Accelerate granulation. What is granulation tissue? The use of drugs at the granulation stage

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

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

As you know, wound healing can take place by primary and secondary intention. In the first case, due to the fit of the wound edges, its linearity and the minimum area of ​​the wound surface, the wound, as a rule, heals quickly and without inflammation. Therefore, if possible, they try to subject any wound to surgical treatment by applying a skin suture. Treatment of such a treated wound in the vast majority of cases is not particularly difficult.

In the case of extensive wounds, with non-closure of the edges of the wound and the presence of areas of tissue necrosis, healing occurs by secondary intention. It is in the management of such wounds that heal by secondary intention that the stage of the wound process should be taken into account very carefully, carrying out differentiated treatment.

Treatment of wounds: stages of the course of the wound process

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

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

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

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

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

If at any stage of the wound process an infection is attached, the discharge becomes larger, and it acquires the appearance, color and smell characteristic of a certain type of microorganisms.

Stage 2. Stage of proliferation (regeneration)

AT ideal conditions during wound healing by primary tension the stage of proliferation (in particular, the synthesis of collagen cells) begins on the second day.

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

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

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

Stage 3. Stage of epithelialization (stage of differentiation)

Sometimes the stage of epithelization is called the stage of scar formation or final healing, as well as the stage of formation and reorganization of the scar. The discharge is already absent or practically absent, the wound is dry. A discharge can occur in case of injury to the wound, as well as when an infection is attached.

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

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

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

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

In order to understand how the medical support of a wound can be as physiological as possible, stimulating the natural processes of wound healing, one must understand the essence of the changes taking place on different stages wound process.

So, although we are talking about the stage of exudation as the first stage of wound healing, it, in fact, is the stage of decay (necrosis) of tissues, which is characterized by inflammation.

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

• Prevention of drying of the wound surface.
• Possibility of free allocation of exudate.
• Improvement of wound trophism to prevent increased necrosis.
• Stimulation of the beginning of the formation of granulation tissue (transition to the second stage).
• Mechanical assistance in the removal of necrotic tissue.
• Prevention of infection penetration into the wound.

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

Requirements for the drug for local treatment of wounds on early stage pretty simple. The drug should have a hydrophilic base, retain moisture for a long time and be easy to use. To dosage forms that meet these requirements include solutions and gels. Solutions, unfortunately, are not able to retain moisture for a long time, therefore, when using solutions, dressings must be done every 1.5-2 hours. That is, they are not very convenient to use.

Gels are much more promising in this sense. They are easy to use, retain moisture better, provide exudate outflow, and do not create a fatty film. Active substance gel preparation for wound treatment at the first stage should have a trophic effect, which will protect the wound from excessive necrosis and stimulate its transition to the second stage.

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

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

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

If the wound is large in area, due to the rather slow mitosis of the epidermal cells of the edges of the wound, it will be difficult to achieve complete epithelialization. So, on average, the epidermis can grow by 1 mm per month. Therefore, with large clean wound surfaces at the second or third stage, auto-transplantation of the skin is often resorted to, which will allow obtaining new, additional, areas of wound epithelialization and accelerating its complete healing.

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

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

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

Differential treatment of wounds is one of the main conditions for their healing. And the right choice of drugs for the treatment of wounds directly ensures the speedy healing of the wound.

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

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

Note. In the treatment of non-infected wounds in the first two stages of the wound process before application local funds the wound should be washed with an aqueous solution of one of the antiseptics to prevent infection. In addition, the skin around the wound at the beginning of each dressing is treated alcohol solution antiseptics.

Rapid healing of scars

Active substance:

Hemoderivat, ointment base.

Indications:

• Venous ulcers
• burns
• Injuries
• Frostbite

Fast healing without scars

Active substance:

Hemoderivat, hydrophilic base.

Indications:

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

Wound granulation is an intermediate step in the natural healing process of damaged tissues. With its help, epithelial cells are formed, which later cover the surface of the wound. A complex process involves many cells that do not allow entry into the body pathogenic microorganisms.

Granulation is one of the stages of skin regeneration, resulting in the formation of a temporary tissue that protects the boundaries of the wound. During complete healing, the granulation regresses, after which the wound becomes covered with scar tissue.

The active granulation process develops on days 5-6, and its duration depends entirely on the degree of tissue damage and the individual characteristics of the body.

