Wound healing after surgery, drugs, dietary rules. Wound granulation

The basic principle of treating open wounds is to restore the regenerative function of the skin - nature is arranged in such a way that skin cells are able to self-repair under certain conditions. But this is possible only if there are no dead cells at the site of injury - this is the essence of the treatment of open wounds.

Stages of treatment of open wounds

Treatment of open wounds in any case involves the passage of three stages - primary self-cleaning, inflammation and granulation tissue repair.

Primary self-cleaning

As soon as a wound occurs and bleeding opens, the vessels begin to narrow sharply - this allows the formation of a platelet clot, which will stop the bleeding. Then the narrowed vessels expand sharply. The result of such a "work" of the blood vessels will be a slowdown in blood flow, an increase in the permeability of the walls of the vessels and a progressive swelling of the soft tissues.

It was found that such a vascular reaction leads to the cleansing of damaged soft tissues without the use of any antiseptic agents.

Inflammatory process

This is the second stage of the wound process, which is characterized by increased swelling of the soft tissues, the skin turns red. Together, bleeding and inflammation provoke a significant increase in the number of leukocytes in the blood.

Tissue repair by granulation

This stage of the wound process can also begin against the background of inflammation - there is nothing pathological in this. The formation of granulation tissue begins directly in the open wound, as well as along the edges of the open wound and along the surface of the closely located epithelium.

Over time, granulation tissue degenerates into connective tissue, and this stage will be considered completed only after a stable scar forms at the site of the open wound.

Distinguish between the healing of an open wound by primary and secondary intention. The first option for the development of the process is possible only if the wound is not extensive, its edges are brought close to each other and there is no pronounced inflammation at the site of injury. And secondary tension occurs in all other cases, including purulent wounds.

Features of the treatment of open wounds depend only on how intensively the inflammatory process develops, how badly the tissues are damaged. The task of doctors is to stimulate and control all the above stages of the wound process.

Primary treatment in the treatment of open wounds

Before the victim seeks professional medical help, he must thoroughly wash the wound with antiseptic agents - this will be a complete disinfection of the open wound. To minimize the risk of wound infection during treatment, hydrogen peroxide, furatsilin, a solution of potassium permanganate or chlorhexidine should be used. Around the wound, the skin is treated with brilliant green or iodine - this will prevent the spread of infection and inflammation. A sterile dressing is applied on top of the open wound after the described treatment.

It is on how correctly the initial cleaning of the open wound was carried out that the speed of its healing depends. If a patient comes to the surgeon with stab, incised, lacerated open wounds, then a specific surgical treatment is mandatory for him. Such a deep cleaning of the wound from dead tissues and cells will accelerate the healing process.

As part of the primary treatment of an open wound, the surgeon removes foreign bodies, blood clots, excised uneven edges and crushed tissues. Only after that, the doctor will suture, which will bring the edges of the open wound closer, but if the gaping wound is too large, then the sutures are applied a little later, when the edges begin to recover and the wound heals. After such treatment, a sterile bandage is applied to the injury site.

Note:in most cases, a patient with an open wound is given anti-tetanus serum, and if the wound was formed after an animal bite, a vaccine against.

The entire described process of treating an open wound reduces the risk of infection and the development of complications (gangrene, suppuration), and accelerates the healing process. If the treatment was carried out on the first day after the injury, then no complications and serious consequences are expected.

How to treat a weeping open wound

If an excessive amount of sero-fibrous exudate is present in an open wound, then surgeons will take steps to treat the open weeping wound. In general, such abundant secretions have a beneficial effect on the healing rate - they additionally clean the open wound, but at the same time, the task of specialists is to reduce the amount of exudate secretion - this will improve blood circulation in the smallest vessels (capillaries).

When treating weeping open wounds, it is important to change sterile dressings frequently. And during this procedure, it is important to use a solution of furacilin or sodium hypochlorite, or treat the wound with liquid antiseptics (miramistin, okomistin and others).

To reduce the amount of serous-fibrous exudate released, surgeons use dressings with 10% aqueous sodium chloride solution. With this treatment, the bandage must be changed at least 1 time in 4-5 hours.

A weeping open wound is also treated with the use of antimicrobial ointments - the most effective will be streptocid ointment, Mafenide, Streptonitol, Fudisin gel. They are applied either under a sterile dressing or on a swab, which is used to treat an open weeping wound.

Xeroform or Baneocin powder is used as a drying agent - they have antimicrobial, antibacterial, and anti-inflammatory properties.

How to treat an open festering wound

It is an open purulent wound that is most difficult to treat - it is impossible to prevent the spread of purulent exudate to healthy tissues. To do this, the usual dressing turns into a mini-operation - it is necessary to remove the accumulated pus from the wound with each treatment, most often drainage systems are installed so that the pus is provided with a constant outflow. Each treatment, except for the indicated additional measures, is accompanied by the introduction into the wound antibacterial solutions - for example, Dimexide. To stop the necrotic process in an open wound and remove pus from it, specific agents are used in surgery - Trypsin or Chymopsin powders. A suspension is prepared from these powders by mixing them with novocaine and / or sodium chloride, and then sterile wipes are impregnated with the resulting agent and filled directly into the cavity of an open purulent wound. In this case, the bandage changes once a day, in some cases, medical wipes can be left in the wound for two days. If a purulent open wound is characterized by a deep and wide cavity, then these powders are poured directly into the wound, without the use of sterile wipes.

In addition to such a thorough surgical treatment of an open purulent wound, the patient must be prescribed antibacterial drugs () orally or by injection.

