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In medicine, there are three main types of wound healing: healing under the 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 an inflammatory process accompanied by suppuration. The edges of the wound are tightly connected and fixed, resulting in normal and rapid healing of the wound without the formation of a large amount of coarse scar tissue.

Only a thin scar remains at the site of the wound, which at first after formation has a red or pink color, 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, while there are no areas of necrosis or any foreign bodies between them, there are no signs of inflammation, and the damaged tissues have fully 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 healing method, granulation tissue first develops in the wound cavity, gradually filling all the available space, forming a fairly large and dense scar of connective tissue. Subsequently, this tissue is covered with epithelium on the outside.

Secondary healing processes usually occur against the background of fairly intense inflammation that occurs 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, only granulation tissue that is not damaged has all the protective properties, 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, minor wounds, abrasions, burns, small and shallow wounds, as well as bedsores, ulcers and other skin injuries.

During the healing process, a crust forms on the surface of the wound or other damage, having first a red and then a 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.

Treatment of minor abrasions and cuts

Abrasions and various small wounds can be treated and treated at home, on your own, but be sure to follow all the rules of care and use the right products.

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, using a gauze swab, treat the damage with a pharmaceutical solution of hydrogen peroxide, carefully wetting the surface.

There is no need to pour hydrogen peroxide directly from the bottle onto the wound. This product allows you to not only 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. Such 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 various ointments, creams or folk remedies to accelerate the formation of epithelium at the site of the former injury, 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, medications, proper care, timely treatment and changing of bandages.

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, the presence of diseases of the endocrine system and any chronic ailments.

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 sterile instruments, sterile materials, the right means to eliminate inflammation and accelerate healing, and also following the rules for changing dressings.

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To establish the healing period of abrasions / Kononenko V.I. // Forensic-medical examination. - M., 1959. - No. 1. — P. 19-22.

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/ Kononenko V.I. // Forensic-medical examination. - M., 1959. - No. 1. — P. 19-22.

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To establish the healing period of abrasions / Kononenko V.I. // Forensic-medical examination. - M., 1959. - No. 1. — P. 19-22.

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At the site of an abrasion on the body of a living person, healing processes begin to be detected quite quickly, which, during an examination, can serve as the basis for an approximate determination of the period of occurrence of abrasions. Literature data on this issue are contradictory.

The first signs accompanying an abrasion are considered to be redness and swelling, noted by Zablotsky, which, in his opinion, can persist for 8-10 days. However, other authors (A. Schauenstein, A. S. Ignatovsky, A. F. Taikov) indicate different periods for the disappearance of redness and swelling.

Data on the timing of the formation and falling off of a crust at the site of an abrasion given in the literature also differ.

The issue of abrasions was studied in most detail by A.F. Taikov, who are allocated 4 stages of healing: the first - when the surface of the abrasion is below the level of the surrounding skin (up to a day or more); the second - the formation of a crust rising above the level of intact skin - from 1 to 3-4 days; the third is the process of epithelization that occurs under the crust, the peeling of which begins from the edges and ends on the 7-9th day; fourth, the disappearance of marks after the crust falls off at the site of the former abrasion (days 9-12).

As you know, there are no scars left at the site of abrasions, but a pale pink area that disappears over time. Literary data on the period of preservation of this site are even more contradictory (N.S. Bokarius, Grzhivo-Dombrovsky, J. Kratter, E.R. Hoffman, W. Neugebauer, K.I. Tatiev, A.F. Taikov, etc.) .

As can be seen from the above, when determining the timing of the formation and falling off of the crust and the healing of abrasions in general, neither the size, nor the depth, nor their localization, nor the age of the witness and the general condition of his body were taken into account. Only A.F. Taikov points out the need to take into account the state of the central nervous system and speaks of its inhibition in fatal injuries, which affects the healing process of abrasions.

It seems to us that with the division of the healing process of abrasions into stages proposed by A.F. Taikov, we cannot agree. The healing process itself proceeds and develops gradually and cannot be limited by the listed stages. In addition, division into stages makes it difficult for experts to determine the period of formation of abrasions.

