How to determine whether a wound is healing or not. Wound granulation

Body tissues can regenerate over time, but this process takes time. How wounds heal and why it can take a long time, we will look at in our article.

How and for how long do wounds heal?

Wound repair occurs in three stages:

1. Inflammation
2. Proliferation
3. Scar formation

At the stage of inflammation, the body fights against the invading infection. A blood clot appears, stopping the bleeding. Swelling also forms. This swelling can put pressure on nerve tissue, causing pain. After a week, the wound cavity begins to fill with tissue called granulation tissue.

In the second stage, the wound is actively filled epithelial tissue. A scar appears, and then capillaries, which are saturated with blood, and therefore the scar looks scarlet or has a purple tint.

The third stage begins in the fourth week and can last quite a long time, up to a year. The epithelium is formed, the scar turns pale and the primary collagen, which was formed in the second phase, is replaced by secondary collagen. This completes the wound healing process. If you want to learn more about stitches and wounds, you can read the article.

What determines the speed of healing?

The wound can take a very long time to heal. It all depends on a number of factors:

• Depth and length of cut
• Quality of the applied bandage
• Application medicines
• Effects on the wound (movement, pressure).

Complex wounds often require sutures. It would seem that this should speed up healing, but tissue regeneration depends not only on the presence of a suture, but also on the use of drugs. At the same time, even if the patient receives medications and eliminates exposure to the wound, it will still need time to heal. This is primarily due to genetic characteristics human body.

How to heal a wound faster

There are various methods to accelerate wound healing. In addition to medications, remedies remain effective traditional medicine. For example:

Bee honey

Thanks to honey, you can eliminate inflammation and improve blood flow. This speeds up the healing process. Honey can be used to treat not only cuts, but also burns, as well as purulent wounds and frostbite. Best to use gauze bandage, which just needs to be soaked in honey and applied to the wound.

Chamomile

Chamomile also has good properties, which can be used to heal wounds. It is enough to prepare a solution of chamomile by mixing it with boiled water. Allow to cool; the resulting tincture should be warm. Next, moisten with cotton wool and apply to the wound. Wrap with gauze. You need to keep this compress for half an hour and apply it twice a day every day.

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In medicine, there are three main types of wound healing: healing under a scab, as well as by secondary and primary intention. A specific healing method is always chosen by the doctor, based on the patient’s condition and the characteristics of his immune system, the nature of the wound received, as well as the presence of infection in the affected area. The stages of wound healing, or rather their duration, depend directly on the type of wound and its scale, as well as on the type of healing itself.

In this article you will learn everything about the type of wound healing and its characteristics, what are the features and how to properly care for the injury after the healing process.

Healing by first intention

This type of regeneration is the most perfect, since the entire process takes place over a short period of time, and a fairly thin, but very durable scar is formed.

As a rule, wounds after operations and suturing, as well as minor injuries after cuts, heal by primary intention if the edges of the wound do not have strong discrepancies.

Wound healing using this method is possible in the absence of inflammatory process accompanied by suppuration. The edges of the wound are tightly connected and fixed, resulting in normal and fast healing wounds without education large quantity rough scar tissue.

Only a thin scar remains at the site of the wound, which at first after formation is red or pink, but later gradually brightens and acquires almost the same tone as the skin.

The wound heals by primary intention if its edges are completely close to each other, and there are no areas of necrosis or any foreign bodies between them, no signs of inflammation, and damaged tissue completely retained their viability.

Secondary tension

Secondary intention mainly heals wounds that cannot be sutured and those that were not sutured on time due to the fact that the person turned to doctors late. Wounds also heal by secondary intention, in which the process of inflammation and pus formation actively develops. With this method of healing, granulation tissue first develops in the wound cavity, gradually filling all available space, forming a sufficiently large and dense scar from connective tissue. Subsequently, this tissue is covered with epithelium on the outside.

Processes secondary healing usually occur against the background of fairly intense inflammation that has arisen due to primary as well as secondary infection, and are accompanied by the release of pus.

The type of secondary intention can be used to heal wounds with severe divergence of the edges and a significant wound cavity, as well as for those injuries in the cavity of which there are necrotic tissues or foreign bodies, blood clots.