The following types of cells are involved in the granulation process:

1. Leukocytes - eliminate pathogenic microorganisms in contact with the wound surface.
2. Plasmacytes - activate the production of substances and blood coagulation factors, with the help of which it is possible to accelerate the process of blood clot formation.
3. Mast cells - contribute to the acceleration of the process of regeneration of damaged cells.
4. Fibroblasts - control the synthesis and transport of collagen cells, with the help of which the process of regeneration of damaged tissues is carried out.

Externally, granulation looks like a thin film that envelops the surface of the wound. She has gently pink color with a characteristic mirror finish. Within a month, granulation is completed, after which a thin film leaves, and dense scar tissue forms under it.

Phases of regeneration of damaged tissues

In the process of healing, the wound goes through several stages:

1. Inflammation - after injury epithelial cells a natural mechanism is launched in the body, with the help of which bleeding is eliminated as soon as possible. Formed blood clots clog damaged vessels, eliminating extensive bleeding. A large number of leukocytes are sent to the wound site, which have a bactericidal effect.
2. Granulation - after 5-6 days from the wound, the granulation mechanism is launched, with the help of which new epithelial cells are formed. The process lasts at least a month, after which the wound is covered with scar tissue.
3. Epithelialization - granulation tissue gradually dies off, and new epithelial cells form under it.

Granulation occurs in stages and consists of six processes that pass into each other:

1. Superficial leukocyte-necrotic layer - consists of light gray or greenish neoplasms, which are located within the wound surface.
2. The surface layer of vascular loops - with its help, new capillaries are formed, which will later fill the site of damage.
3. A layer of vertical vessels - ensures the restoration of metabolic processes in damaged tissue areas.
4. The maturing layer of the epithelium has a pale pink color with a characteristic gloss.
5. A layer of fibroblasts located horizontally provide maximum protection of the wound surface from the ingress of pathogenic microorganisms, as well as additional injuries.
6. The fibrous layer is the densest and precedes scar formation.

The period of granulation for each person lasts individually. For some, the process of complete healing is no more than 3 weeks, while others observe a picture of regeneration for about a year.

Treatment of injured areas in the granulation phase

Granulation tissue in the early stages of formation is very thin and delicate, easily amenable to injury. This requires compliance with certain rules, with the help of which it is possible to achieve the fastest healing of the wound and the preservation of granulation tissue for the longest possible time.

1. Wipe the wound, peeling off the top layer, using cotton pads - the wound is treated with exclusively warm disinfectant solutions with minimal contact with the wound surface. Cotton particles can get into the wound, which will increase the process of inflammation and cause a slowdown in the process of regeneration of damaged cells.
2. Tear off bandages that have dried to the wound - along with the bandage, the granulation layer is torn off, so the regeneration of damaged areas slows down tenfold. Before changing the bandage, it is soaked in disinfectant solutions, which will facilitate its discharge from the wound.
3. Comb and independently tear off the crusts formed on the surface of the wound.

There are three ways to treat a wound during the granulation period: medication, physiotherapy and folk. All of them are selected individually, taking into account the specifics of wounds.

Medical treatment

The use of local wound healing agents contributes to more rapid scar formation. Such drugs have bactericidal properties, reducing the risk of penetration of pathogenic microorganisms through the wound into the blood.

by the most effective drugs with granulation wounds are:

1. Bepanten-Plus (Panthenol, Dexpanthenol) - in addition to the active regeneration process, the drug has bactericidal action due to the content of chlorhexidine. It has a dense texture that protects the surface of the wound from the penetration of pathogenic microorganisms. It can be applied both under the bandage and openly.
2. Methyluracil ointment - normalizes the exchange of nucleic acids in cells, which accelerates the regeneration process by increasing the rate of metabolism. Active ingredients act locally, without penetrating into the blood. Suitable for the treatment of weeping and long-term non-healing wounds.
3. Solcoseryl - improves local blood circulation, which helps to accelerate the process of formation of new cells. The gel texture will allow you to apply the drug in a thin layer, which is quite enough to prevent the development of the inflammatory process.

Methyluracil ointment is one of the drugs that is used for ranulation of wounds.

Ointments, creams and gels are applied only to a previously cleaned wound surface. For preliminary disinfection, hydrogen peroxide, furacillin solution, iodicirin are used. Before applying the cream, the wound should be dried with a dab of a sterile bandage.