Our observations have shown that during the healing of abrasions, changes occur in them continuously, over short periods of time, especially in the initial period of healing, and these changes can be the basis for establishing the timing of their formation.

24 abrasions in people aged 11 to 56 years (mainly 11, 25, 30 and 56 years) were observed. On the first day, observations were carried out 4 times, on the second and third - 2 times, on the rest - 1 time every day. The localization of abrasions varied: lower leg, thigh, forearms, hands, neck and chest.

The table below shows signs of different periods of intravital healing of abrasions. In 3/4 of all cases, a fresh abrasion lies below the level of the surrounding skin, but sometimes at the level of the surrounding skin. Its surface is moist, soft to the touch, in most cases pinkish-red in color, but shades can vary from pale pink, brown to dark tones. During the first 24 hours, there is minor pain and the effects of infection may be observed.

On the second day, in 3/4 of all cases, the abraded surface is located at the same level as the surrounding skin, but sometimes it already begins to rise, and only a few abrasions are below the skin level.

On the third day, almost all abrasions are covered with a raised crust of brown-red color, but shades of pink-red color, sometimes dark, brown and yellowish, may also be observed.

After 4 days, the crust, as a rule, is above the level of the skin and only in those rare cases when the body’s reactivity is weakened or suppressed as a result of extensive trauma (severe bodily injury), it does not rise above the level of the surrounding skin. By the end of the 8-11th day, the crust is easily separated, but it can fall off even earlier, especially in cases where the abrasion was first smeared with iodine or brilliant green, as well as in cases of superficial abrasions of small sizes and when they are localized on the neck.

Signs detected during the healing process	Time from the moment of abrasion formation
The surface of the abrasion is mostly pink-red in color, moist, below the level of the surrounding skin, and there is whitening around it	1 hour
The surface dries out, redness and swelling around the abrasion is about 0.5 cm wide	6-12 hours
The surface becomes denser, the swelling disappears. There is a disappearance of the sometimes existing pain	24-36"
The surface is often brownish-red in color, dense to the touch, mainly at the level of intact skin. The influence of the infectious onset is reduced	2 days
The abrasion is almost always covered with a crust that rises above the skin level. Dark, brown, yellowish shades predominate. Noticeable wrinkling and reduction in size	3"
The crust usually rises above the skin level	4 "
A crust with undermined edges, its color is often red-brown, the size of the abrasion is halved	5 days
The same phenomena are expressed more sharply; peeling of the skin is observed around the abrasion	6-7"
Reducing the initial size of the abrasion by 4 times	8 "
The crust falls off (its rejection is possible earlier), a pale pink area remains in the place where it fell off	9-11"
Reducing the size of the indicated area, its color is dominated by pinkish-reddish shades	15-16 days or more
Gradual, traceless disappearance of the specified area	20-30 days

One cannot, of course, think that the signs and terms given in the table are absolute for all cases (sometimes the crusts disappear on the 6th day), but this does not exclude the possibility of using these data in the practical activities of a forensic expert.

The duration of healing also depends on the size of the abrasion. In this case, the following pattern should be noted: in superficial abrasions measuring 0.5×0.3 cm, other things being equal, the crusts separated on the 6th day, and in abrasions measuring 2×1 cm - on the 8th day. Localization is also important: when abrasions are located on the neck, the time for separation of the crust is reduced. Thus, with abrasions measuring 6x1 cm on the neck, the scabs fell off already on the 8th day.

Infection of abrasions has a significant impact on the healing process. In one case, with an abrasion size of 2x1 cm, when an infection occurred on the 4th day (suppuration), the crust separated only on the 15th day.

When determining the age of an abrasion, a forensic expert must take into account such points as the localization of the abrasion, the depth of the abrasion of the skin (superficial or deep abrasion), size, infection, lubrication of the surface of the abrasions with iodine, brilliant green, as well as the individual properties of the victim.