This technique is also used in cases where the patient has hypovitaminosis, general exhaustion of the body, metabolic processes are disrupted, due to which not only the body’s defenses decrease, but also the intensity of the natural processes of tissue regeneration.

The granulation tissue that develops in the wound cavity has a very important biological significance for the overall healing process and the body as a whole. It is a kind of physiological as well as a mechanical barrier that creates an obstacle to the absorption of toxins, microbes from the wound cavity and decay products of the inflammatory process, which are toxic to the body, into the body tissues.

In addition, granulation tissue secretes a special wound secretion, which promotes faster cleansing of the wound mechanically, and also has a natural bactericidal effect, which prevents the spread of bacteria and other pathogenic microorganisms from the damaged area to the skin and healthy tissue.

It is through the process of granulation in the wound cavity that dead tissue is separated from living tissue while simultaneously filling the damaged space.

Of course, everyone protective properties only granulation tissue is present and is not subject to damage, so when changing dressings it is very important to be extremely careful and careful not to cause additional damage to the wound.

Healing under the scab

This type of healing usually restores scratches, small wounds, abrasions, burns, minor and not deep wounds, as well as bedsores, ulcers and other skin lesions.

During the healing process, a crust forms on the surface of the wound or other damage, having first red, and then, dark brown color, which is called a scab. Such a formation consists of lymph, coagulated blood and wound exudate mixed together and covering the surface of the injury with the formed substance.

The scab is a fairly dense formation that perfectly protects the wound from contamination, penetration of harmful microorganisms, mechanical damage, while holding the edges of the injury together, ensuring their relative immobility.

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The scab also provides the correct balance inside the lesion, preventing possible drying out. granulation tissue.

Under the scab, wounds heal according to the principle of primary and secondary intention. By primary intention, the wound under the scab heals when the recovery process is not disrupted and the crust falls off on its own in due time. If the scab was damaged and forcibly removed before the internal tissues were restored, then re-education crusts and healing occurs by secondary intention.

Treatment of minor abrasions and cuts

Abrasions and various small wounds can be treated and treated at home, independently, but be sure to follow all the rules of care and apply the right means.

First of all, when receiving any wound, it must be washed with soap and water to clean it of dirt and microorganisms that have gotten inside.

After this, the wound should be dried with a napkin and treated with a gauze swab. pharmaceutical solution hydrogen peroxide, gently wetting the surface.

There is no need to pour hydrogen peroxide directly from the bottle onto the wound. This product allows you not only to effectively disinfect the surface of the injury and the skin around it, eliminating almost all types of harmful microorganisms, but also helps stop bleeding.

Then it is best to apply a sterile bandage. If the wound is very small or the damage is a scratch or minor abrasion, you can fold a piece of bandage according to the size of the injury or take a cotton pad, soak it in a solution, for example, apply it to the wound and secure it with a plaster or bandage. If the bandage becomes saturated with blood, it must be changed to a fresh one, repeating the treatment of the wound.

It is necessary to change a bandage soaked in blood so that later, when replacing the dressing material, you do not accidentally tear off a blood clot that has formed on the surface of the wound, which will later become a scab.

Once a crust has formed, the bandage should be removed and the lesion left open. Wounds under a scab heal best and much faster in the air.

Post-healing care

After the formation of a scab on the surface of the injury, which indicates the beginning of the normal healing process, it is very important to ensure that the scab is not injured by any careless movement.

Under no circumstances should you try to tear off a scab prematurely, when new tissues underneath have not yet formed. Similar actions can lead not only to infection and an increase in the recovery time of damaged tissues, but also to the formation of a scar, which will subsequently require treatment and adjustment. After the formation of full-fledged tissue, the scab will fall off on its own.

It is important that the surface of the scab always remains dry. If the crust becomes wet with water, for example, when washing your hands or body, it should be dried immediately with a paper napkin.

After the scab falls off you can use it various ointments, creams or folk remedies to accelerate the formation of epithelium at the site of former damage, as well as to soften and moisturize young tissue and prevent the formation of a serious scar.

Damage restoration

The recovery time for any injury largely depends on its characteristics, location, location, depth, size, healing method used, medical supplies, correct care, timely treatment and changing of dressings.

The healing method plays a significant role in the healing process and recovery time.

If the wound heals by primary intention, is clean, and there is no inflammatory process, then healing occurs in about 7 to 10 days, and tissue restoration and strengthening occurs within about a month.