The wound is treated at least 3 times a day. If a bandage is used, then it is pre-soaked, after which it is removed along with the scab. It is recommended to give the wound some time to dry before applying ointments and creams.

In the event that the wound is very sore, painkillers can be used:

1. Nonsteroidal anti-inflammatory drugs - have antipyretic, anti-edematous and anti-inflammatory effects. It has an analgesic effect up to 5 hours. Used for shallow wounds.
2. Complex analgesics - eliminate pain, and also relieve additional unpleasant symptoms.
3. Opioid analgesics - are used when the wounds are extensive and deep. They block the centers of pain formation in the brain.

An integrated approach to treatment provides best result. It is strictly forbidden to use medicines without a doctor's prescription, as some of them have adverse reactions and can lead to the development of allergies.

Physiotherapy procedures

With their help, it is possible to accelerate the processes of regeneration of damaged cells, as well as reduce the likelihood of penetration of pathogenic microflora. The most effective of them are:

1. UHF - exposure to ultraviolet radiation favorably affects the condition of the wound. The rays destroy germs and also help skin cells grow faster.
2. Magnetotherapy - exposure to magnetic radiation can accelerate the formation of granulation tissue, as well as make the scar more even, smooth and durable.

Physiotherapeutic procedures are indicated when the wound does not heal well, a purulent scab forms for a long time, and its edges become inflamed. In most cases, minor wounds are treated without the use of physiotherapy. This method of treatment is indicated for extensive lesions, the presence of immunodeficiencies, as well as pathologically reduced local immunity.

Folk methods of treatment

Self-treatment using non-traditional methods of medicine is indicated only when the wound is shallow and small in area, has even edges, and there is no contamination. In this case, you can resort to such methods of treating wounds:

1. Compress from medicinal herbs- take 1 teaspoon of oak bark, sage and nettle, 1 tablespoon of eucalyptus in a glass of boiling water. Steamed in a thermos for 3-4 hours, then filtered. Add 1 teaspoon to the broth. sea ​​salt, after which compresses are placed on the wound surface for 2-3 hours.
2. Wound irrigation disinfectant solution- for 1 liter of water, take 1 teaspoon of sage, coltsfoot, hogweed, 2 teaspoons of nettle leaves, 3 drops of essential oil tea tree. Herbs are boiled in a water bath for 10 minutes, allowed to cool, then filtered and injected. essential oil tea tree. The resulting decoction is drawn into a syringe and the wound is irrigated 5-8 times a day.
3. Ointment based on lamb fat - take 25 g of interior fat and melt in a water bath to a liquid state, after which 6 drops of lavender oil, 3 drops of eucalyptus oil, 2 drops of tea tree oil are introduced. Mix well and place in a jar, allowing to cool at room temperature. Apply a thin layer to the wound, touching the edges.

Ointment based on mutton fat - a folk way to speed up the granulation of wounds

• the wound constantly bleeds and hurts a lot;
• the edges around the wound are inflamed, sore and itchy;
• the wound does not heal for a long time;
• a purulent plug and an unpleasant odor appear.

Any wounds that do not heal for more than 5 days should be examined by a specialist. For various reasons, the regeneration process is difficult, which is extremely dangerous for the whole organism.

In the event that the granulation process is delayed, the wound can rot, which threatens the health of the whole organism. This requires a surgical operation, during which the affected and necrotic areas of the skin are excised. Further treatment requires the use of antibiotics that help eliminate pathogenic microorganisms.

Complications

If granulation is complicated by other processes, the wound does not heal for a long time, which requires additional measures. by the most dangerous complications are:

1. Sepsis is a blood poisoning that develops due to the ingestion of a large amount of pathogenic microflora, which is activated at a low level of the body's defenses.
2. Suppuration of the wound and the need for necroectomy, during which the affected areas of the wound are excised.

Granulation is complicated by reasons of non-compliance with the rules of hygiene, as well as improper treatment of wounds. Special ointments and creams will help speed up the regeneration process, with the help of which the wound will be covered with scar tissue as quickly as possible.

A wound means an injury in which the skin, muscles, tendons, internal organs, bones are damaged. Usually, healing occurs in several stages, but not everyone knows what wound granulation is.

The wound healing process includes the stages of inflammation, granulation and epithelialization. In addition, healing can be with primary and secondary intention, as well as under the scab. It depends on how complex the damage is and how all the phases go, how quickly the victim will be cured.