We studied the examination reports at the Kharkov Forensic Outpatient Clinic for the first half of 1957, in which there were descriptions of 1270 abrasions. It turned out that in 75% of cases the expert sees an abrasion on the 2nd day of its formation. In 81.4% of these cases, the abrasions were located at the same level with the surrounding skin, in 66.5% they were brown-red, in 31.2% reddish, in 2.3% yellowish-red, in all cases there was redness of the skin around the abrasion. On the 3rd day, abrasions were examined in 14.6% of cases, and on the 4th day - in 7.2%, etc. The sizes of the abrasions were different: the color of the crust on the 3rd day was mainly red-brown ( 71.9%) and only in 18.1% of cases - brown-red.

A comparison of our data on the healing of abrasions with those from the practice of the Kharkov Forensic Outpatient Clinic showed a coincidence of the detected signs during healing.

Thus, the presented data, it seems to us, can be used to judge the timing of the formation of abrasions in the practical activities of a forensic expert.

Scars (scars) - history and anthropology History of scar treatment Classification of wounds Scar classification Factors influencing scar formation Therapeutic methods for treating scars	Scar treatment with laser Treatment of scars with corticosteroids Treatment of scars with liquid nitrogen Surgical treatment of scars Scar resurfacing (mechanical dermabrasion) Photos before and after treatment of scars (scars)

Phases of wound healing and scar formation

Scars occur as a result of surgical treatment, any injury, as well as after thermal, chemical and radiation injuries to the skin, sometimes after infections. They pose a serious problem for surgeons and patients, as they remain for life and create significant cosmetic defects and sometimes cause functional impairment in the form of limited joint mobility.

The wound process is a wound healing process that begins immediately after tissue damage and includes three main phases: inflammatory, the phase of granulation tissue formation, the phase of epithelization and scar organization.

1. Inflammatory (or exudative) phase.
It begins from the moment of injury and lasts about 5-7 days.
The body's primary response to injury is to stop bleeding. During the first hours after injury, biologically active substances are released from damaged tissues, which cause vasoconstriction and activation of blood clotting factors. A fresh blood clot stops bleeding and creates conditions for further wound healing. After the bleeding stops, an inflammatory reaction develops. At this stage, a cascade of complex cellular reactions occurs, aimed at implementing the mechanism of inflammation. At the same time, platelets release cytokines (factors of intercellular interactions), which attract leukocytes and fibroblasts to the wound, and also stimulate cell division and collagen synthesis. Leukocytes accumulated in the wound phagocytose foreign bodies and bacteria. After 24 hours, macrophages appear in the wound. They not only carry out phagocytosis, but also secrete chemotactic and growth factors. Growth factors stimulate the development of skin epithelium and vascular endothelium and collagen synthesis. During this phase, the wound defect is filled with new tissue, which plays an important role in wound healing. The so-called granulation tissue develops, in the construction of which fibroblasts play a decisive role. Most often, at the end of this phase, the sutures are removed from the postoperative wound (on days 5-7). If there is tension in the suture area, it may come apart, since the edges of the wound are connected by granulation tissue and not by scar. To avoid this, tension should be minimal or eliminated.

Type of wound on the first day after surgery.

2. Proliferation (phase of formation of granulation tissue)
If the course of the wound process is favorable, this phase begins on the 7th day and lasts on average up to 4 weeks. During this phase, the wound defect continues to be filled with granulation tissue, in the construction of which fibroblasts play a decisive role. They are responsible for both the production of collagen and the basic substance of the extracellular space. Subsequently, granulation tissue matures, which consists of connective tissue, new sprouting capillaries and inflammatory cells. For vascular growth and collagen maturation, it is necessary to have cytokines in the wound, a sufficient content of oxygen, zinc, iron, and vitamin C. When the granulation lining is ready, epithelial cells settle on it and close the wound. At the end of this stage, the edges of the wound are already connected by a young, fragile scar, which still remains relatively easily extensible and clearly visible due to the large number of vessels it contains.
The scar at this time has a bright red color.