If the wound gets infected and an inflammatory process develops with pronounced suppuration, then healing occurs by the method of secondary intention and the recovery period is delayed. In this case, the timing of complete healing will be individual, since much depends on the condition and correct functioning of the patient’s immune system and the presence of diseases. endocrine system and any chronic illness.

If the human body is weakened and there are disturbances in metabolic processes, then the recovery time in the presence of an inflammatory process can be very long and last several months.

The speed of healing of wounds under the scab primarily depends on the state of the immune system and on proper care of the wound site. It is very important not to rip off the crust that has formed, but to wait for it to fall off on its own after the process of regeneration of new tissue is completed.

With the help of special preparations, such as various antiseptic solutions, medicinal powders in powder form, as well as gels, creams and ointments, in many cases it is possible not only to significantly speed up the recovery time, but also to make the scar after healing much smaller, softer, lighter or not formed at all. Traditional medicine can also be used for the same purpose, but it is important that any prescriptions for treating wounds are made only by a qualified doctor.

What to do in case of suppuration and microbial infection of the wound

If an infection has entered the wound cavity, an inflammatory process will certainly begin, the intensity of which primarily depends on the general health of the person, as well as on the type of microorganisms that have penetrated into the wound cavity.

When suppuration begins, wounds should be treated frequently, changing dressings at least twice a day, but if the dressing material becomes contaminated more quickly, changing dressings is carried out more often, as necessary, each time treating the wound.

When changing dressings, the surface of the wound and the skin around it must be treated with an antiseptic solution, after which, if necessary, special ointments are applied that help not only fight microorganisms, but also eliminate inflammation, swelling, accelerate the cleansing of the wound cavity, and also maintain the necessary moisture balance in the wound, without allowing it to dry out.

It is important to carry out dressings correctly and in a timely manner, using for this sterile instruments, sterile materials, the right means to eliminate inflammation and speed up healing, as well as observing the rules for changing dressings.

Cuts and scrapes - part everyday life. In most cases, such wounds heal easily. However, sometimes bacteria enter the wound and lead to a potentially dangerous infection. Early recognition of infection facilitates rapid and effective recovery. Most often, taking antibiotics (depending on the severity of the infection) is enough to get better. There are several signs of infection - redness, purulent discharge and pain. The ability to check a wound for infection is an integral part of caring for your health.

Steps

Check for increased pain, redness, swelling and temperature around the wound

Wash your hands. Be sure to wash your hands before examining the wound. If you think the wound is infected, dirty fingers will only make the situation worse. Wash your hands with antibacterial soap and water before touching the wound.

• Remember to wash your hands after touching the wound.

1. Examine the wound carefully. Remove before examining wounds. Do this carefully so as not to damage the sensitive area. If the bandage does stick to the wound, wet it with running water or use a spray bottle.

   • Once the bandage is removed, throw it away and never reuse it.

2. Notice the redness and... Carefully examine the wound and pay attention to the redness: whether it has increased or decreased. If the wound is red and the redness spreads to surrounding tissue, this is a sign of infection.

   • The skin around the wound may also feel hot to the touch. If you have any of these symptoms, consult your doctor.

3. Notice if the pain increases. The appearance or intensification of pain is a sign of spreading infection. Pain alone or along with other symptoms (eg, swelling, heat, pus) is a sign of infection. Consult your doctor if the pain gets worse. Pain may be felt deep in the wound. Thus, swelling around the wound, heat (warmth) and tenderness (pain) are the first signs of an infected wound.

   Do not use antibiotics (unless prescribed by your doctor). Studies have shown that antibiotic ointments do not help treat wound infections. The infection spreads throughout the body, so topical antibiotics are not an effective way to fight the infection.

Check for pus or fluid

See if yellowish or greenish pus or fluid comes out of the wound. These secretions may have bad smell. If you notice green or yellow pus discharge, the wound is infected. Seek medical help as soon as possible.

Notice the accumulation of pus around the wound. If you notice pus accumulating under the skin around the wound, the wound is infected. Even if you see a small collection of pus that does not drain from the wound, or feel a soft, growing lump under the skin, this could be a sign of a serious infection.

