WOUNDS 2

HEALING 2






1.2 CLINICAL FEATURES
Acute inflammation due to any cause is manifest by:
• Rubor: Redness due to the dilated vessels
• Calor: Local heat due to excess blood flow
• Edema: Swelling due to inflammatory exudate
• Dolor: Pain due to the exudate and specific pain factors
• Functio-laesor: loss of function

The inflammatory process may:
1.2.1 RESOLVE completely when the exudate is reabsorbed and the particulate necrosed cellular elements are phagocytosed.(removed by macrophages)
This is achieved when there is minimal injury, the injured part i.e. rested and the skin and deeper part are in continuity. This is referred to as healing by PRIMARY intent

1.2.2 SUPPURATION occurs following bacterial inflammation at the start of injury or when infection is superadded on the injured tissue at a later date. The pus formed is a combination of liquefied injured cells, W.B.C. and in addition dead and alive causative bacteria (thus the need of pus for culture).

1.2.3 ULCERATION occurs if the injury is close to the surface. Epithelium (skin, mucosa) is destroyed and this allows bacteria to infect the exposed deeper structures.

1.2.4 GANGRENE is diagnosed when there is change of colour and viability is lost of a large volume of tissue and, usually occurs due to injury to the blood supply of that part.

1.2.5 FIBROSIS is the end result in all varieties of above events except those that resolve. There is in all other cases, a loss of tissue which is replaced by fibrosis. There is thus a delay in return of function and in some cases there may be a permanent loss of a certain amount of function. This is healing by SECONDARY intent

1.3 MANAGEMENT
1.3.1 All inflamed parts require REST. Raising the part will reduce the pain by avoiding dependant edema. Compression dressing will also help. However, it must not be so tight as to impede arterial flow. ANALGESICS anti-inflammatory drugs and ANTIBIOTICS may be required.
1.3.2 If the patient shows swinging temperatures, throbbing pain in the part and in superficial inflammations, local edema, tense shinning overlying skin, local redness and fluctuation, an abscess must be suspected (aspirate to confirm). These patients will require drainage of the abscess under antibiotic cover using local or generalized anesthesia.

Hilton’s method of skin incision in the long axis of the limbs to avoid injury to vessel and nerves is used, the abscess is entered with a sinus forceps (Fig.1.2). The index finger is then introduced to break all the septa in the abscess cavity, which is now closed with a drain in the cavity or left open with a dressing pack. Frequent dressings will be required till the wound heals by SECONDARY intent.
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