3. Formation and organization of the scar.
This phase begins around the 4th week and lasts about 1 year. Starting from the 4th week, the number of cellular elements and vessels in the scar tissue decreases significantly. There is a transformation of a brighter and more noticeable scar into a less bright and therefore less noticeable scar. The wound is finally filled with connective tissue and epithelium. Collagen growth continues: the primary delicate collagen is replaced by a rougher and stronger one. As a result, a scar is formed, the strength of which is 70–80% of the strength of the skin.
At the end of this phase, due to the contraction of smooth muscle cells, the edges of the wound are brought closer together.

The body is a complex biological system that has a natural ability to regenerate. One of the significant proofs of the existence of a self-healing mechanism is wound healing.

Each wound has a natural reparative potential, which is presented in the form of a clear, long-studied by researchers, staged healing mechanism based on physiological processes. That is, if, during the treatment of a wound, measures and drugs contribute to the physiological course of the staged wound process, the wound will heal in the shortest possible time. Taking into account the physiology of the wound process is the most important condition for effective wound treatment.

As is known, wound healing can occur by primary and secondary intention. In the first case, due to the adherence of the edges of the wound, its linearity and the minimal area of the wound surface, the wound, as a rule, heals quickly and without inflammation. Therefore, if possible, they try to subject any wound to surgical treatment by applying a skin suture. Treatment of such a treated wound in the vast majority of cases does not present any particular difficulties.

In the case of extensive wounds, when the edges of the wound are not closed and there are areas of tissue necrosis, healing occurs by secondary intention. It is when managing such wounds that heal by secondary intention that the stage of the wound process should be extremely carefully taken into account when carrying out differentiated treatment.

Treatment of wounds: stages of the wound process

Regardless of the type of wound and the degree of tissue damage, the wound process goes through three physiological stages of healing in accordance with morphological changes at the cellular and tissue level. Also N.I. Pirogov identified 3 stages. Today, the approach most often used is M.I. Cousin to the stages of the wound process.

Stage 1. Stage of exudation (vascular reaction and inflammation)

The wound at the exudation stage is characterized by perifocal edema, slight hyperemia and specific discharge.

At the exudation stage, all physiological processes are aimed at separating damaged tissues that can no longer be restored and can potentially become a source of infection and intoxication. Thus, the inflammatory process at the exudation stage helps remove dead tissue and cleanse the wound. All processes in the wound at this stage are caused by the activation of complex enzyme-catalyst systems (kallikrein-kinin, Hageman factor, fibrinogen, C-reactive protein, prostaglandins, biogenic amines, etc.)

Wound discharge at the exudation stage is usually initially serous, serous-fibrinous, with blood clots. Then the discharge becomes purulent and contains leukocytes and cells of necrotic tissue.

If at any stage of the wound process an infection occurs, the discharge becomes larger, and it takes on the appearance, color and smell characteristic of a certain type of microorganism.

Stage 2. Stage of proliferation (regeneration)

Under ideal conditions, when a wound is healed by primary intention, the proliferation stage (in particular, the synthesis of collagen by cells) begins on the second day.

When a wound heals by secondary intention, at the stage of regeneration, foci of cell division - granulation tissue - begin to appear in the most cleaned areas. They are usually pale pink in color, moist, easily damaged and therefore require protection from damaging factors.

As granulation progresses, a parallel decrease in the area (size) of the wound gradually begins due to its transition in the zone of the wound edges to the third stage.

The discharge from the wound at the regeneration stage is scanty, serous-hemorrhagic, and with the slightest trauma to the granulation tissue, the discharge becomes hemorrhagic.

Stage 3. Epithelization stage (differentiation stage)

Sometimes the epithelialization stage is called the stage of scar formation or final healing, as well as the stage of scar formation and reorganization. The discharge is already absent or practically absent, the wound is dry. Discharge can occur in case of wound traumatization, as well as in case of infection.

Additionally, it should be taken into account that the wound process in the same wound (especially if it has a large area) is almost always characterized by a one-stage multi-stage process. That is, the stages usually smoothly transition from one to another, and it is not always possible during such a transition to clearly say at what stage the wound is. After all, sometimes in some areas the wound is in one stage, and in others - in another.

Most often, epithelization begins at the edges of the wound or from the area of the so-called islands of epithelization. In this case, the rest of the wound may be in the proliferation stage.