Features of the treatment of purulent open wounds:

After cleaning the open wound from pus, Levosin ointment is injected directly into the cavity. This drug has antibacterial, anti-inflammatory, and analgesic effects.
For medicinal dressings in the treatment of an open wound with purulent contents, Levomikol ointment and Synthomycin liniment can be used.
Baneocin ointment will be most effective in the treatment of open wounds with identified, Nitacid ointment - in the treatment of wounds with diagnosed anaerobic bacteria, Dioxidine ointment generally refers to a universal remedy - is effective in most types of infections, including against and gangrene pathogens.
Most often, in the treatment of open purulent wounds, surgeons use ointments based on polyethylene oxide; modern medicine refuses vaseline / lanolin in this case.
Vishnevsky's ointment helps to get rid of pus in an open wound - it dissolves infiltrates, and increases blood flow in the wound. This drug is applied directly to the wound cavity 1-2 times a day.
When treating a patient with an open purulent wound in a medical institution, detoxification therapy is necessarily prescribed and carried out.
Ultrasound or liquid nitrogen may be used to speed up the wound healing process in the hospital.

Creams and ointments for treating wounds at home

If the damage is minor, there is no extensive cavity, then such open wounds can be treated at home with the help of various ointments. What experts recommend to use:

Folk remedies for open wounds

If the wound is not wide and deep, then some folk remedies can be used to speed up its healing. The most popular, safe and effective include:

aqueous solution - it helps with weeping open wounds;
a decoction based on flowers, eucalyptus leaves, garden raspberry sprigs, calendula flowers, St. John's wort, heather, elecampane, yarrow, calamus root and comfrey;
a remedy made from aloe juice, sea buckthorn oil and rosehip oil (everything is mixed in equal proportions) is effective in the treatment of shallow open and dry wounds.

Note:before using folk remedies in the treatment of open wounds, you must make sure that the victim is not allergic to any of these medicinal plants.

It is best to entrust the treatment of open wounds to professionals - surgeons will be able to determine the beginning of the development of the infectious process in time, and select an effective treatment. If a decision is made to dispense with therapy at home, then it is necessary to carefully monitor the condition of the victim. In the event of an elevated body temperature, pain at the site of injury of unknown etiology, it is urgent to seek professional medical help - it is quite possible that a dangerous infectious process is progressing in the wound.

Wounds are damage to the skin and underlying tissues of varying degrees of depth and breadth. It is impossible to protect yourself from such injuries with a guarantee, you can only influence the healing process. In order for the recovery process to go as quickly as possible, special preparations that enhance tissue regeneration, as well as folk remedies and proper nutrition, help.

Stages of wound healing

Wounds of any origin in the healing process go through three successive stages:

Inflammation. The duration of this phase is about 5 days from the moment of injury. It is characterized by edema and an increase in the temperature of adjacent tissues arising from vasodilation and infiltration, pain. At this time, leukocytes migrate to the wound, which cleanse it of dead tissue. The filling of the defect begins with a special granulation tissue with many capillaries,
Regeneration. At this stage, lasting 1-2 weeks, special fibroblast cells actively synthesize elastin and collagen for healing. Edema subsides, pain and temperature decrease. Granulation tissue fills the wound, and a layer of epithelium is formed on top - the damage is delayed.
Scar formation. This phase lasts at least six months, during which the primary scar thickens and reorganizes. This happens due to the transformation of the granulate into connective tissue.

If the wound heals quickly and without complications, we are talking about healing by primary intention.

When an infection joins at the stage of inflammation and suppuration occurs, the wound heals with a longer secondary intention.

Factors affecting healing

The duration of each phase of healing may differ significantly from the indicated time. In this case, the difference can be both in the direction of decrease and increase. It depends on many factors.

Accelerating healing

The following factors contribute to a quick recovery:

Age. The younger the patient, the faster tissue healing occurs. In childhood and youth, the ability of tissues to regenerate is maximum.
No wound infection. Any inflammatory process increases the regeneration time.
Proper nutrition provides strong immunity and the presence of all the necessary nutrients for the recovery process.
Quality and timely first aid. If the wound was immediately washed and treated with an antiseptic, the likelihood of suppuration is minimal.
Careful care. Regular dressings and supportive drug therapy promote healing.

In addition, not too extensive and deep damage is healed faster.

slowing down healing

Negatively, the rate of tissue repair is affected by factors such as:

Elderly age. Over the years, metabolism slows down and, accordingly, the regenerative capabilities of the body.
Availability chronic inflammatory diseases, diabetes mellitus, immunodeficiency states (HIV, AIDS and others), skin diseases.
wound infection pathogenic bacteria, which leads to suppuration and significantly delays the healing process.
Incorrect first aid and inadequate wound care subsequently contributes to infection.

Note! As a rule, deep and extensive wounds heal longer, even if the victim was provided with high-quality medical care and all medical prescriptions were observed.

How to speed up wound healing

It has a great influence on the course and duration of treatment.

Correct actions - washing, decontamination and a sterile dressing - prevent complications and contribute to a quick recovery. The faster the wound is treated, the more thoroughly it is cleaned, the less likely it is to do without infection.

When suturing for speedy healing, it is necessary to treat the wound with brilliant green, iodine, or simply alcohol.

Photo 2. Iodine can only be applied to abrasions and shallow cuts, as well as to the edge of the wound. Source: Flickr (kenga86).

Should bandage the wound 1-2 times a day. It is important to be sterile and treat instruments with alcohol, wash hands thoroughly and dry hands using only a clean towel and sterile dressing material.

Note! Before each dressing, the wound must be cleaned. It is recommended to wash it with antiseptics - hydrogen peroxide, Miramistin, Chlorhexidine.

The choice of means for healing depends on what type of damage has. Wet and dry wounds are treated with different means.

Do not use on wet wounds., since the film that forms on its surface in this case will stop the outflow of fluid, and healing will be delayed. It is possible to treat a wound with means for accelerated healing only if there is no inflammation.

As soon as the wound begins to dry out, you need to change the remedy. It is better if another form of the same drug is used, for example, the gel is replaced with an ointment. In this case, the use of the bandage can already be canceled, or it can be applied a couple of hours after the wound has been treated.

