Wound healing is a complex process consisting of several intersecting phases: inflammation, proliferation and remodeling. Each phase has its own specific role and its own specific characteristics at the molecular and tissue levels. Healing can occur by primary, secondary and tertiary intention. Each type of healing has its own advantages and disadvantages, the choice of a healing method depends on the wound and on the characteristics of the process in each individual patient.
and) Epidemiology... Wounds can occur for a wide variety of reasons, the most common of which are trauma and surgery. It is not possible to calculate the exact ratio of the causes of wounds.
b) Terminology... The wound healing process consists of three overlapping phases. The initial phase of wound healing is the inflammatory phase, which begins immediately after tissue damage. It is characterized by gradual wound closure and migration of inflammatory components of the immune system. In the proliferation phase, a stable wound matrix is \u200b\u200bformed, and granulation tissue is formed in the healing wound. In the remodeling phase, which lasts up to two years, the scar matures and hardens.
Granulation tissue is new emerging tissuecomposed of fibroblasts and developing blood vessels. Healing by primary intention occurs when the primary sutures are applied, as a result of which the “dead space” is eliminated, and the wound surface is quickly re-epithelialized. If the wound heals on its own, without any surgical intervention, the process is called secondary intention healing. In infected wounds, secondary sutures are applied and the wound heals with tertiary tension. Infected wounds require daily care, and when the infection resolves, the edges of the wound can be brought together surgically.
Wounds can capture all layers of tissue. Soft tissues include skin and subcutaneous tissues (fatty tissue, muscles, nerves, blood vessels). More complex injuries are combined with damage to the cartilage and bones of the facial skeleton.
in) The course of wound healing:
1. Etiology... In the vast majority of cases, wounds are caused by trauma and surgery.
2. Pathogenesis... In the absence of proper care, the healing outcome of open wounds can be poor. Open wounds can become infected, causing tissue destruction and delay in healing. Also, contaminated and dry crusted wounds heal worse, since in these cases the migration of the epithelium to the edges of the wound is disturbed. Unfavorable wound healing can lead not only to the formation of a rough scar, but also to functional disorders, for example, to eyelid retraction or difficulty in nasal breathing if the wound is located near the eye or nose, respectively.
3. The natural course of the process... During the inflammatory phase, a clot formed from the bleeding tissue closes the wound. This process is accompanied by primary vasoconstriction, which is then replaced by controlled vasodilation, during which platelets and fibrin migrate to the wound. The clot also protects the wound from the environment and contamination. The inflammatory cells that migrate into the wound release a number of cytokines and immune factors that further regulate the healing process. These include fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), transforming growth factors (TGFs).
Gradually forming fibronectin matrix, on which proteins and cell complexes are subsequently deposited. Immune cells, neutrophils and monocytes entering the wound bed are involved in phagocytosis. At the periphery of the wound, migration of epithelial cells begins as early as 12 hours after injury. This process is accompanied by flattening of epithelial cells and the formation of pseudopodia. In sutured wounds, the re-epithelialization process can be completed within 48 hours. Depending on the size and degree of wound contamination, the inflammatory phase lasts 5-15 days. Clinically, the processes described above are manifested by edema and inflammation.
During proliferative phase regeneration of cellular structures inside the wound occurs. At this time, there is an active proliferation of fibroblasts, accompanied by the deposition of collagen, and the formation of granulation tissue, consisting of inflammatory cells and new blood vessels. Clinically, yellowish fibrin plaque is gradually replaced by pure red granulation tissue.
Remodeling phase starts after a few weeks. This is the longest phase, taking up to two years after the injury. The deposition of collagen continues, its fibers intersect, become thicker. Collagen type III is gradually replaced by type I collagen, which ensures the formation of a stronger scar. Cellular composition also undergoes changes that ensure long-term maintenance of tissue integrity. For example, fibroblasts differentiate into myofibroblasts, contributing to wound contraction. The blood vessels slowly regress; clinically, this process is accompanied by the disappearance of hyperemia and the appearance of a mature scar of a typically white color.
4. Possible complications... If untreated, the wound can become infected, resulting in healing resulting in the formation of a cosmetically unsatisfactory scar. Severe bleeding can occur if large vessels of the face and neck are damaged. Unrecognized trauma to the facial nerve can lead to permanent paralysis. Damage to the parenchyma or the parotid duct can result in a cutaneous salivary fistula or sialocele.