Stages of wound healing

When healing, any wound goes through several stages:

1. Inflammation. The body first reacts to a wound by producing substances that clot the blood. Blood clots form that clog blood vessels. They prevent the development of severe bleeding. Further, cellular reactions occur, leading to an inflammatory process, a new tissue begins to grow - granulation, which is impossible without the participation of fibroblasts. In cases where the treatment of a wound requires suturing, they are removed after a week, but if there is tension under the suture, this can lead to a divergence of the edges of the wound. This happens because a scar has formed on the edges of the wound, and not granulation. The inflammatory stage lasts an average of 5-7 days.
2. Granulation wounds. With a favorable course of the healing process, a week after the injury, the stage of wound granulation begins. During the month, the damaged area continues to be filled with maturing granulation tissue, which includes inflammatory cells, connective tissue, and newly formed vessels. Successful granulation is not possible without cytokines and sufficient oxygen. Toward the end of this phase, new epithelial cells grow on the granulation tissue, and the edges of the wound are connected by a bright red scar.

The granulation tissue has different kind depending on the stage of its development. Normal tissue initially looks like soft-grained tissue, covered with a cloudy, gray-greenish coating, juicy, rich in thin-walled vessels, which bleeds easily. In more later periods the tissue becomes paler, denser, the granularity disappears, turning into a whitish dense scar.

The granulation tissue consists of six layers that gradually merge into each other:

• superficial leukocyte-necrotic layer
• superficial layer of vascular loops
• layer of vertical vessels
• maturing layer
• layer of horizontal fibroblasts
• fibrous layer

1. epithelialization. This stage of healing begins immediately after granulation is completed. This phase lasts for almost a year. epithelium and connective tissue completely fills the damage space. The scar becomes brighter, because the vessels in it become much smaller than initially. As a result, the healed wound is covered with a scar, the strength of which is approximately 85% compared to healthy skin.

All these stages of wound healing are purely individual, their duration depends on many factors, including the general condition of the patient and the care of the injury.

The role of the granulation stage

Leukocytes will play not the last role in wound granulation.

So, wound granulation is a complex process in which the following types of cells take part:

• leukocytes;
• mast cells;
• plasmacytes;
• histiocytes;
• fibroblasts.

A special role is played by fibroblasts, which produce the supply of collagen after the granulation reaches the edges of the wound. Пpи нaличии oбшиpных гeмaтoм, пpи бoльшoм cкoплeнии экccyдaтa или нeкpoтизaции ткaни в oблacти pacпoлoжeния paны пpoцecc пepeмeщeния фибpoблacтoв к кpaям пoвpeждeния зaмeдляeтcя, чтo yвeличивaeт вpeмя, нeoбхoдимoe для зaживлeния.

Important! The most pronounced activity of fibroblasts is observed on the 6th day after the formation of the lesion. And the granulation process itself continues for a month.

Granulations are a temporary tissue, which, after performing its function, undergoes regression and is replaced by a scaly tissue. The morphological basis of granulation is the glomeruli of newly formed cells. The tissue growing in the process of healing of injuries envelops these vessels, increasing in volume. Outwardly, granulation looks like a delicate fabric of pink color.

The granulations formed during the healing process also perform a sanitary function, separating non-viable tissues. Similar ischemic areas of the tissue, as the wound heals, independently regress by lysing. When treating a wound surgically, non-viable tissues are removed mechanically.

Wound care at the initial stage of healing

The optimal solution for the speedy recovery of damaged tissue is the regular use of dressings. Disinfection here is carried out with solutions of potassium permanganate and hydrogen peroxide. These substances are applied in a warm form on a gauze swab. Next, a careful impregnation of the wound is performed, in which touching the damage with the hands is excluded - this can lead to the development of infections.

Treatment of injured areas in the granulation phase

Granulation tissue has a delicate, loose structure. It is easy to damage it by touching carelessly or carelessly changing the bandage. When treating a wound, you should be as careful as possible.

It is not allowed to wipe the surface of the damaged area with cotton pads, swabs.

Only irrigation of the wound with warm bactericidal solutions is permissible.

There are several types of treatment for injured tissue:

• Physiotherapy;
• medication;
• Treatment at home;

When choosing a method of treatment, it is necessary to take into account the nature of the wound, as well as the characteristics of its healing.