Medicines

For treatment, pharmaceutical preparations for topical use in various dosage forms are used:

Methyluracil ointment. Anti-inflammatory drug that increases local immunity and stimulates regeneration. It is used at the stages of inflammation and recovery for wounds of any type, including purulent ones (in combination with antibiotics). It is applied under the bandage with a thin layer twice a day, the course of treatment is from 2 to 16 weeks.
Dexpanthenol and other products based on it in the form of gels, sprays and creams. They have wound healing properties. Used from the moment of injury (after its disinfection). Aerosols can be applied without dressing to dry wounds, for wet wounds gels and creams are used (under a bandage). Frequency and duration of application - at least 2 times a day until complete healing.
Solcoseryl or Actovegin. These ointments promote the production of collagen, accelerate cellular metabolism and oxygen exchange in tissues. Designed for dry wounds, applied 1-2 times daily (with or without a bandage) until an elastic scar is formed.
Curiosin. Drops and cream contain a zinc compound with hyaluronic acid, which provide an antibacterial effect and activate skin cell division. Suitable for any wounds, applied twice a day: the gel is applied without a bandage, lotions are made with the solution. The duration of treatment is not limited (until healing).
Contractubex. The ointment should be used at the stage of regeneration, since it inhibits the development of connective tissue cells from which a rough scar is formed. Not suitable for purulent and wet wounds. The course of treatment is 4 weeks, during which the ointment is applied in a thin layer 2-3 times daily (under the bandage).

Folk remedies

Used as adjunctive therapy.

To speed up regeneration, you can do lotions from decoctions of calendula, chamomile or oak bark.

Usually they take a tablespoon of raw materials in a glass of water, boil for 15 minutes and use after cooling and straining several times a day.

Apply compresses from juice or cut leaf aloe.

Propolis in the form of a home-made alcohol tincture (1 part of propolis is infused for 10 days in 10 parts of alcohol) to lubricate wounds, promotes healing.

Mummy: 0.2 g of the substance is dissolved in a glass of water, the resulting solution is drunk daily at night, and is also used for washing the wound and compresses.

Nutrition to maintain the body

An organism that receives the necessary trace elements and vitamins with food is able to recover faster.

In order for wounds to heal faster, the menu must have a lot of vitamins(fresh vegetables and fruits) and protein foods. Namely lean meat, fish and poultry, dairy products. Protein necessary for the synthesis of elastin and collagen fibers, due to which healing occurs.

Vitamin complexes

Supportive therapy in the form of taking vitamins is mandatory at all stages of wound healing.

You can take regular multivitamin complexes or vitamin preparations with a high content of essential components. Particularly important antioxidants C, E, and B-group vitamins. They increase the body's ability to heal itself.

Quite a lot of people get various injuries and wounds. Everyone is subject to this and no one is immune from accidents that bring abrasions, wounds, etc. most often wounds are received by children, adolescents, and, of course, people who are actively involved in sports. The reasons for this may be different, so everyone should know what means contribute to the rapid healing of wounds.

Wound healing is a rather complex and often long process that demonstrates the ability of the human body to regenerate and restore. Fortunately, there are many different means by which the healing process of wounds can be accelerated and at the same time complications can be prevented. Of course, not a single wound will heal in a couple of days, since the process of its healing proceeds directly according to the laws of our body and, depending on what happens in it, wounds will also heal.

The time of wound healing largely depends on the state of the human body, immunity, the presence of diseases and much more. For our part, we can only assist our body in passing through all stages of wound healing as quickly as possible. But for this you need to know what affects the speed of wound healing.

External factors affecting wound healing

If the wound is treated immediately and done correctly, and in the future to choose the right treatment, then perhaps the recovery will go faster. It is necessary to treat the wound immediately after its appearance, but this must be done very carefully. Dirt and dead tissue should be immediately removed from it, while the wound itself should not be touched.

It is advisable to immediately consult a doctor after treatment, and if the wound is deep, then this is simply necessary. It will be better if first aid is provided by a specialist, since suturing may be necessary, and it is strictly forbidden to do this on your own.

If you see that the wound is not deep and not serious, and you think that you can handle the treatment yourself, treat the skin around the wound with any antiseptic, apply a sterile bandage for the first time, and after a couple of hours, be sure to bandage it. Make sure that you have bandages, tweezers and scissors at home that need to be constantly treated with alcohol, wound healing drugs and antiseptic solutions.

Keep bandages and plasters in your first aid kit in case of wounds.

Important to know about wound healing

Wound healing directly depends on factors such as the state of the body as a whole and the presence of diseases. The wound will heal quickly if the body has enough resources for this, including high immunity. But everyone's body is different, so the immune system can be weakened for various reasons. If you have chronic diseases that slow down the healing process of wounds, you should not expect a quick effect.

Even if you are completely healthy and have good immunity, if the wound and the skin around it are not properly treated, it will still heal more slowly.

Intrinsic Factors Delaying Wound Healing

There are a number of diseases in which wounds will heal slowly:

diabetes;

obesity;
dermatitis, eczema, psoriasis;
liver and kidney failure;
depletion of the body (including those caused by diets);
hypovitaminosis;
immunodeficiency;
oncological diseases.

Also, internal factors include the state of the body after chemotherapy, and the body of a smoker. Therefore, when healing is slow, it is necessary to undergo an examination in order to identify the reasons for this. The disease must be treated or taken into account in the treatment of wounds, otherwise they will heal for a long time.

Other Factors Affecting Wound Healing

The following factors also have an important effect on the rate of wound healing:

regularity of dressings (it is necessary to carry out once or twice a day, depending on what kind of wound and what remedy is used to heal it);

regular treatment of the skin around the wound (to prevent infection);

sterility of dressing materials, cleanliness of the instruments used (infection prevention);

a correctly chosen agent that accelerates healing (should include an active substance that stimulates healing and improves tissue nutrition in the wound area);

when choosing a drug - the correct consideration of the state of damage (use jelly products while the wound is still wet, but when the wound begins to dry out, use ointment products).