1. Complaints... If the wound is in the healing phase, patients usually complain of pain and discomfort. Deeper injuries to the face and neck can also be accompanied by dysfunction of the nerves or salivary glands. Sometimes patients do not attach importance to them, so the doctor must be careful to detect them. Damage to the bones of the facial skeleton can lead to the appearance of additional complaints, for example, diplopia in explosive fractures of the orbit, or malocclusion in fractures of the mandible or midface.
2. Survey... In most patients with soft tissue wounds, additional examination methods are not required. Penetrating wounds to the head and neck should alert the physician to major vessel damage that requires CT angiography. For any bone injury, CT scan is necessary. If surgical wound closure is required, the main blood parameters (hemoglobin, electrolytes, coagulation system indicators) are determined.
3. Differential diagnosis... The cause of the injury can often be found out during the initial presentation of the patient. It is imperative that, when managing a patient with soft tissue injuries, the physician is able to formulate a "reconstructive algorithm", which is a concept for treating patients with soft tissue injuries. The algorithm starts with the simplest methods and then gradually moves on to the more complex ones.
Areas of the face in which injuries are optimized for healing by secondary intention.
As the complexity grows, the reconstructive algorithm includes the following steps:
1. Wound healing without surgery (secondary tension)
2. Wound healing with delayed suturing (tertiary tension)
3. Simple wound closure (primary tension)
4. Complex wound closure with plastics of local tissues (primary tension)
5. Skin grafts
6. Complex treatment using distant tissues (regional or free flaps).
e) Forecast of head and neck wound healing... The correct analysis of the existing wound and the selection of the appropriate treatment method usually reduce the risk of gross scar formation. Some wounds may require reoperation for optimal results. First of all, the prognosis is influenced by the desire of both the patient and the surgeon to make every effort to promote favorable wound healing.
bibliographic description:
To the establishment of the healing time of abrasions / V.I. Kononenko. // Forensic-medical examination. - M., 1959. - No. 1. - S. 19-22.
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At the site of the formation of an abrasion on the body of a living person, healing processes begin to emerge rather quickly, which, during an examination, can serve as the basis for an approximate determination of the time of occurrence of abrasions. Literature data on this issue are contradictory.
The first signs accompanying an abrasion are 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 terms for the disappearance of redness and swelling.
The data on the timing of the formation and falling off of the crust at the site of the abrasion given in the literature also differ.
The most detailed study of the issue of abrasions was A.F. Taikov, who have 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 that rises above the level of intact skin - from 1 to 3-4 days; the third is the process of epithelialization, which occurs under the crust, the detachment of which begins from the edges and ends on the 7-9th day; the fourth is the disappearance of traces after the crust has fallen off at the site of the former abrasion (9-12 days).
As you know, no scars remain at the site of abrasions, but a pale pink area that disappears over time is found. Literary data on the timing of the preservation of this area are even more contradictory (N.S. Bokarius, Grzhivo-Dombrovsky, Yu. Kratter, E.R. Hoffman, V. Neigebauer, 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, in general, the healing of abrasions, neither the size, nor the depth, nor their localization, nor the age of the person being witnessed and the general condition of his body were taken into account. Only AF Taikov points out the need to take into account the state of the central nervous system and speaks of its suppression in fatal injuries, which affects the healing process of abrasions.
It seems to us that with the division of the healing process of abrasions at the stage proposed by A.F. Taikov, one cannot agree. The healing process itself proceeds and develops gradually and cannot be limited by the above stages. In addition, the division at the stage makes it difficult for experts to establish the timing of the formation of abrasions.
Our observations have shown that during the healing of abrasions, changes occur in them continuously, for short periods of time, especially in the initial period of healing, and these changes can be used as the basis for establishing the timing of their formation.
We observed 24 abrasions in people aged 11 to 56 years (mostly 11, 25, 30 and 56 years old). On the first day, the observation was carried out 4 times, on the second and third - 2 times, on the rest - 1 time every day. The localization of abrasions was different: lower leg, thigh, forearms, hands, neck and chest.
The table below shows signs of different periods of abrasion healing in vivo. A fresh abrasion in 3/4 of all cases lies below the level of the surrounding skin, but sometimes at the level with the surrounding skin. Its surface is moist, soft to the touch, in most cases pinkish-red in color, but changes in shades from pale pink, brown to dark tones are possible. During the first day, slight pain is noted and the effect of infection can be observed.
On the second day, in 3/4 of all cases, the precipitated surface is located at the same level with 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 towering brown-red crust, but shades of pink-red, sometimes dark, brown and yellowish, can also be noted.