After examining the wound, apply a new sterile dressing. If there are no signs of infection, apply a bandage to protect the wound. If there are signs of infection, apply a sterile dressing to protect the wound from further contamination and consult a doctor.

• When applying a bandage, make sure that the adhesive surfaces of the bandage (if any) do not come into contact with the wound. The bandage should be large enough to completely cover the wound.

1. If the wound continues to fester, consult a doctor. A little discharge from a wound may be normal - it means that the body is fighting an infection. But if yellowish or greenish pus comes out of the wound, consult a doctor. This is especially necessary if, along with the discharge, other symptoms of inflammation described above are observed.

Check for lymphatic system infection

Carefully examine the skin around the wound for red lines. These lines spread across the skin from the wound. Red lines mean that the infection has penetrated into the vessels of the lymphatic system (it plays important role in metabolism and cleansing of body cells and tissues).

Locate the lymph nodes closest to the wound. For the arms, the nearest lymph nodes are in armpits, for legs - in groin area. Lymph nodes can also be found on the lateral surfaces of the neck (under lower jaw left and right).

Check your lymph nodes. Using two or three fingers, gently press the area of ​​the enlarged lymph nodes. It is more convenient to palpate the lymph nodes to detect pathology with both hands at the same time. U healthy person lymph nodes are symmetrical on both sides.

Feel to see if the lymph nodes are enlarged and if there is any pain. If the lymph nodes are swollen or painful to touch, this may indicate an infection, even if there are no red stripes. IN in good condition The size of the lymph node is 1.5 cm and it cannot even be palpated. Lymph nodes can double or even triple in size; in this case you can easily find them.

Take your temperature and assess your overall health

Take your temperature. In addition to the above symptoms of wound infection, you may develop a fever. If the temperature rises to 38 °C, then this is a sign of an infected wound. You should see a doctor without delay if you have a fever and some symptoms of a wound infection.

Notice if your overall health has worsened. A sign of an infected wound may be general malaise. If you get injured and then feel unwell a few days later, it's most likely related. Check the wound for signs of infection and if it does not improve, consult a doctor.

• If you have headache, dizziness, upset stomach, vomiting, then these are signs of infection. A recent rash is another reason to see a doctor.

1. Pay attention to the lack of fluid in the body. Dehydration may be a sign of an infected wound. Some of the symptoms of dehydration are: infrequent urination, dry mouth, sunken eyes, dark urine. If you experience these symptoms, immediately check the wound for signs of infection and consult a doctor.

   • While fighting the infection, you need to drink enough fluids and stay hydrated.

Know what to do in serious cases

1. Find out what types of wounds can become infected. Although most wounds heal without difficulty, some factors lead to wound infection. A wound becomes infected if it is not properly cleaned and cared for, or if it is located in an area where it is easier for bacteria to enter (for example, leg wounds). If you are bitten by an animal or even a person, the wound is most likely infected.

   Learn about other risk factors for infection. Most often, wounds become infected in people with weakened immune system, such as those with diabetes, HIV or malnutrition. Bacteria, viruses and fungi, which the body of a healthy person can cope with, penetrate the body of people with weakened immunity and multiply in it. This is especially true for people with severe burns because their first line of physical defense (skin) has been damaged.

   Watch for signs of a serious infection. You may experience elevated temperature and dizziness, as well as rapid heartbeat. The wound will be hot, red, swollen, and painful. You may smell a foul odor, like rotting. All of these symptoms can be mild or very severe, but if you have more than one of them, you need to see a doctor.

   • If you feel dizzy or have a fever, do not drive. Ask a friend or relative to take you to the hospital or call an ambulance. You may need to be treated with strong antibiotics.
   • If in doubt, it is better to consult a doctor. In case of infection, it is not enough to diagnose yourself based on articles from the Internet. Only a doctor can accurately diagnose an infection.

2. See your doctor. If you think the wound may be infected, contact your surgeon or emergency room. This is especially important if you have a medical condition or another risk factor for infection.

Early healing period(the first 12 hours after the wound) is characterized mainly by the presence blood clot on the surface of the wound and initial reactive phenomena inflammatory in nature(leukocyte infiltrate around vessels, in intercellular spaces, in a fibrin clot; round cell infiltration of mononuclear cellular elements of perivascular spaces and wound edges).

Clinically, the inflammatory reaction is not yet expressed during this period.