Pharmaceuticals that accelerate wound healing

Ointment "Eplan"

This is a universal remedy that is used to treat dermatitis, burns, ulcers and wounds. The tool has microbicidal properties, thanks to which it actively fights infection. Therefore, this ointment is simply necessary to treat a fresh wound that has been contaminated. In addition, it has regenerating properties.

Pharmacies sell effective wound care products

It is worth noting that this ointment cannot be used to treat wounds that bleed. The ointment has an anticoagulant effect, which means a deterioration in blood clotting. Eplan can be used to treat wounds in children, since the ointment does not contain antibiotics, toxins or hormones.

Solcoseryl

This remedy is well suited for the treatment of any wounds. Its use is especially effective on clean wounds that require rapid healing. The ointment must be applied to the wound several times a day in a small amount. It will protect the wound from getting bacteria and microbes into it, has an analgesic effect, accelerates the processes of regeneration and metabolism.

Levomikol

Such an ointment is applied to a non-sterile wound with inflammation, and covered with a bandage. The tool kills the infection, quickly penetrating to the focus of inflammation.

Baneocin

The ointment has an excellent wound healing and bactericidal effect. It quickly relieves inflammation, so its use is necessary in the treatment of wounds and burns of varying degrees. The composition of this tool contains two antibiotics - bacitran and neomycin.

Means for quick healing of wounds from traditional medicine recipes

As well as pharmacy ointments, there are also a lot of traditional medicine that can be prepared at home. At home, you can prepare an ointment that can heal even festering wounds.

You can make your own wound healing ointment

Recipe #1

It is necessary to take one tablespoon of goose cinquefoil juice, add sixty grams of melted pork fat to it. The mixture must be mixed, allowed to stand warm for a while, then mixed again to obtain a homogeneous mass. Add a teaspoon of beeswax (natural) and a little propolis to the mixture. Put the mixture on the fire, bring to a boil and cook for five minutes. Leave the mixture in a warm place for two hours, and then place it in the refrigerator so that the ointment becomes thick. Every hour it must be mixed well, then the mixture will thicken evenly. The ointment is applied to the wound under a bandage. You need to store it in the refrigerator.

Recipe number 2

Take fresh shoots of St. John's wort, cut them and fill a half-liter jar with them by a third. Add olive oil there and heat the jar in a pot of water for half an hour. The tool must be infused for three days, then drain the oil and carefully squeeze the grass. Store the oil in the refrigerator, and just wet the wound with it several times a day.

Recipe number 3

Peel a large onion and hold it over an open fire until the top layer is too black. Then remove this layer, and put the middle of the bulb on the open wound, fix it with a tight bandage. The bandage must be kept for a day and, if necessary, repeat the procedure several more times.

This method is quite effective, since the onion cleans wounds well and restores tissues. For small cuts, you can use the onion film, which is located between its layers. Peel off the thin film and apply to the wound. This will stop the bleeding, have a disinfecting effect and quickly heal the wound.

Recipe #4

Take one tablespoon of the following herbs: yarrow, St. John's wort, sweet clover. Mix the herbs, pour a small amount of water and put on fire. Bring the mixture to a boil, then simmer for about half an hour over low heat, then cool. Spread boiled herbs on gauze and apply to the wound in the form of a compress. Keep the lotion on the wound for an hour. Such lotions contribute to the extremely rapid tightening of wounds.

Recipe number 5

Soak one tablespoon of calamus root in alcohol. Put to thaw for two weeks in a dark place. Soak a cotton swab in the tincture and apply to the wound. This tool speeds up healing and prevents infection.

Recipe number 6

You will need pine tree resin, some beeswax and butter. Pound the resin of coniferous trees into powder and freeze. Melt the wax in a water bath, and as soon as it begins to thicken, add butter to it and mix well. Add resin to this mixture. You need to store such an ointment in the freezer.

There are many more ways to prepare traditional medicine that contribute to the speedy healing of wounds. For example:

Hydrogen peroxide and aloe. If the wound is not deep and not too dangerous, immediately after its appearance, rinse the edges with hydrogen peroxide and apply a fresh, freshly cut and cut lengthwise aloe leaf. Put a bandage on top and leave overnight. This plant covers the wound with a thin film, previously disinfecting it and pulling out purulent formations. Promotes rapid healing.

White lily tincture. Place white lily flowers in a dark glass jar, fill with vodka and leave to infuse in a dark place for ten days. Apply to the wound as a compress.

Tincture based on birch buds. This tool is effectively used for abscesses, long-term non-healing wounds. Fill a third of the bottle with birch buds, fill with vodka to the top and insist for ten days. Lubricate the wounds with the resulting tincture.

It is worth remembering that no matter how effective pharmacy ointments and folk remedies are, a visit to the doctor when wounds appear is necessary.

Everyone in the course of daily activities receives minor cuts, cracks, abrasions, minor burns or other superficial skin wounds. These small wounds are often very annoying and not serious enough to warrant a visit to the doctor. Typically, these changes are not dangerous, but can cause great discomfort. That is why it is very important to speed up the healing process. So how do you heal a wound quickly?

Acute and chronic wounds

Wounds are divided into acute and chronic. Acute ones occur after cuts or operations. These wounds heal quickly (2-7 days) and, if properly cared for, are not a major problem. Chronic wounds, those that do not heal within a week, even though hygiene is maintained. In this situation, not only the treatment of wounds becomes a necessity, but, above all, to find the reasons for this. Non-healing wounds may indicate a serious illness of the body.