After 4 days, the crust, as a rule, is above the level of the skin and only in those rare cases when the reactivity of the body is weakened or depressed 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 earlier, especially in cases where the abrasion was first smeared with iodine or brilliant green, as well as in cases of superficial abrasions of minor sizes and when they are localized on the neck.
| Signs detected during the healing process | Time from the moment of the formation of abrasion |
| The surface of the abdomen is mostly pink-red, damp, below the level of the surrounding skin, whitening is observed around | 1 hour |
| The surface dries up, redness and swelling around the abrasion about 0.5 cm wide | 6-12 hours |
| The surface is compacted, the swelling disappears. The disappearance of the sometimes existing soreness is noted | 24-36 " |
| The surface is often brownish-red, dense to the touch, mainly at the level of intact skin. The influence of the infectious origin decreases | 2 days |
| The abrasion is almost always covered with a crust that rises above the level of the skin. Dark, brown, yellowish shades prevail. Wrinkling is noticeable, reduction in size | 3 " |
| The crust usually rises above the level of the skin | four " |
| A crust with undercut edges, its color is often red-brown, the size of the abrasion is halved | 5 days |
| The same phenomena are more pronounced, peeling of the skin is observed around the abrasion | 6-7 " |
| Reduction of the original size of the abrasion by 4 times | 8 " |
| Falling off of the crust (it can be rejected earlier), a pale pink area remains at the site of falling off | 9-11 " |
| Reducing the size of the specified area, its color is dominated by pinkish-reddish shades | 15-16 days and more |
| The gradual disappearance of the specified area without a trace | 20-30 days |
It is impossible, of course, to 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 practice of a forensic expert.
The duration of healing 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 were separated on the 6th day, and in abrasions measuring 2 × 1 cm - on the 8th day. Localization is also important: with the location of abrasions on the neck, the time for separation of the crust is reduced. So, with abrasions measuring 6 × 1 cm on the neck, the crusts fell off already on the 8th day.
Infection of abrasions has a significant effect on the healing process. In one case, when the size of the abrasion was 2 × 1 cm, when the infection was attached on the 4th day (suppuration), the crust was separated only on the 15th day.
A forensic expert, when determining the duration of an abrasion, should take into account such points as the localization of the abrasion, the depth of skin sedimentation (superficial or deep abrasion), size, infection, smearing with iodine, brilliant green of the abrasion surface, as well as the individual properties of the victim.
We studied the certificates of examination in the Kharkov forensic medical outpatient clinic for the first half of 1957, which contained a description of 1270 abrasions. At the same time, it turned out that the expert in 75% of cases 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.
Comparison of our data on the healing of abrasions with those from the practice of the Kharkov forensic medical outpatient clinic showed the coincidence of the detected signs during healing.
Thus, the given data, it seems to us, can be used to judge the timing of the formation of abrasions in the practice of a forensic expert.
Material from the Forensic encyclopedia
Abrasion - This is a superficial mechanical damage to the skin, not deeper than the papillary layer. It occurs as a result of the tangential impact of blunt or sharp (scratched) objects.
Abrasions - this is damage to certain layers of the epidermis or epithelium of the mucous membranes, in some cases, the papillary layer of the dermis is also damaged. (a source?)
Depending on the depth, abrasions are divided into:
- superficial - damage only to the epidermis;
- deep - damage to all layers of the epidermis and the upper layers of the dermis.
The duration of the formation of abrasions
The average healing time is 10 to 14 days. However, the timing of the healing of abrasions can vary greatly depending on the depth of the injury and its size, on the localization (intensity of blood supply to the body regions), age, state of the immune system, and concomitant injuries.
V. N. Kryukov et al. (2001)
"... During external examination in the first hours after the formation of the abrasion, its bottom is sunken, the surface is pink-red, moist due to the constant release of lymph. In cases where the papillary layer is damaged, droplets of blood are added to the lymph.
After 6 hours, the bottom of the abrasion, as a rule, dries up, and a zone of hyperemia up to 1.0 cm wide is formed around it. At the same time, swelling (edema) increases and soreness is noted. This process continues until the end of the first day. A yellowish-brown crust forms at the bottom. With deep abrasions with damage to the papillae, the crust is reddish-brown. The forming crust plays a protective biological role, protecting the damaged surface from contamination and infection.
The developing edema and cellular infiltration raise the crust, which by the end of the day is located at the level of the surrounding skin. At the end of the first day and at the beginning of the second, the crust becomes higher than the level of intact skin due to the development of a proliferative process - restoration of the damaged epidermis.
By this time, the crust itself acquires a permanent dark brown color.
Since the processes of regeneration of the epidermis are more pronounced in the peripheral areas, where it is damaged, as a rule, less deeply, on the 3-5th day, peripheral exfoliation of the crust is observed ... which ends by the 7-10th day.