Degenerative-inflammatory period(approximately 5 - 8 days) is characterized by necrotic changes in damaged tissues, inflammatory swelling of the wound edges, active phagocytosis, and the formation of purulent exudate. In parallel with this, the wound is gradually cleansed of the products of degeneration and necrosis, a decrease in the polymorphonuclear leukocyte infiltrate and the proliferation of large mononuclear cells (polyblasts).

Clinically, this period is characterized by the development of a picture of inflammation with all its typical manifestations: pain, hyperemia, lymphangitis and regional lymphadenitis, local and general increase temperature, purulent discharge.

Regenerative period of wound healing(approximate duration - 30 days) is divided into 3 phases.

First phase characterized by the development of newly formed vessels, the release of the wound from necrotic tissue, and the formation of granulation tissue. Phagocytic activity in the wound and blood leukocytosis increase. The number of microorganisms in the wound decreases, their virulence decreases. Clinically, the purulent discharge from the wound decreases, and the general condition of the patient is normalized.

Second phase characterized by further attenuation of the inflammatory reaction and the development of regenerative processes: granulation tissue maturing, filling the wound, fibrous connective tissue is formed. The number of bacteria in the wound progressively decreases, the number of leukocytes decreases, and differentiated cells type of fibroblasts. Clinically, in this phase, swelling of the wound edges is eliminated and epithelization begins.

Third phase(final) is accompanied by filling the entire wound cavity with regenerate, consisting of young connective tissue. Clinically, a slight purulent discharge is observed; a rapid decrease in the size of the wound occurs due to tightening of the edges and epithelization of the wound defect.

It should be noted that the division of wound healing processes into certain periods is largely arbitrary, since they do not strictly follow one another, but develop in parallel. However, on different stages certain processes prevail. The speed and completeness of healing of purulent wounds is influenced by local conditions in the purulent focus and the general condition of the body, which may be favorable or unfavorable.

From local conditions, promoting accelerated healing wounds, we can call good blood supply, preserved innervation. Thus, wounds on the face and scalp heal faster due to good blood supply (however purulent process more dangerous due to structural features subcutaneous tissue and venous collaterals). On the contrary, they slow down wound healing local factors, such as crushing and separation of tissues, the presence of pockets, sequestration of soft tissues, foreign bodies, closely spaced purulent foci, as well as additional infection of the wound.

The general condition of the child’s body is determined by the normal function of its organs and systems, as well as age. In well-developed, physically strong children, wound healing occurs faster. Transferred acute infectious diseases and chronic debilitating diseases (hypotrophy, rickets, diabetes, vitamin deficiency, etc.) slow down reparative processes. In infants, and especially in newborns, the healing processes become protracted, which is explained by reduced resistance to infection and a shortage of plastic material.

Treatment. In an outpatient setting, minor wounds are treated, which, as a rule, are not accompanied by general symptoms.

Principles of treatment purulent wound are in accordance with the doctrine of wound healing processes. Therapeutic measures should promote the fastest current natural process, therefore, when creating a treatment plan, be sure to take into account the period wound process and provide for local and general events, improving regeneration conditions. These activities are somewhat different different periods wound healing.

Early treatment wound wounds, in essence, comes down to the prevention of suppuration.

In the degenerative-inflammatory period when it prevails active work microbes and melting of dead cells and tissues, it is important to suppress the activity of microorganisms and promote faster cleansing wounds.

These goals are met by:

1) antibacterial therapy and increasing the body’s defenses;
2) increased hyperemia and exudation in the wound, as well as the creation of reliable outflow of wound contents;
3) rest of the diseased organ and careful treatment of tissues.

Among antibacterial agents Antibiotics are the most widely used. Due to the emergence of penicillin-resistant forms of microbes, preference is given to antibiotics wide range actions, the choice of which is guided by the sensitivity of the flora sown from the wound. Antibiotics are used in the form of irrigation or pricking the affected surface with a solution of one or another drug with novocaine. Other antibacterial methods include the Vishnevsky method, which is widely known to surgeons and is based on the use of an ointment dressing and a novocaine block. When a wound becomes infected with Pseudomonas aeruginosa, use a 3% solution boric acid. Along with antibacterial therapy, attention is paid to increasing the body's defenses.