Chronic wounds are more likely to affect the elderly. There may be several reasons. Worse tissue regeneration, the inability of the elderly to treat a wound, serious illness, such as a difficult-to-treat wound in diabetes (permanently elevated blood sugar leads to damage to the arteries, a process that ends in injuries and even amputation of the foot), or venous insufficiency when wounds are the result of nutritional disorders of the leg tissues.
A wound that does not heal within two weeks should be cause for concern. Especially when there are additional symptoms such as redness, swelling, or pain that indicate an infection or inflammation. You should then immediately go to the doctor to determine the cause. The sooner the treatment is carried out, the greater the chance for rapid healing.

1. Formation of wounds

In order to understand what are the possibilities of accelerating the process and what substances can affect the healing process, it is worth referring to the individual stages of the process. Injury to the skin triggers an inflammatory response, which leads to the accumulation on the surface of a fluid that contains, among other things, growth factors, and whose main function is to stimulate the proliferation and migration of immune cells to the wound area. These substances work best in a moist environment, and drying an open wound greatly prolongs the healing process. Under the influence of the above factors, epithelial cells and intact hair follicles grow to cover the injury site and lead to the formation of a new epithelium covering the wound. In this case, the wound heals without scarring.

2. Stages of wound healing

As we can see, the healing process is complex and involves many defense and regeneration mechanisms in our body.

First of all, it is very important for the healing process to properly clean the wound. The skin should be cleaned under running cold water or an inert liquid such as saline. The use of substances containing alcohol, iodine, to cleanse damaged skin is not desirable, and the use of such compositions can additionally irritate the skin and cause large wounds. In addition, such opening of the wound causes drying, which delays the regeneration of the epidermis and makes it an easy target for microbes. In order to speed up the healing process, keeping the wound surface moist is essential. Such an environment delays the formation of a crust. It is worth after cleaning the wound, apply a substance that provides a moist environment in the area of \u200b\u200bdamaged skin.

Several types of bacteria always live on human skin, which usually do not pose a danger to the body, but during skin damage, there is a risk of infection. In addition, in the case of wounds, abrasions and burns, we are exposed to a number of bacteria in the external environment. That is why the drug applied to the wound surface must have antibacterial properties.

3. Speed up wound healing

A good choice for these minor skin lesions is a combination preparation in the form of an ointment for topical application to the skin. The dosage form provides sufficient moisture to the wound so that the healing process continues as quickly as possible. It is desirable that such a composition has a composition of active substances with antibacterial activity. The influence of antibiotics reduces the risk of developing resistant strains.

Healing stages

Wounds, scratches, cuts, happen every day. To facilitate understanding of first aid in such cases, you should know the four stages of treatment:

1. Inflammation

The body's immediate defensive response to any injury is to dilate the blood vessels to speed up the transport of blood to the injured tissue—the blood vessels become more permeable, allowing fluids and white blood cells (leukocytes) to be carried from the blood to the tissues. An increase in blood flow causes unpleasant, but transient symptoms:

- an increase in tissue temperature due to an increase in blood circulation;
- redness due to vasodilation (vasodilation);
- edema caused by exudation of blood to the tissues;
- pain due to increased tension and excess fluid in the tissues.

2. Thrombus

After a wound, for at least 10 minutes, depending on the extent of the injury, the body forms a clot (thrombus) that connects the edges of the wound to prevent excessive blood loss.

3. Removal of dead tissue.

White blood cells begin the process of absorption of microorganisms, dead cells and foreign substances, having previously cleaned the wound site. The damaged cells then release chemicals to stimulate blood flow and attract more white blood cells to the site of injury. Dead white blood cells containing excess microorganisms and decomposition products are partially removed through the lymphatic system and partially form a purulent discharge.

4. Wound healing.

In the following days, common tissues and epithelium grow, replacing the damaged surface of the skin. In the case of extensive injuries, a scar forms over the entire surface of the wound. The immune system and white blood cells play another important role, producing antibodies that help the body fight infection. Therefore, the healing process proceeds smoothly if the general health of the patient is good. A weakened immune system greatly reduces the body's ability to fight infections and impairs wound healing. The fever that occurs with extensive injury from an infection is part of a defense mechanism that helps fight infection (an increase in body temperature does not encourage the development of harmful microorganisms) and speeds up the healing process (fever increases the flow of blood and nutrients to the area of injury).

First aid

- Stop the bleeding

A bleeding wound requires the immediate application of direct pressure. A piece of clean material that absorbs moisture, such as gauze bandages, towels, or a napkin, is placed in place of the wound and pressed firmly. If possible, the victim himself should clamp the wound, because he knows better with what force to do this. In general, pressure stops bleeding within 1-2 minutes. If blood leaks out, another layer of material must be applied and pressure continued. It is safe to apply a sterile compress to open wounds. Very severe bleeding can be quickly stopped using a hemostatic agent.

– Reduced pressure in damaged blood vessels

Wound treatment should be carried out as soon as possible to prevent infection and injury to the skin. The entire area around the injury site is washed with soap and water, hydrogen peroxide, antiseptic or water. This reduces the number of bacteria, foreign objects, and dead tissue fragments that threaten the wound. The wound (wound surface) should be gently washed with water and gauze or a cotton swab 2 times a day, in the direction from the wound outward, to avoid infection with skin bacteria. Then stick a patch and leave it overnight. The patch should only be applied when the wound is wet.

- Wound dressing

Exposure to air causes the formation of crusts, which slows down the process of growing new cells. Therefore, a sterile bandage with plastic or gauze lubricated with petroleum jelly is applied to the wound. This prevents the wound from drying out and allows a small amount of air to enter. Cell regeneration is faster in moist tissues.
After the bleeding stops, wrap the wound with an elastic bandage in the right direction - the blood should flow freely. The bandage must be controlled, it should not interfere with blood circulation.