In place of the crust that has fallen off, a pink surface remains, disappearing by the end of the second week ... "
Belikov V.K., Mazurenko M.D. (1990)
| Duration of abrasion | Abrasion |
|---|---|
MACRO - the surface sinks, wet, red. MICRO - expansion of capillaries, small arteries and veins, an increase in the number of leukocytes with their parietal location, edema. |
|
MACRO - the surface sinks, red, dries up. MICRO - perivascular accumulation of predominantly segmented leukocytes, leukocyte infiltration in the peripheral parts of the lesion. |
|
MACRO - the surface sinks, brown-red, dried out. MICRO - leukocyte infiltration is well expressed not only along the periphery, but also in the damaged area, some leukostae. |
|
MACRO - the surface at the level of the skin is dry, reddish-brown. MICRO - pronounced leukocyte roll at the border of damage, collagen damage and changes in nerve fibers are detected. |
|
MACRO - dense red-brown crust above the skin level. MICRO - lymphoid infiltrates, proliferation of cells of the growth layer of the epidermis. |
|
MACRO - dense, brownish crust above the level. MICRO - macrophage reaction with the appearance of fibroblasts, proliferation of cells of the growth layer in the form of epithelial strands. |
|
MACRO - dense, brown peeling crust. MICRO - the defect of the epidermis is replaced by several layers of epithelial cells. |
|
10-15 days | MACRO - the spot at the site of the abrasion is even, smooth, pink or bluish. MICRO - the epidermis at the site of the former defect has a normal appearance. |
Akopov V.I. (1978)
"... the formation of a crust, on average, occurs 4-6 hours after the onset of an abrasion. The newly formed crust is tender, pale pink, located below the level of the surrounding skin. By the end of the 1st day, a clearly formed dense red crust is formed, which falls off in 7-12 days. However, the trail that remains after it fell away, we found a month or more after receiving an abrasion ... "
A.F. Kulik (1975)
"... on the neck the crust disappears after 5-6 days, on the upper limbs - after 8-9 days, on the lower ones - after 9-11 days, on the stomach - after 10-13 days."
A.F. Kulik (1985)
Stages of healing of abrasions of various ages and localization
| № p / p |
Stages of abrasion healing | Localization of abrasions | ||||
|---|---|---|---|---|---|---|
| Neck | Back | Upper limbs | Lower limbs | Stomach | ||
| 1 | The crust is located at the level of intact skin | After 12 hours | By the end of the first day | By the end of the first or the beginning of the second day | By the end of the second day | By the beginning of the third day |
| 2 | The crust rises above the level of intact skin | By the end of the first day | On the second day | By the beginning of the third day | Third - fourth day | Fourth day |
| 3 | The crust peels off along the periphery of the abrasion | Fourth day | Fifth day | On the sixth day and is noticeable only under a magnifying glass | Seventh - eighth day | End of the eighth day |
| 4 | Separate parts of the crust fall off | By the end of the fifth day | Sixth day | By the end of the eighth day | Ninth day | Tenth day |
| 5 | The crust falls off completely | Sixth day | Eighth day | Ninth day | Tenth - eleventh days | Twelfth day |
| 6 | Abrasion marks disappear | After 12-13 days | After 12-15 days | After 14-15 days | After 17-18 days | After 18-20 days |
Mukhanov A.I. (1974)
The surface of the fresh abrasion is pink-red, moist, soft, painful ...
After 6-12 hours, the bottom of the abrasion dries up; around the sediment, redness and swelling appear in the form of a ring up to 0.5 cm wide. By 24-36 hours, the surface of the abrasion becomes denser, the swelling and soreness disappear.
As noted by M.I.Raysky, in most abrasions (up to 70%) by 24 hours the bottom is covered with a brownish dense crust located above the skin level. The surface of the rest of the abrasions is sometimes moist and soft, more often dried out, dense, brownish, located at the level of the skin (up to 8%) or below it (up to 21%). According to the observations of V.I. Akopova (1967), by the end of the first day, all abrasions have a crust, On the second day, the surface of the abrasions rises above the intact skin due to thickening of the crust ...
On the 3-4th day (according to V.I.Kononenko, more often on the 5th day), the crust along the edge begins to flake off and the abrasion is halved. Then there is peeling of the skin around the abrasion, its crust peels off over a large extent and disappears after 1-2 weeks.
The surface at the site of the fallen off crust is at first pink, but within a week this color disappears, and the site of the abrasion ceases to differ from the surrounding skin. The healing of abrasions ends by 2-3 weeks ...