Also, often the cleansing of the wound does not occur simultaneously over the entire surface. In some cases, the edges of the wound will clear more slowly than the center if there is more damaged tissue around the edge. Therefore, differentiated wound treatment should take into account the possibility of several stages of healing of one wound at once, and not slow down progress.

Treatment of wounds depending on the stage of the wound process: selection of the drug in the optimal dosage form

To understand how medical support for a wound can be as physiological as possible, stimulating the natural processes of wound healing, it is necessary to understand the essence of the changes that occur at different stages of the wound process.

So, although we talk about the exudation stage as the first stage of wound healing, it is, in fact, a stage of tissue disintegration (necrosis), which is characterized by inflammation.

What are the needs of a wound at the exudation stage?

Preventing the wound surface from drying out.
Possibility of free release of exudate.
Improving wound trophism to prevent increased necrosis.
Stimulation of the beginning of the formation of granulation tissue (transition to the second stage).
Mechanical assistance in removing necrotic tissue.
Preventing infection from entering the wound.

Mechanical removal of necrotic tissue and prevention of infection is achieved by primary surgical treatment of the wound and, subsequently, frequent dressings using sterile dressings and washing the wound and antiseptics. The remaining needs of the wound can only be met by using the most effective local wound treatment drug at this stage.

The requirements for a drug for local treatment of wounds at an early stage are quite simple. The drug must have a hydrophilic base, retain moisture for a long time and be convenient to use. Dosage forms that meet these requirements include solutions and gels. Solutions, unfortunately, are not able to retain moisture for a long time, so when using solutions, dressings must be done every 1.5-2 hours. That is, they are not very convenient to use.

Gels are much more promising in this sense. They are easy to use, retain moisture better, ensure exudate drainage, and do not create a fatty film. The active substance of the gel preparation for treating a wound at the first stage must have a trophic effect, which will protect the wound from excessive necrosis and stimulate its transition to the second stage.

At the second stage (proliferation), as the wound is cleansed, the formation of new tissue begins, on the basis of which healing begins. This new granulation tissue is very sensitive to damage and disruption of trophism. It can regress and even collapse. Therefore, when managing a wound, it must be protected as much as possible. To do this, a drug with the same trophic effect, stimulating collagen synthesis and cell division, but on an ointment basis, should be applied to the islands of granulation tissue and to the edges of the wound, where the most intense proliferation processes also occur.

As the second stage of the wound process progresses, more and more of the wound surface must be treated with ointment. And as a result, when the wound becomes dry and significantly reduced in size due to marginal epithelization, it is necessary to completely switch to the use of ointment. By creating a fatty film on the surface of epithelialization areas, the ointment will protect young skin cells from drying out and provide them with greater resistance to environmental factors.

At this stage, it is also important to stimulate the patient’s permitted motor activity: this tactic is justified by the fact that the patient’s activation also increases blood circulation in the wound area, which improves the healing process.

If the wound is large in area, due to the rather slow mitosis of epidermal cells at the edges of the wound, it will be difficult to achieve complete epithelization. So, on average, the epidermis can grow by 1 mm per month. Therefore, with large, clean wound surfaces at the second or third stage, they often resort to autologous skin transplantation, which will make it possible to obtain new, additional areas of epithelialization of the wound and accelerate its complete healing.

Wound treatment: differentiated use of wound-healing drugs for local treatment of non-infected wounds at different stages of the wound process

Sometimes healing wounds is a lengthy process. The duration of healing (and, accordingly, the course of treatment) depends on the nature of the wound, its area, the condition of the body, infection of the wound and other factors. Therefore, when managing a wound, the doctor must constantly analyze at what stage of the wound process it is currently located.

So, if regression occurs during the healing process, you should stop using the ointment and again return to prescribing, for example, gel forms of medications and wait for the wound to cleanse and new granulations to appear. When dry areas appear, on the contrary, it is necessary to treat them with ointments.

Differentiated treatment of wounds is one of the main conditions for their healing. And the correct choice of drugs for the treatment of wounds directly ensures the fastest healing of the wound.