Ways to accelerate wound healing

In modern regenerative medicine, hygiene without the use of chemicals is preferred. The method of maintaining hygiene affects the healing rate of all skin lesions. Chemical cleaning of the wound with products (soaps, gels, shampoos, etc.) can irritate the wound and delay the healing process, but cleaning is necessary to prevent the development of a secondary infection.
Therefore, the original solution is to maintain daily hygiene using a natural air-water sterilizing effect. Thanks to this, the healing process goes without interference, intensifies and occurs much faster. In addition, the microbubbles perform a unique micro-massage that stimulates blood flow within the wound. For these reasons, the constant use of microbubbles in daily hygiene significantly reduces the appearance of scars.
Japanese experts in water nanotechnology have developed and patented homemade drug bubble generators in the form of shower heads and systems, bath faucets.

Traditional medicine for healing

Herbal infusions and oils can be added to the bath to further enhance the therapeutic effect.

Herbs are wound healing.
The compress is soaked in a chilled and strained solution of herbs, and then applied to the wound. Recommended tinctures: nettle, sage, yarrow and St. John's wort.
Ointment for wounds.
The best are ointments containing broad-spectrum antibiotics, such as Fenistil or Bipanten. People using antibacterial ointments show 30% faster healing and less scarring. Popular ointments containing preservatives can cause allergies - redness and itching around the wound, which can cause a secondary infection. Preparations containing components are the best alternative for local treatment of wounds with pharmaceutical preparations. Recommended: green clay, honey, ointments based on echinacea, arnica, marigold and oregano, broom, coconut, argan oil and essential oils to support wound healing:

rosemary oil;
essential oil of bergamot;
patchouli oil;
rose oil;
geranium oil.

Allantoin facilitates the separation of necrotic tissue and wound cleansing, stimulates the epidermal mucous membranes and skin. Hyaluronic acid as a component of the skin plays a key role in all stages of wound healing: accelerates wound scarring and clot formation (at least 3 times faster). Promotes renewal of the epidermis. Hyaluronate-containing preparations are recommended as a supplement for the healing of all types of wounds.

A DOCTOR should be contacted in the following cases:

- blood from the wound pulsates and its color is light red - this may be due to damage to the artery;
- it is not possible to remove all foreign bodies from the wound;
- an injury to a place where there should not be a scar, for example, a face;
- around the wound there is pus or redness along the edges of the wound wider than a finger;
- a large wound in which the bottom is visible - it needs to be sewn up!
- the wound is deep and may result in damage to blood vessels, nerves, tendons, ligaments and / or muscles (for example, puncture wounds.)
- a wound caused by a bullet - a gunshot wound;
- any wound on the head, serious wounds of the abdomen and chest;
- the injury does not begin to heal within 24 hours;
Need injections for tetanus. The large surface of the wound and its contamination with earth, objects that were in the ground, dust are indications for the introduction of antitetanus serum. If you do not remember the last time you received a dose of vaccine, be sure to see a doctor on the day of the injury!

If the wound does not heal - the reasons

It is true that chronic wounds are difficult to heal, especially in the elderly. However, wound problems are often associated with non-compliance with the rules of behavior - the wrong choice of hygiene, medicine, or neglect of them. Very often, therapeutic measures are directed only at the wound, and not at the removal of the cause. And this is a mistake! Wound healing depends primarily on the underlying disease.

The most common mistake that prevents wounds from healing is changing dressings too often.

The rule is this: the dressing should be changed as often as necessary and as little as possible. In the case of chronic wounds, it is changed once a week, and with abundant discharge from the wound - every 2-3 days. Frequent change damages new, soft tissue and destroys reparative processes.

The second mistake is to pour disinfectant liquids into the wound (for example, hydrogen peroxide or salicylic alcohol, as well as iodine).

Wounds are also not treated with antibiotics. These disinfectants and antibiotics cause damage to healthy cells and slow wound healing.

The safest environment for a wound is normal saline and preparations that prevent the entry of pathogens and infections from outside, but do not damage the wound environment. Vaseline or zinc-based ointment also cannot be classified as a good solution. They are only used to protect the skin around the wound.

1. Wounds are irrigated with saline, 0.9%, or Ringer's solution. Do not use disinfectants - alcohol, iodine or hydrogen peroxide, because they destroy the newly formed very delicate skin and granulation newly formed tissues.
2. Avoid frequent and excessive application to the wound (without medical advice) of ointments, creams and gel.
3. The wound must be in a humid environment, thanks to modern dressings. They do not stick to the wound surface, so they do not cause tissue damage and pain.
4. The skin around the wound is nourished with preparations with a slightly acidic PH, which inhibits the growth of harmful bacteria.
5. The wound should not have any contact with clothing and the dressing should be positioned to prevent contamination.
6. Depending on the stage of healing, the doctor indicates the frequency of dressing changes, preferably once a week.

Preparations for rapid wound healing

There are hundreds of different types of drugs. They can be divided into the following types:

hydrogels (For example, Intrasitegel, aquagel) - capable of absorbing exudate, maintaining high humidity, and also having cleansing properties, which leads to hydration of necrotic tissues;
hydrocolloids (eg Granuflex, Tegasorb), which are in the form of layered plates and form a gel upon contact with the exudate, which occurs during the granulation process;
dextromers (For example, Acudex, Debrisan) - dressings consisting of polysaccharide grains form a gel upon contact with wound exudate; used to treat large, deep, and infected bedsores;
alginates dressings (eg Kaltrostat, Tegagel.) - dressings, natural polysaccharides derived from seaweed with very high absorbent properties;
semi-permeable polyurethane film (eg, Opsite, Tegaderm.) - Able to allow free evaporation from the surface of the wound exudate, but not permeable to water and bacteria from the outside.

How to speed up wound healing?

