WOUND HEALING 5

3. LOCAL GROWTH FACTORS

These are released by many activated cells in a healing wound. These factors stimulate cell proliferation, migration and synthesis of required products. Among the cytokines is TGFB that helps all phase of healing. Topical application of TGFB acclerates wound healing.

Angiogenesis is simulated by acid and basic fibroblast growth factors (aFGF + bFGF). Epithelialisation is stimulated by epithelial growth factor (EGF) and keratinocyte growth factor (KGF).


4. CLINICAL FACTORS EFFECTING WOUND HEALING

Age: The younger the patient the more rapid the healing

Nutrition: Malnutrition impedes the healing process. The prime nutritional factors are protein,
Vitamin C for the synthesis of ground substance
Vitamin A for epithelisation
Vitamin D for bone formation

Vascularity: Highly vascular areas like face and scalp heal better than less vascular areas like the pretibial region.

This is because the level of oxygen available for the healing process is less, thus tight sutures, tight bandaging and hypotension can impede healing.

Local sepsis: This is the most common factor delaying healing of wounds in practice.

Diabetes: Wound healing is affected by diabetes. (Poor blood flow, high cortisol levels , high infections the mechanism is not understood).
Control of blood sugar restores the normal healing

Cortico: Steroid therapy impairs inflamation steroids epithelialisation and collagen synthesis

Radiation : Both have a significant effect on dividing cells chemotherapy and these effect fibroblasts and keratinocytes.
Thus both of these shoud be avoided for 5-7 days post-operatively.

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