Abrasions heal faster in healthy people, slower in sick people, in victims with severe injuries.
Kononenko V.I. (1959)
| Signs detected during the healing process | Time from the moment of the formation of abrasion |
|---|---|
| The surface of the abrasion is mostly pink-red, damp, below the level of the surrounding skin, whitening is observed around | 1 hour |
| The surface dries up, redness and swelling around the abrasion about 0.5 cm wide | 6-12 hours |
| The surface is compacted, the swelling disappears. The disappearance of the sometimes existing soreness is noted | 24-36 " |
| The surface is often brownish-red, dense to the touch, mainly at the level of intact skin. The influence of the infectious origin decreases | 2 days |
| The abrasion is almost always covered with a crust that rises above the level of the skin. Dark, brown, yellowish shades prevail. Wrinkling is noticeable, reduction in size | 3 " |
| The crust usually rises above the level of the skin | four " |
| A crust with undercut edges, its color is often red-brown, the size of the abrasion is halved | 5 days |
| The same phenomena are more pronounced, peeling of the skin is observed around the abrasion | 6-7 " |
| Reduction of the original size of the abrasion by 4 times | 8 " |
| Falling off of the crust (it can be rejected earlier), a pale pink area remains at the site of falling off | 9-11 " |
| Reducing the size of the specified area, its color is dominated by pinkish-reddish shades | 15-16 days and more |
| The gradual disappearance of the specified area without a trace | 20-30 days |
"... 24 abrasions were observed in people aged 11 to 56 years old (mainly 11, 25, 30 and 56 years old). On the first day, the observation was carried out 4 times, on the second and third - 2 times, on the rest - 1 time every day. Localization of abrasions was different: lower leg, thigh, forearms, hands, neck and chest ... "
Taikov A.F. (1952)
(quoted from A.I. Mukhanov)
Terms of healing of abrasions in days (source unknown)
Employees of the Department of Forensic Medicine of the Kiev Institute for Advanced Training of Physicians summarized the data of various authors on the timing of healing of abrasions, depending on their localization, and offered the following table:
| Sign | Localization | |||||
|---|---|---|---|---|---|---|
| face | arms | legs | ||||
| surface | deep | surface | deep | surface | deep | |
| Abrasion without a crust | 1 | 1 | 1 | 1 | 1 | 1 |
| Does not rise above the surface | 1-2 | 1-3 | 1-2 | 1-3 | 1-2 | 1-5 |
| Rises above the surface | 2-5 | 2-8 | 2-6 | 2-10 | 2-7 | 2-12 |
| The edges of the crust are raised | 5-6 | 6-9 | 6-8 | 6-15 | 5-8 | 6-15 |
| Partially dropped | 6-8 | 7-15 | 7-12 | 11-18 | 7-12 | 11-12 |
| Completely disappeared | 7-11 | 12-18 | 9-13 | 16-23 | 8-13 | 15-24 |
| Abrasion marks | up to 30 | up to 30 | up to 50 | up to 50 | up to 120-150 | up to 150 |
The source is unknown. If you know - write on the forum
No sources specified
A.P. Gromov distinguishes between superficial and deep abrasions. In a superficial abrasion, there are no upper and partially middle layers of the epidermis or completely upper, middle and partially germ (basal) layers; the latter usually remains in the depression between the papillae of the skin itself. On the surface of a superficial abrasion, an accumulation of lymph is observed. The latter mixes with particles of the destroyed epidermis and foreign inclusions and dries quickly, forming a thin pink crust.
In a deep abrasion, either the entire epidermis with the tops of the papillae or the upper layers of the dermis is absent. In such cases, there is a massive accumulation of cut and lymph on the surface of the abrasion. Mixing with the remnants of the destroyed epidermis and foreign particles, the blood coagulates, forming at first a moist, and then a drying red crust.
According to V.I. Akopov all abrasions by the end of the first day after their occurrence are covered with crusts, on the second day - the surface of the abrasions rises above the intact skin.
A.F. Taikov distinguishes four stages in the healing of an abrasion:
- 1st - minus fabric; lasts for several hours;
- 2nd - crust formation; starts after a few minutes and lasts up to 4 hours (sometimes 2-4 days);
- 3rd - epithelialization and crust falling off; lasts from 5 to 7-9 days;
- 4th - traces remaining after the crust has fallen off; are found within 9-12 days, sometimes they persist up to 25 days.