1. Medicines applied topically

The classic plaster or dressing has now been replaced by the so-called hydrocolloid dressings. Preparations of this type Fenistil for wounds. Acid hydrocolloid creates optimal conditions for wound healing. Provides sufficient moisture to dry wounds, absorbs excess exudate from the wound, protects against external factors. As a result, the dressing hydrocolloid accelerates tissue repair and reduces scarring. Such a bandage can be applied to the wound surface, such as minor abrasions, cuts and wounds - bedsores. They should not, however, be applied to festering wounds. The drugs are applied directly to the wound. In addition, you can apply a regular bandage or plaster on top.

To accelerate the healing of serious wounds, Solcoseryl is prescribed in the form of a gel on a wet wound and Solcoseryl ointment on a dry wound and Curiosin gel. The preparations are applied to the cleaned wound 2 times a day. The active ingredient of Solcoseryl is dialysate from the blood of calves, which facilitates the access of oxygen and nutrients to the cells inside the wound. In Curiosin, the active ingredient zinc hyaluronate provides adequate hydration and an appropriate response of inflammatory cells.

For slow-healing, purulent wounds, drugs can be used to speed up the cleaning. Ichthyol ointment has an anti-inflammatory effect, slightly astringent. It can be used for boils, 2-3 times a day. The drugs may temporarily irritate the skin.

The new skin that forms must be properly hydrated and nourished from the outside. It is necessary to apply ointments or moisturizing creams with allantoin (Alantan), dexpanthenol (Bephanten, Dermopanten), vitamin ointments. Creams are safe and can be used several times a day for adults and children.

2. Diet and nutritional supplements to speed up healing

For large cuts, surgical wounds, it is important to supplement the amount of vitamin C in the body. It participates together with the amino acids lysine, proline, in the formation of collagen, which is a kind of scaffolding for cells. The body cannot synthesize vitamin C and lysine, so it must be obtained from the diet. Foods rich in lysine are hard cheeses, legumes, fish, meat. Take high vitamin C supplements - 1 g, preferably of natural origin.

Before surgery, and to promote skin regeneration, it is worth enriching your diet with omega-3 preparations, taking flaxseed oil, B vitamins, especially vitamin B5, vitamin A and E.

What to eat to speed up healing?

Carnosine.
It should be borne in mind that the wound healing process is supported by carnosine. As a rule, the main source of carnosine is beef and pork. If, however, for various reasons, the patient cannot eat meat, preparations containing carnosine should be taken. Carnosine is thought to help heal pressure sores (and prevent new ones from forming), but it actually helps heal all wounds. Colostrum, or the first milk that is produced after childbirth, is a unique immune support system. Colostrum accelerates the healing of all types of wounds.

Clinical course and morphology of wound healing

Wound healing is a deterministic biological process that lasts about a year and ends with the formation of a mature scar. However, in the future, the tissues that form the scar continue to change, albeit to a minimal extent.

From a practical point of view, several periods can be conditionally distinguished in this biological process, during which two main indicators change significantly, the most significant for both the surgeon and the patient:
1) strength and external characteristics of the skin scar;
2) the possibility of elongation and restructuring of deep scars under the influence of tissue movement (movement of muscles, tendons, etc.).

Table 12.1.1. Clinical and morphological characteristics of the stages of uncomplicated healing of a sutured surgical wound

Stage 1 - postoperative inflammation and epithelialization of the wound (7-10 days). During this period, the processes of postoperative (post-traumatic) inflammation occur in the wound, after the resolution of which the edema decreases and, under certain conditions (uncomplicated course and comparison of the edges of the skin), epithelialization of the skin wound occurs.

A distinctive feature of this stage of the wound process is the fact that the edges of the wound are connected to each other by a very fragile granulation tissue, and not by a scar. Therefore, after the removal of the sutures on the 7-10th day, the edges of the wound can easily disperse under the influence of even a small load. In order to obtain a minimal width of the skin scar in the future, the edges of the wound must be held with sutures for a much longer period of time.

It is also very important that during this stage the sliding structures involved in the healing process of the wound (tendons, muscles, ligaments) remain mobile, however, their uncontrolled movements can enhance the process of postoperative inflammation and thereby worsen the quality of future deep scars.

Stage 2 - active fibrillogenesis and the formation of an unstable scar (10 - 30 days after surgery). During this period, in the young granulation tissue located between the edges of the wound, the active formation of collagen and elastic fibers begins, the number of which increases rapidly. This tissue matures rapidly, which is accompanied by a decrease in the number of vessels and cellular elements, on the one hand, and an increase in the number of fibers, on the other. After this stage is completed, the edges of the wound are already connected by a scar, which remains stretchable and visible to others.

Deep scars during this period are still able to rebuild as much as possible when moving the sliding structures involved in the reparative processes. Therefore, it is at this time that surgeons begin to use special techniques aimed at restoring the mobility of tendons, muscles and joints. From this point of view, this period is key in restoring the function of tendons that have a significant amplitude of movement and are located in canals with dense walls (flexor and extensor tendons of the fingers in the corresponding zones, capsule and ligaments of the joints).

Finally, this phase is different in that the tissues involved in the reparative processes are still sensitive to any additional trauma, including that caused by uncontrolled movements.

Stage 3 - the formation of a strong scar (30-90 days). This stage lasts for the 2nd and 3rd months after the injury (surgery). During this period, the number of fibrous structures in the scar increases significantly, and their bundles acquire a certain orientation in accordance with the dominant direction of the load on the scar. Accordingly, the number of cellular elements and vessels in the scar tissue is significantly reduced, which is manifested by an important clinical trend - the transformation of a bright and noticeable scar into a less bright and less noticeable one. It should be noted that under unfavorable initial conditions, it is at this stage that the hypertrophic growth of scar tissue begins.