Physiotherapy treatment method

Of the specific ways to accelerate regeneration, the method of ultraviolet irradiation should be distinguished. When it is used, the surface of the damaged area is cleansed of pathogenic microflora, and the regeneration processes are significantly accelerated. This method will be especially relevant for slowly forming, sluggishly granulating tissue.

Indications for the use of radiation:

• wound infection;
• Profuse purulent discharge;
• Weakened immunity and, as a result, a violation of the mechanisms of reparation;

However, other methods of treatment are used to speed up the healing of the injury. Most often resort to medical methods wound surface treatment.

The use of drugs at the granulation stage

Properly selected medication promotes faster epithelialization of the wound. As a rule, with hypergranulation, doctors recommend using gel forms of drugs. Whereas with excessively rapid drying of the surface of the damaged area, ointments are used.

Main medicines used at the granulation stage

One of the most popular drugs prescribed at this stage is Solcoseryl. Granulation of sutures, healing of damaged areas after burns and other injuries skin accompanied by the appearance of unaesthetic scars. Solcoseryl contributes to the formation of a more homogeneous connective tissue, which looks much more natural.

Home treatment of a wound in the granulation phase

In the presence of a simple injury, in which only the superficial extreme layers of the epithelium are affected, recovery can be resorted to folk ways treatment. A good solution here is the imposition of gauze bandages soaked in St. John's wort oil.

The presented method contributes to the early completion of the granulation phase and active tissue renewal. To prepare the above remedy, it is enough to take about 300 ml of refined vegetable oil and about 30-40 grams of dried St. John's wort. After mixing the ingredients, the composition should be boiled over low heat for about an hour. The cooled mass must be filtered through gauze. Then it can be used to apply bandages.

It is also possible to heal wounds at the granulation stage with the help of pine resin. The latter is taken in pure form, rinsed with water and, if necessary, softened by gentle heating. After such preparation, the substance is applied to the damaged tissue area and fixed with a bandage.

Options for further development of the granulation stage

If the first and second stages of wound healing passed without complications, then gradually the damaged area is completely covered with dense scar tissue and the regeneration process is successfully completed.

However, sometimes the mechanisms of tissue repair fail. For example, there is necrotization of areas adjacent to the wound.

This condition is extremely dangerous for the patient and requires immediate surgical intervention.

A necrectomy is an operation to remove dead tissue. If the wound is infected with pathogenic microflora, the healing process can be delayed for a long time. Antibiotics are used to restore normal tissue regeneration .

The granulation stage of healing of the damaged area is a complex adaptive mechanism aimed at early separation the internal environment of the body from adverse external influences. It provides the formation of new layers of tissue to replace the damaged ones. Thanks to the granulation stage, the trophism of the injured area is restored and other, deeper tissues are protected.

Surgical intervention

With a delay in the processes of granulation, the formation of deep wound passages is possible, in which an accumulation of purulent streaks is observed. In such cases, it is difficult to clean the wound due to the use of ointments and gels. The elimination of unpleasant complications most often occurs through surgical intervention. In this case, the specialist performs an incision, removes purulent accumulations, disinfects the wound, and then applies counter-openings.

Finally

So we figured it out, wound granulation - what is it? As practice shows, one of the determining conditions for accelerating the healing process is differentiated treatment. The correct selection of medications is also important. All this contributes to the speedy granulation of the damaged area and the formation of a new, healthy tissue.

A granulating wound is a common skin lesion filled with granulation tissue, which implies healing by secondary intention. Treatment of granulating wounds performed during the provision of first aid - stopping the blood flow, anesthesia, applying a special preparation for fast and effective regeneration of the skin, as well as the application of a bandage. The healing time of granulating wounds is determined individual features organism and the extent of damage to the epidermis. As you know, granulating wounds are common lesions of the integrity of the human skin. Her distinctive feature is that the cavity formed as a result of an injury is filled with granulation tissue. Due to its presence, the wound heals due to the secondary tension of the tissues. It should be remembered that since this injury can be considered open, it is not protected from bacteria, infections and any other contaminants of various kinds. Therefore, in addition to regular treatment with antibacterial agents, as well as ointments that accelerate regeneration, a sterile dressing should be used.