An important factor, accelerating wound cleansing, is an increase, intensification of the current of the wound contents. This is achieved by using dressings with a hypertonic solution of sodium chloride (5 - 10%), magnesium sulfate (25%), grape sugar (20 - 25%). By increasing hyperemia and exudation into the wound, hypertonic dressings, due to the osmotic effect, simultaneously promote the flow of wound discharge into the dressing. Unimpeded evacuation of exudate is achieved by drainage. For children, we usually use thin strips of rubber gloves. The rejection of necrotic tissue and the acceleration of resorption of infiltrate is facilitated by the use electric field high frequency (UHF). The procedures are carried out daily until the wound is cleansed in oligothermic and low-thermal doses for 5 - 10 minutes, 7 - 8 times in total.

Rest is created for the diseased organ by immobilization. Frequent daily dressings should also not be performed, unless the interests of the method require it (for example, the presence of drainage that needs to be monitored or removed).

During the regenerative period, when the inflammatory reaction subsides, the virulence of the infection weakens, granulations develop, and the fight against the infectious agent no longer has the same importance as in the previous period.

Treatment measures should be aimed at creating optimal conditions for recovery processes. This goal is met by:

1) protection of the wound from damage;
2) the use of means that enhance the regeneration process.

The granulations that fill the wound serve as a protective barrier that prevents the penetration of microbes into the wound. internal environment body, and wound discharge has bactericidal properties. However, the cells and vessels of granulation tissue are easily vulnerable. Minor mechanical or chemical exposure damages them and opens the entrance gates of infection. Therefore, the wound is protected with a bandage, and the damaged organ is immobilized (the latter mainly applies to the hand and foot). During the regenerative period, you cannot use hypertonic and antiseptic dressings, which also damage granulations. We attach great importance to infrequent dressing changes (once every 4-5 days).

To speed up and stimulate healing processes many remedies have been proposed. We will mention only those that find the greatest application in outpatient treatment infected wound. In the first phase of the regenerative period, very valuable means that have a beneficial effect on healing are Vishnevsky ointment, Shostakovsky balm, blood products (whole blood, plasma, serum), as well as ultraviolet irradiation, which stimulates the growth of granulations. During treatment, it is necessary to use stimulants wisely, because excessive growth of granulations delays epithelization wound surface. Excess granulation is removed by treating the surface with a 5% solution of silver nitrate (lapis) or mechanically.

When normal granulation tissue appears in the second and third phases of the regenerative period, the best are dressings with indifferent ointment (fish oil, Vaseline oil etc.). When epithelization is delayed, wound healing is accelerated by bringing its edges closer together with a strip of adhesive plaster.

In addition to the methods listed above, the complex of therapeutic measures can also include surgical methods(bringing the edges of the wound together with sutures). In the degenerative-inflammatory period, sutures are contraindicated, but after cleansing the wound and eliminating the inflammatory process, indications for secondary sutures may arise (in particular, after suppuration of the surgical wound). A suture placed on a granulating wound with movable, unfixed edges without the presence of scars (8 to 10 days after injury) is called an early secondary suture, and a suture placed on a granulating wound with the development of scar tissue after excision of its edges and bottom (after 20 or more days) - late secondary suture. An early secondary suture is most effective.

In children, wounds larger than 5x5 cm, localized on the head, in some cases they are not prone to self-healing. In such cases, skin grafting is used (in the hospital).

In newborns and young children infancy head wounds (pincer wounds, after vacuum extraction of the fetus, incision with an infected cephalhematoma) are often complicated by contact osteomyelitis of the calvarial bones. During the treatment of such wounds, especially with prolonged healing, X-ray monitoring is necessary. The patient is promptly sent to the hospital. After osteomyelitis, they sometimes remain large defects in the cranial vault, which pose a threat to the child’s life when he begins to walk and hits his head. Protective bandages are required.

How long will it take for the wound to heal?

We all experience injuries from time to time. How to speed up the healing process and avoid scars if possible, read our article.

By the 7-8th day, granulation tissue replaces a significant part of the blood clot, which remains only in the central part of the socket. The first signs of new bone formation appear in the form of small osteoid beams. Where the bone was damaged during surgery, it undergoes lacunar resorption. Resorption of the inner compact surface of the socket also begins. Simultaneously with the formation of granulation tissue, epithelium grows from the edges of the gums. The first signs of wound epithelization are detected already on the 3rd day after tooth extraction. Complete epithelization of the surface of the wound (depending on its size) is completed by the 14-18th day.