According to V.G. Naumenko and V.V. Grekhov. the crust disappears on the 7-12th day, the traces of the abrasion disappear on the 10-12th day. Rubin V.M. and Krat A.I. observed crust falling off superficial abrasions on days 7-12, deep abrasions on days 12-21, traces of abrasions can be discerned even after 1.2-1.5 months.
Any surgical intervention is a forced measure associated with a varying degree of trauma to the tissues of the body. How quickly the patient can return to an active life depends on the recovery time of the body after the operation and the rate of healing of the stitches. Therefore, the questions about how quickly the stitches will heal and how to avoid postoperative complications are so important. The speed of wound healing, the risk of complications and the appearance of the scar after surgery depend on the suture material and on the method of suturing. We'll talk more about seams today in our article.
Types of suture materials and suture methods in modern medicine
An ideal suture material should have the following characteristics:
Be smooth, slide without causing additional damage. Be elastic, stretchable, without causing compression and tissue necrosis. Be durable, withstand loads. Tie securely in knots. Possess biocompatibility with body tissues, inertness (do not cause irritation of tissues), have low allergenicity. The material should not swell from moisture. The time of destruction (biodegradation) of absorbable materials should coincide with the time of wound healing.
Different suture materials have different qualities. Some of them are advantages, others are disadvantages of the material. For example, smooth threads will be difficult to pull into a strong knot, and the use of natural materials, so valued in other areas, is often associated with an increased risk of infection or allergies. Therefore, the search for the ideal material continues, and so far there are at least 30 variants of threads, the choice of which depends on specific needs.
Suture materials are divided into synthetic and natural, absorbable and non-absorbable. In addition, materials are made consisting of one or several strands: monofilament or polyfilament, twisted, braided, with various coatings.
Non-absorbable materials:
Natural - silk, cotton. Silk is a relatively strong material, due to its ductility it ensures the reliability of knots. Silk is a conditionally non-absorbable material: over time, its strength decreases, and after about a year, the material is absorbed. In addition, silk threads induce a pronounced immune response and can serve as a reservoir of infection in a wound. Cotton is not very durable and can also cause intense inflammatory reactions. Stainless steel threads are durable and produce minimal inflammatory reactions. They are used in operations on the abdominal cavity, for suturing the sternum and tendons. The best characteristics are synthetic non-absorbable materials. They are more durable and cause minimal inflammation. Such threads are used to match soft tissues, in cardio and neurosurgery, ophthalmology.
Absorbable materials:
Natural catgut. The disadvantages of the material include a pronounced tissue reaction, the risk of infection, insufficient strength, inconvenience in use, the inability to predict the timing of resorption. Therefore, the material is currently practically not used. Synthetic absorbable materials. Produced from biodegradable biopolymers. They are divided into mono and polyfilament. Much more reliable than catgut. They have certain resorption times, which differ in different materials, are quite durable, do not cause significant tissue reactions, do not slip in the hands. They are not used in neuro and cardiac surgery, ophthalmology, in situations where constant strength of sutures is required (for suturing tendons, coronary vessels).
Suture methods:
Ligature sutures - with their help, the vessels are ligated to ensure hemostasis. Primary sutures - allow you to match the edges of the wound for healing by primary intention. The seams are continuous and interrupted. Submerged, purse-string and subcutaneous sutures can be applied according to indications. Secondary sutures - this method is used to strengthen primary sutures, to re-close a wound with a large number of granulations, in order to strengthen a wound that heals by secondary intention. Such sutures are called retention sutures and are used to relieve the wound and reduce tissue tension. If the primary suture was applied in a continuous manner, interrupted sutures are used for the secondary, and vice versa.
How many sutures heal
Every surgeon strives to achieve wound healing by primary intention. At the same time, tissue restoration takes place in the shortest possible time, the swelling is minimal, there is no suppuration, the amount of discharge from the wound is insignificant. Scarring with this healing is minimal. The process takes place in 3 phases:
Inflammatory reaction (first 5 days), when leukocytes and macrophages migrate to the wound area, destroying microbes, foreign particles, and destroyed cells. During this period, the connection of the fabrics did not reach sufficient strength, and they are held together by the seams. The phase of migration and proliferation (on the 14th day), when collagen and fibrin are produced in the wound by fibroblasts. Due to this, from the 5th day, granulation tissue is formed, the strength of fixation of the wound edges increases. The phase of maturation and restructuring (from the 14th day to complete healing). Collagen synthesis and connective tissue formation continue during this phase. Gradually, a scar forms at the site of the wound.
How long does it take to remove the stitches?
When the wound has healed so much that it no longer needs the support of non-absorbable sutures, they are removed. The procedure is carried out under sterile conditions. At the first stage, the wound is treated with an antiseptic; hydrogen peroxide is used to remove the crusts. Grasping the thread with surgical tweezers, cross it at the point of entry into the skin. Gently pull the thread from the opposite side.