Wound treatment: differentiated use of wound-healing drugs for local treatment of non-infected wounds at different stages of the wound process

Drug compound	At what stage of the wound process is it used?	Release form	Ease of use	Peculiarities
1. Acerbin	1, 2, 3	Solution	-	Versatility
1. Acerbin	1, 2, 3	Ointment	+	Versatility
2. Hemoderivative of the blood of dairy calves	1, 2, 3	Gel, ointment	+	Versatility
3. Zinc hyaluronate	2	Solution	-
3. Zinc hyaluronate	2	Gel	+
4.Dexpanthenol	1, 3	Ointment, cream, aerosol	+	Use limited to wound stage
5.Dexpanthenol with miramistin	1	Gel	+	Use limited to wound stage
6.Dexpanthenol with chlorhexidine bigluconate	2	Cream	+	Use limited to wound stage
7. Karipazim	2	Powder for preparing ex tempore solution	-	Use limited to wound stage
8. Ebermin	2, 3	Ointment	+	Use limited to wound stage

Note. When treating uninfected wounds in the first two stages of the wound process, before using local agents, the wound should be washed with an aqueous solution of one of the antiseptics to prevent infection. In addition, the skin around the wound at the beginning of each dressing is treated with an alcohol solution of antiseptics.

Fast healing of scars

Active substance:

Hemoderivat, ointment base.

Indications:

Venous ulcers
Burns
Injuries
Frostbite

Fast healing without scars

Active substance:

Hemoderivate, hydrophilic base.

Indications:

At the weeping stage for the treatment of erosions, ulcers of various origins, including radiation
Bedsores, burns
Trophic ulcers of atherosclerotic and/or diabetic origin

Early healing period(the first 12 hours after the wound) is characterized mainly by the presence of a blood clot on the surface of the wound and initial reactive phenomena of an inflammatory nature (leukocyte infiltrate around the vessels, in the intercellular spaces, in the fibrin clot; round cell infiltration of mononuclear cellular elements of the 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 in 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 such as fibroblasts appear. 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, at 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 that promote accelerated wound healing, we can call good blood supply, preserved innervation. Thus, wounds on the face and scalp heal faster due to good blood supply (however, the purulent process is more dangerous due to the structural features of the subcutaneous tissue and venous collaterals). On the contrary, local factors such as crushing and tissue separation, the presence of pockets, soft tissue sequestration, foreign bodies, nearby purulent foci, as well as additional infection of the wound slow down wound healing.

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. 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 of purulent wounds are in accordance with the doctrine of wound healing processes. Therapeutic measures should contribute to the rapid progress of the natural process, therefore, when constructing a treatment plan, be sure to take into account the period of the wound process and provide for local and general measures that improve the conditions of regeneration. These activities are somewhat different during different periods of wound healing.

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

In the degenerative-inflammatory period When active microbial activity and melting of dead cells and tissues predominate, it is important to suppress the activity of microorganisms and promote rapid wound cleansing.

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 the antibacterial agents, antibiotics are the most widely used. Due to the emergence of penicillin-resistant forms of microbes, preference is given to broad-spectrum antibiotics, the choice of which is guided by the sensitivity of the flora isolated 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, a 3% solution of boric acid is used. 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 use of a high frequency electric field (UHF) promotes the rejection of necrotic tissue and accelerates the resorption of infiltrate. 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 is no longer as important as in the previous period.

Therapeutic 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 internal environment of the body, and the wound discharge has bactericidal properties. However, the cells and vessels of granulation tissue are easily vulnerable. A slight mechanical or chemical effect damages them and opens the entrance gates to 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 are most used in the outpatient treatment of an 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 the treatment process, it is necessary to use stimulants wisely, because excessive growth of granulations delays the epithelization of the 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, surgical methods (bringing the edges of the wound together with sutures) can also be used in a complex of therapeutic measures. In the degenerative-inflammatory period, sutures are contraindicated, but after cleansing the wound and eliminating the inflammatory process, indications for the application of 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 early infants, 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, large defects sometimes remain 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.