Slight swelling of the gums and redness after tooth extraction is considered common. There should be concern inflammation that does not go away within 5 days, incessant pain, the presence of pus, increased body temperature, increased bleeding, bad breath.

Inflammation after removal can also occur for the following reasons:

• Anesthesia, if it was chosen incorrectly.
• Damage to the gums during tooth extraction.
• The surgical technique was violated.

First aid

The main rule for any injury is immediate treatment. The sooner you take action, the lower the risk of an open wound becoming infected. The wound should be washed with clean water to remove foreign bodies (if any), and then disinfected with any antiseptic. Please note that the edges of the wound also need to be disinfected.

Wound contraction

Wound contraction is one of the most powerful mechanical forces in the body. There are different, often opposing, points of view regarding the exact biological mechanism underlying this process. In addition, surgeons view the process of wound contraction as both a favorable and an unfavorable factor. Even ancient doctors knew that open skin wounds healed if kept clean and protected with bandages. During the healing process, the edges of the wound come together until they are in full contact with each other, ensuring scarring of the wound.

In many cases contraction wound that is normal, active biological process, leads to education contracture - persistent deformations accompanied by both cosmetic defect, and dysfunction in the patient. The most dramatic are contractures of the skin and hollow organs. Loss of an area of ​​skin due to a burn or mechanical injury may be accompanied by contracture as the wound healing process brings the edges of the skin closer together to close the wound. If a flap of skin is not transplanted here, a contracture will form. This is especially common in the area of ​​the flexor surface of the joints, for example on the neck or on the palmar surface of the fingers. But the process is not limited to the skin. Any type of injury to hollow organs such as the esophagus or general bile duct, can trigger the process of their cicatricial contraction, leading to the development of strictures that mechanically disrupt the function of the hollow organ. Researchers note the presence of fibroblast-like cells in the contracting open skin wound, the cytoplasm of which contains components characteristic of both fibroblasts and smooth muscle cells. These cells are called "myofibroblasts". When strips of granulation tissue from an open wound are placed in a bath of water, they contract in the presence of agonists of smooth muscle cell function and relax in the presence of their antagonists. Moreover, myofibroblasts are found in significant numbers in human tissues in several conditions, such as Dupuytren's contracture, post-burn contractures and contractures around the capsules of silicone breast prostheses. The peak number of these cells is observed during the process of scar contraction and after its completion.

All attempts to use pharmacological preparations to correct wound convergence failed. For example, some researchers have tried to slow down the contraction of an open wound using function inhibitors. smooth muscles, such as trocynate, which gave an effect only as long as it was on the wound surface. Applying a splint in the area of ​​developing contracture does not prevent its formation. Once the splint is removed, powerful biological forces move the edges of the wound to the position they would have been in if the splint had not been applied at all. At surgical treatment contractures there are a number of proven principles. First, it is necessary to establish whether the scar is mature or immature. A mature scar is soft and pliable, while an immature scar can be immobile, hardened, hypertrophic and even tense. Residual myofibroblasts and inflammatory cells attempt to create contracture under the skin graft, as in other attempts to close an immature scar. When dealing with contractures, it is preferable to replace defects with flaps consisting of skin and subcutaneous tissue, and in in some cases- And muscle tissue. Since the flap consists of several components and replaces the defect of all soft tissues in the wound, contractures after such a transplant are rarely observed.

By for some unknown reason contractures are less common after closure open wounds whole skin graft rather than split skin graft. The point is not in the measured thickness of the graft, but in the is it whole or split. In any case, before transplantation, a splint should be applied to fully open the wound. This may take several months. Splinting is necessary until all myofibroblasts and inflammatory cells have disappeared from the wound. The length of time a splint should remain in place is determined by “clinical judgement” and there are no scientific guidelines on this.