Time to remove stitches, depending on their location:
The stitches on the skin of the trunk and extremities should be left in place for 7 to 10 days. The stitches on the face and neck are removed after 2-5 days. The retention sutures are left for 2-6 weeks.
Factors affecting the healing process
The rate of healing of sutures depends on many factors, which can be conditionally divided into several groups:
Features and nature of the wound. Definitely, wound healing after minor surgery will be faster than after laparotomy. The process of tissue restoration is lengthened in the case of wound closure after injury, when there was contamination, penetration of foreign bodies, crushing of tissues. Location of the wound. Healing is best in areas with good blood supply, with a small layer of subcutaneous fat. Factors due to the nature and quality of the surgical care provided. In this case, the features of the incision, the quality of intraoperative hemostasis (stopping bleeding), the type of suture materials used, the choice of the suture method, compliance with the rules of asepsis, and much more are important. Factors related to the patient's age, weight, health status. Tissue repair is faster at a young age and in people with normal body weight. They lengthen the healing process and can provoke the development of complications of chronic diseases, in particular, diabetes mellitus and other endocrine disorders, oncopathology, vascular diseases. At risk are patients with foci of chronic infection, with reduced immunity, smokers, HIV-infected. Reasons associated with the care of the postoperative wound and sutures, adherence to the diet and drinking regime, the patient's physical activity in the postoperative period, the implementation of the surgeon's recommendations, taking medications.
How to properly care for seams
If the patient is in the hospital, the doctor or nurse will take care of the stitches. At home, the patient should follow the doctor's recommendations for wound care. It is necessary to keep the wound clean, treat it daily with an antiseptic: a solution of iodine, potassium permanganate, brilliant green. If a bandage is applied, consult your doctor before removing it. Special medications can speed up healing. One of these agents is contractubex gel containing onion extract, allantoin, heparin. It can be applied after wound epithelialization.
For the speedy healing of postpartum sutures, strict adherence to hygiene rules is required:
- washing hands thoroughly before using the toilet;
- frequent change of gaskets;
- daily change of linen and towels;
- within a month, taking a bath should be replaced with a hygienic shower.
In the presence of external seams on the perineum, in addition to careful hygiene, you need to take care of the dryness of the wound, for the first 2 weeks you cannot sit on a hard surface, and constipation should be avoided. It is recommended to lie on your side, sit on a circle or pillow. Your doctor may recommend specific exercises to improve blood flow to tissues and heal wounds.
Healing of stitches after cesarean section
You will need to wear a postoperative bandage, observe hygiene, after discharge, it is recommended to take a shower and wash the skin in the seam area twice a day with soap. At the end of the second week, you can apply special ointments to restore the skin.
Suture healing after laparoscopy
Complications after laparoscopy are rare. To protect yourself, you should observe bed rest for 24 hours after the intervention. At first, it is recommended to adhere to a diet, give up alcohol. For body hygiene, a shower is used, the seam area is treated with an antiseptic. The first 3 weeks limit physical activity.
Possible complications
The main complications of wound healing are pain, suppuration, and insufficient sutures (dehiscence). Suppuration can develop due to the penetration of bacteria, fungi or viruses into the wound. Most often, infection is caused by bacteria. Therefore, often after the operation, the surgeon prescribes a course of prophylactic antibiotics. Postoperative suppuration requires identification of the pathogen and determination of its sensitivity to antibacterial agents. In addition to prescribing antibiotics, it may be necessary to open and drain the wound.
What to do if the seam is broken?
Insufficiency of sutures is more often observed in elderly and debilitated patients. The most likely timing of complications is from 5 to 12 days after surgery. In such a situation, you should immediately seek medical help. The doctor will decide on the further management of the wound: leave it open or re-suture the wound. With evisceration - penetration of the intestinal loop through the wound, urgent surgical intervention is required. This complication can result from bloating, severe coughing, or vomiting.
What to do if the seam hurts after the operation?
Soreness in the stitches for a week after surgery can be considered normal. During the first days, the surgeon may recommend taking an anesthetic. Compliance with the doctor's recommendations will help reduce pain: limiting physical activity, wound care, wound hygiene. If the pain is intense or persists for a long time, it is necessary to consult a doctor, since pain can be a symptom of complications: inflammation, infection, adhesion formation, hernia.