At the 3rd stage, internal scars are also significantly strengthened, which gradually lose their ability to rebuild and elongate. It should be noted that the formation of deep scars in conditions of complete 3-month immobilization of the limbs often leaves patients with no chance of restoring the function of sutured tendons, especially if they have a significant range of motion and are surrounded by dense tissues (for example, finger flexor tendons). The joint capsule also loses its extensibility, especially after damage to its elements and the surrounding ligamentous apparatus. Under these conditions, effective rehabilitation involves appropriate surgical operations.

On the other hand, upon completion of the 3rd stage, almost full load on the sutured tendons and ligaments can be resolved.

It is important that at the 3rd stage of wound healing, the intensity of reparative tissue regeneration processes changes significantly: from relatively high to very low. We also note that during this stage, a significant influence on the characteristics of the resulting scar is exerted by the effect of tensile forces on it. So, with longitudinal stretching of the scar, additional formation of collagen and elastic fibers occurs in the zone of this constantly acting force, and to a greater extent, the stronger the stretching. If the processes of fibrillogenesis are initially enhanced in patients, then the result of early exposure to the scar in the phase of active fibrillogenesis is the formation of hypertrophic and even keloid scars.

Stage 4 - the final transformation of the scar (4-12th month). This stage is characterized by further and slower maturation of scar tissue with the almost complete disappearance of small blood vessels from it with further systematization of fibrous structures in accordance with the forces acting on this area.

The result of a decrease in the number of vessels is a gradual change in the color of the scar: from bright pink to pale and less noticeable. Under unfavorable conditions, the formation of hypertrophic and keloid scars is completed, which sometimes significantly limit tissue function and worsen the appearance of the patient. It is important to note that in most cases it is in the middle of the 4th stage that one can finally assess the skin scars and determine the possibility of their correction. During this period, the formation of internal scars also ends, and they are only slightly affected by the load.

Types of wounds and types of their healing. The main types of wounds

A wound is a violation of the anatomical integrity of tissues, accompanied by the formation of a wound space (cavity) or wound surface. There are several main types of wounds: traumatic, surgical, trophic, thermal, etc. (Scheme 12.2.1).

Scheme 12.2.1. The main types of wounds and options for their healing.

Traumatic wounds make up the bulk of the wounds and can be of a very different nature (from cut to gunshot). These wounds can heal on their own or after surgical treatment, when the wound is transferred from traumatic to surgical.

Surgical wounds are distinguished by the fact that in the vast majority of cases they are applied with a sharp scalpel. This determines their incised character and more favorable conditions for healing. Traumatic wounds treated by a surgeon are a special type of surgical wounds. Their scale, location and condition of the walls of the wound cavity are often determined not so much by the surgeon as by the nature of the primary injury.

Trophic wounds occur in violation of the venous outflow and (or) arterial inflow, as well as in some endocrine and other disorders. Their main feature is the gradual occurrence as a result of the slow death of tissues due to a violation of their nutrition.

Thermal lesions (burns and frostbite) have specific features, since the wound surface can be formed simultaneously (flame burn) or gradually (with frostbite), in the process of forming a line of demarcation and rejection of dead tissues.

Other wounds. Rare types of wounds are sometimes found. These include wounds formed after self-opening of abscesses, deep abrasions, scratching, etc.

Types of wound healing

Traumatic and surgical wounds are of the greatest importance for clinical practice. Their healing occurs in two fundamentally different ways: primary intention (primary healing) and secondary intention (secondary healing).

Wound healing by primary intention occurs when the edges of the wound are separated by no more than 5 mm. Then, due to edema and contraction of the fibrin clot, gluing of the edges of the wound may occur. Most often, this situation occurs when the edges of the wound are brought together with surgical sutures.

The second most important condition for the primary healing of wounds is the absence of suppuration. This happens if the edges of the wound are sufficiently close and viable, intrawound hematoma is small, and bacterial contamination of the wound surface is insignificant.

Primary wound healing has three implications for practice.

Firstly, it occurs in the shortest possible time, which, as a rule, means the minimum period of inpatient treatment of the patient, his faster rehabilitation and return to work.

Secondly, the absence of suppuration during reconstructive operations creates favorable conditions in the wound for the subsequent functioning of structures restored by surgeons (in the area of the tendon suture, the suture of vessels and nerves, the zone of osteosynthesis, etc.).

Thirdly, during primary healing, as a rule, a skin scar is formed with more favorable characteristics: it is much thinner and less likely to require correction.

Wound healing by secondary intention is characterized by a much slower course of the wound process, when the gluing of the edges of the wound cannot occur due to its large size. The most important features of this type of healing are suppuration of the wound and its subsequent cleansing, which ultimately leads to gradual epithelialization of the wound in the direction from the periphery to the center. Note that peripheral epithelialization is rapidly depleted and can lead to spontaneous wound healing only if the wound is not too large (up to 2 cm in diameter). In other cases, the wound granulates for a long time and becomes non-healing.

Wound healing by secondary intention is unfavorable in all respects.

Firstly, this process lasts several weeks and even months. Treatment of the patient requires not only constant dressings, but also additional operations (imposition of secondary sutures, skin grafting, etc.). This increases the duration of the patient's stay in the hospital and the economic costs.

Secondly, when the wound suppurates, the outcomes of reconstructive operations (including those performed with open injuries) deteriorate sharply. So, suppuration of the wound during the application of a tendon suture, at best, leads to blockade of the tendon with more pronounced scars, and at worst, to necrosis of the tendon.

The development of rough scars can block the regeneration of axons in the area of the suture or nerve plasty, and suppuration in the area of osteosynthesis usually ends with osteomyelitis. This creates new, often very complex problems for the patient, the surgical solution of which may require several months, and sometimes even years, and the effectiveness of the measures taken is often low. Finally, after suppuration of the wound, as a rule, a wide scar is formed with a gross violation of the relief of the skin surface. There are frequent cases when suppuration of the wound leads to disability and even creates a real threat to the patient's life.

IN AND. Arkhangelsky, V.F. Kirillov