Epithelialization

All surfaces in contact with external environment, covered with epithelium. An example is the skin, although the mechanisms of epithelization are the same throughout the body. The skin is covered with the epidermis, which is a multilayered squamous stratified epithelium that protects the body from moisture loss, invasion of microorganisms and injury. Wounds with partial skin damage heal by [i]epithelialization. In this case, two main phenomena are observed: migration and proliferation of epithelial cells. After the destruction of the epithelium, a blood clot is formed. When it dries, a scab forms, which protects the deeper layers of the wound. The healing process begins with migration epithelial cells, which does not depend on their proliferation. Migration is the dominant process. The migrating cells grow from the epithelium of the wound edge and the epithelium of the hair follicles and sebaceous glands remaining at the bottom of the wound. Superficial wounds without damage to the basement membrane regenerate very quickly. Deeper wounds with damage to the dermis, such as burns, in which basement membrane appears destroyed, they can also heal by epithelialization and, although this takes longer, the result is often satisfactory. One of the best means not only epithelization, but also healing is the drug iruksol instructions.

Regardless of the type of damage, migration begins precisely in the basal layer of the epidermis and in the deep hair follicles and sweat glands. The cells flatten and send out their cytoplasmic processes, which penetrate into the surrounding tissues. These cells also lose contact with neighboring cells in the basal layer and begin to migrate. A few days after migration, the migrated cells begin to divide.

On outer surface In the granulation tissue, fluid leaks out, cells come out, new vascular shoots appear and, thus, the tissue layer grows and fills the wound cavity.

Simultaneously with the filling of the wound cavity, its surface is covered with epithelium (epithelialization). From the edges, from neighboring areas, from the remains of the excretory ducts of the glands, from randomly preserved groups of epithelial cells, they multiply, not only by growing continuous layers of epithelium from the edges, but also by forming separate islands on the granulation tissue, which then merge with the epithelium running from the edges of the wound. The healing process generally ends when epithelium covers the surface of the wound. Only with very large wound surfaces may the epithelium fail to cover them and it becomes necessary to transplant skin from another part of the body.

If you immediately lubricate a fresh abrasion with pure resin-resin from pine, spruce, fir, it will heal very quickly.

For the treatment of abscesses, ulcers, cuts, abrasions, boils, an ointment is prepared from spruce resin, sunflower oil, honey and wax. The ingredients are taken equally, melted in a water bath, mixed and used to lubricate sore spots.

For a long time non-healing wounds there is one more thing effective remedy- ointment made from burdock and celandine. Crushed celandine and burdock roots (20 and 30 g each) are poured into 100 ml of sunflower oil and boiled for 15 minutes over low heat, removed, filtered, cooled and applied to the sore spots several times a day - after a week the wounds usually heal.

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.

(b) For heavily contaminated wounds, the use of antibiotics is therapeutic, not prophylactic. However, when treating this type of wound, surgical debridement, drainage, and irrigation are of paramount importance.

(2) The use of antibiotics is most justified for conditionally contaminated wounds. Antibiotics must be administered before or during surgical treatment. Antibiotics have virtually no effect when administered later than 3 hours after the wound is infected with bacteria.

(3) The type of antibiotic used depends on the nature of the potential infectious agent. After surgical intervention in the intestines, patients should be prescribed antibiotics that are effective against anaerobic and gram-negative microorganisms. After surgery on the upper half of the body, patients should be prescribed antibiotics against gram-positive cocci.

D. Wound dehiscence (wound failure) is considered a serious complication.

1. Dehiscence of wound edges usually occurs early postoperative period(usually 7–10 days after surgery), when the strength of the forming scar is low and tissue tension is observed (for example, with flatulence, intestinal obstruction, pulmonary pathology).

2. Dehiscence may be the result of any of the factors discussed in Section I D. In addition, as the wound heals, its edges secrete collagen-degrading enzymes. If there are complications, the risk of destruction of the tissue on which the sutures were placed increases. Renal or liver failure also increases the rate of wound dehiscence.

3. Divergence of all layers postoperative wound usually requires urgent re-surgical intervention (for example, dehiscence of the laparotomy wound can lead to eventration).

E. Scars resulting from wound healing can be of different types. Over time, they are often rebuilt (thus, often initially rough and even disfiguring scars after several months, and sometimes years, become cosmetically quite acceptable).

According to the degree of contamination and the presence of signs of infection, all wounds are divided into:

• - Aseptic – surgical wounds for “clean” surgical interventions
• - Contaminated - wounds contaminated with microflora, but without signs of suppuration. These include all accidental wounds after their application and some surgical wounds
• - Infected – purulent wounds.