You can speed up wound healing with the help of folk remedies. For this, phyto-teas are used inside in the form of infusions, extracts, decoctions and local applications, phytomazi, rubbing. Here are some of the folk remedies used:
Pain and itching in the area of \u200b\u200bthe seams can be relieved with decoctions of herbs: chamomile, calendula, sage. Wound treatment with vegetable oils - sea buckthorn, tea tree, olive. The frequency of processing is twice a day. Lubrication of the scar with a cream containing calendula extract. Applying a cabbage leaf to the wound. The procedure has anti-inflammatory and healing effects. The cabbage leaf must be clean, it must be doused with boiling water.
Before using herbal remedies, you should definitely consult a surgeon. He will help you choose an individual treatment and give the necessary recommendations.
There are several stages of tattoo healing, each of which differs in certain rules for caring for the damaged area of \u200b\u200bthe skin. In order for the body drawing to remain a spectacular and beautiful decoration for a long time, you should not neglect the advice of the tattoo artist. Strict adherence to his recommendations is the main guarantee that you will not need correction. What should you be aware of in order to avoid deformation of the tattoo and maintain its durability?
First step
The quality of a tattoo depends in half on proper care in the first days after the session. The application of a permanent pattern is a mechanical intervention in the human body that cannot pass painlessly and without a trace. After the procedure, small microcracks remain on the body, through which the ichor is released. Thus, the process of healing and cleansing of the skin begins, which starts the lymphatic system.
At the first stage of healing, the area of \u200b\u200bthe body with the tattoo swells and discharge appears in the form of a sticky liquid mixed with ink. Many people first of all think that the drawing simply spreads and washes off, but this is not so. This is a normal reaction of the body to such a procedure. Even in the salon, the tattooist processes the site of application with a healing ointment and wraps it with a protective film. It is not recommended to remove the film during the first day. At home, you need to take a warm (not hot!) Shower, gently wash the wound with antibacterial soap and leave to dry. In no case should you rub the drawing with a washcloth or towel. After washing, apply a healing anti-inflammatory cream to the tattoo.
Second phase
On the second day of the tattoo healing, the ichor disappears, the tumor goes away. At this stage, the skin tightens, becomes dry and dehydrated. Why is this happening? The fact is that ink is perceived by the body as a foreign body. It takes time for them to take root and not be rejected. During this period, the drawing should be actively treated with healing ointments. It is recommended to avoid body contact with clothing as friction does not promote the healing of the tattoo If you need to go outside, it is advisable to wrap the place of application with a protective or ordinary cling film. At home, during the second phase of healing, it is best to leave the tattoo open to allow the skin to breathe.
Stage Three
Usually, a crust will form on the tattoo on the third day. The skin begins to peel off, white or colored flakes appear. The fact is that the ink remains in the lower layer, the dermis, and the epidermis, that is, the upper layer, is renewed and restored after the procedure. This reaction of the body provokes severe itching and discomfort. In no case should you scratch the tattoo and peel off the crust. This will significantly damage the pattern and increase the healing time. You can lightly pat the body with your palm and continue to treat the area with ointment. Sinaflan Antiseptic Solution will also help relieve itching. At this time, it is advisable not to visit the gym, solarium, limit the time spent in the open sun and reduce physical activity. Do not be alarmed if the tattoo fades a little and loses its brightness. It will go away after complete healing.
Healing time
The healing time of a tattoo is individual for each person and depends on the following factors.
Place of application
The buttocks, chest and abdomen heal faster. The recovery period takes 4 to 7 days. Areas with a small amount of subcutaneous fat (back, ankle, neck) may take up to 2 weeks to heal.
Tattoo volume
Large tattoos are usually applied in several stages, so complete healing occurs in a month. This is especially true for portrait photos in the style of realism or blackwork tattoo, where a large amount of ink is used to complete the shading of the picture. Small to medium tattoos regenerate faster because the area of \u200b\u200bthe body is small.
Line thickness and depth
Thin, neat lines do not traumatize the skin much and regenerate faster, deep, wide and thick lines take longer: 1-2 weeks.
You can tell if a tattoo has healed by swiping your hand over it. If the pattern is uniform, without roughness and peel, the restoration process was successful.
Healing ointments
After the session, the tattoo needs proper care. At the end of the work, the tattooist treats the site of application with an anti-inflammatory ointment that relieves swelling. Further, a similar procedure must be done at home in order to speed up the regeneration process. The most effective and recommended drugs include the following.
Remember that during the regeneration of the damaged area (that is, during all three stages listed above), you should completely abandon cosmetic hand creams and even baby cream. The fact is that they contain additives, fragrances and essential oils that do not promote healing, but, on the contrary, injure the skin.
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