, reaches its maximum strength and turns pale.
If at this time fresh connective tissue fibers are subjected to excessive pressure, tension or other mechanical stress, the process of restructuring collagen and removing its excess is disrupted. As a result, the scar may become rough, or even acquire the ability to constantly grow, turning into. In some cases, this is possible even without exposure external factors- because of individual characteristics body.

At this stage, there is no need to stimulate healing; it is enough for the patient to avoid excessive stress on the operated area.

If a tendency towards excessive fibrosis becomes apparent, the doctor will prescribe injections to reduce scarring activity - usually corticosteroid-based drugs (hydrocortisone or similar). Good results gives or collagenase. In less difficult cases, and also for preventive purposes, non-steroidal external agents are used -, etc.
It is important to understand that such therapy should be carried out exclusively under the supervision of a doctor - a dermatologist or surgeon. If you assign yourself hormonal ointments or injections on your own, just because the appearance of the suture does not meet expectations or is different from the photo from the Internet, you can significantly disrupt the process of tissue restoration, up to their partial atrophy.

Stage 4: final restructuring and formation of a mature scar

Begins 3 months after surgery and continues for at least 1 year:

The vessels that penetrated the ripening scar tissue at the previous stages almost completely disappear, and the collagen and elastin fibers gradually acquire their final structure, lining up in the direction of the main forces acting on the wound.
Only at this stage (at least 6-12 months after surgery) can the condition and appearance of the scar be assessed, as well as plan any corrective measures, if necessary.

Here, the patient is no longer required to take such serious precautions as in the previous ones. In addition, it is possible to carry out wide range additional corrective procedures:

Surgical threads are usually removed much earlier than the surface of the scar is completely formed - otherwise the scarring process may be disrupted due to excessive compression of the skin. Therefore, immediately after removing the sutures, the edges of the wound are usually fixed with special adhesives. The surgeon decides how long to wear them, but most often the fixation period coincides with the “average” period of scar formation. With this care, the mark from the surgical incision will be the thinnest and most invisible.
Another, less known, method that is used mainly on the face is. “Switching off” the adjacent facial muscles allows you to avoid tension on the developing scar without the use of a patch.
Aesthetic defects of mature scars are difficult to treat conservative treatment. If hormonal injections and external ointments used earlier did not give the desired result, then at the 4th stage and upon its completion, techniques based on mechanical removal of fibrous excess are used: dermabrasion, peelings and even surgical excision.

Briefly about the most important things:

Stage of scar formation and its timing	Main characteristics	Therapeutic and preventive measures
1. Epithelization of the skin wound as a response to tissue damage (the first few days after surgery)	At the site of injury, the body releases biologically active substances that cause the development of edema, and also trigger the processes of cell division and collagen synthesis.	Careful treatment and suturing of the incision (performed by a surgeon). After the sutures are removed, they can be replaced with a plaster to avoid unnecessary tension on the edges of the wound.
2. “Young” scar (1-4 weeks after surgery)	The production of a significant, usually even excessive amount of collagen continues. Vasodilation and increased blood flow at the site of injury contribute to the formation of a voluminous, soft, red or pink scar.	Application of healing ointments (Solcoseryl, etc.) In the presence of severe swelling and/or the threat of proliferation of fibrous tissue - corrective hardware procedures (microcurrents, lymphatic drainage, etc.)
3. “Maturation” of the scar (from 4th to 12th week)	Excess connective tissue gradually dissolves, blood flow weakens. The scar thickens and fades - normally it becomes flesh-colored to white.	The use of non-hormonal ointments to prevent severe scarring. If there are obvious signs of keloid formation, injections or external application of corticosteroids are required.
4. Final tissue restructuring (from 13 weeks to 1 year).	Collagen and elastin fibers are aligned along the lines of greatest tension in the skin. In the absence of complications, a thin whitish stripe is formed from the loose, voluminous and elastic scar formation, almost invisible from the outside.	Towards the end of this stage, if necessary, you can use any mechanical methods of scar correction: grinding, peeling, surgical excision.

In addition to the local factors mentioned above, the healing processes of surgical incisions largely depend on the following circumstances:

Age. The older a person is, the slower the damaged tissues heal - but the more accurate the final result will be. Statistically, rough hypertrophic and keloid scars occur more often in patients under 30 years of age.
Heredity. The predisposition to forming large, uncontrollably growing scars often runs in families. In addition, people with dark and dark skin are more prone to excessive division of connective tissue cells.

Also, the following can disrupt the normal wound healing processes and worsen the final condition of the scar:

obesity or, conversely, underweight;
illnesses endocrine system(hypo- and hyperthyroidism, diabetes);
systemic collagenoses (systemic lupus erythematosus, systemic scleroderma, etc.);
use of medications (corticosteroids, cytostatics, anti-inflammatory drugs).

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 in the 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 the 4-5th day, the nature of general reactions is determined 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 laboratory parameters of blood and urine normalize.

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 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 of 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 the inflammatory reaction of 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. When breaking up cellular proteins(proteolysis) K+ and H+ ions are released from destroyed cells, increasing osmotic pressure in tissues, water retention occurs, tissue edema develops (hydration), which is the main external manifestation 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. In cleansing the wound, the most significant role is played by blood cells 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, connective tissue cells with the ability to synthesize and secrete macromolecules of the extracellular matrix, migrate to the wound area. An important role of fibroblasts in wound healing is the synthesis of connective tissue components and the 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. Mast cells are concentrated around the capillaries, which promote capillary proliferation.

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 accompanying illnesses(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 heal by primary intention: aseptic surgical wounds or accidental wounds with minor infection if the 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 best type healing of wounds, which we must always strive for, and create the necessary conditions for it.

Healing by secondary intention - healing through suppuration, through the development of granulation tissue. In this case, healing occurs after 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 - special kind 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.

The scab performs a protective function and is a kind of “biological bandage.” 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 the external environment.