Treatment for granulating wounds

The process of regeneration of a granulating wound depends on how the patient adheres to the instructions issued by the medical officer. If you decide to prescribe a course of treatment yourself, we recommend that you read the instructions for "Lioxazin" - a high-quality and effective gel preparation a wide range actions. The composition of this anti-burn agent includes lidocaine, which has anesthetic properties, preventing the occurrence of pain"Lioxazin" promotes rapid healing of tissues, leaving no scars and scars after the entire course of treatment.

In order to cope with skin lesions, you should know exactly how granulating wounds are treated. First of all, you should consult a doctor to make an accurate diagnosis, as well as determine the appropriate course of restorative manipulations.

Gel "Lioxazin" is an indispensable assistant in the healing of injuries to the integrity of the skin. Its composition includes substances that promote skin regeneration. It also has a number of additional properties, such as the removal of inflammation, irritation and local anesthesia.

Treatment of granulating wounds with drugs

A wound is a local lesion of the skin caused by a violation of the integrity of tissues. Treatment of granulating wounds carried out on the seventh day after the injury. This process is valid for initial stage healing and is accompanied by filling the damaged area with granular tissue. The process of regeneration of such wounds lasts for a month - during this period, the connective tissue and epithelial cells unite the edges of the skin with a young bright red scar. Granulation is a temporary stage in which the tissue in this phase is replaced by a scar. Granulation of wounds is accompanied by the separation of non-viable tissues and stimulation of the healing effect.

Local wound healing may be accompanied by a delay purulent discharge- in these cases it is necessary surgical intervention accompanied by an incision of damaged tissues. The speed of the healing process of a granulating wound depends on the degree of primary treatment of the affected area of ​​the skin, however, the appearance of complications in the later stages is not observed.

The rehabilitation period for the treatment of granulating wounds is accompanied by the use of dry antiseptic dressings.

Treatment of granulating wounds with suturing

Since granulating wounds can be quite extensive, sometimes normal preventive measures is not enough. Therefore, for their speedy healing, you have to resort to the help of a surgeon. Suturing in case of damage to the skin is as follows:

• Wound treatment - removal of accumulated external contaminants; if present, pus and other factors that can cause infection of tissues and blood. Often, washing with a disinfectant solution is performed, followed by the use of antibacterial agents.
• Immediate suturing operation. During this procedure, the surgeon, using a special thread (ligature) and a needle, brings the skin areas together with complete concealment of the muscle tissue.
• postoperative processing. It includes disinfection of the wound and the application of a bandage that will reliably protect your skin from further damage.

Thus, the treatment of granulating wounds with suturing is sufficient. effective method. The main thing is to follow all the recommendations of the doctor to accelerate complete healing. The use of the Lioxazin-Gel gel will prevent possible inflammation, and will also make it possible to avoid the formation of scars and scars.

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Granulations are a specific subtype of connective tissue structures that are formed only during wound healing by secondary intention. If the granulation phase is disturbed, complications may develop in the form of a sluggish process with a long-term non-healing surface and layering of a secondary infection or, conversely, hypergranulation. It is the next phase of healing after inflammation and ends with epithelialization of the surface.

According to the International Classification of Diseases, they are not classified as separate category subspecies granulating wound code according to ICD 10, since the formation of granulation is a reaction of the body during regeneration after a pronounced inflammatory process.

Cleared of necrotic layers:

• surface lesions with microbial contamination lead to granulation;
• bitten or crushed by blunt objects;
• with bone fractures, injuries of internal organs;
• open wounds;
• with the presence of foreign bodies;
• complicated (immunodeficiency, concomitant diseases);
• after a burn with different localization. In terms of coverage of areas of the human body (10-30%, 30-60%, 60-90%).

A prerequisite is suppuration. Secondary infection, impaired healing process with the formation of pus.

• open wounds: skull - S01, cervical area– S11, chest cavity– S21;
• superficial: heads - S00, forearms - S50, shoulder girdle - S40;
• crushed: hands - S67, scalp - S07;
• traumatic amputations: lower leg - S88, unspecified area - T14.7, both feet - T05.3 or hands - T05, one finger - S68.1:
• open wounds involving several parts of the body, T01;
• thermal burn - T30.0, chemical - T30.

In such cases, wound granulation treatment is necessary.

In case of damage to the skin and soft tissues of various etiologies, the healing process consists of several successive stages.

In dentistry, artificial planting of one's own fibrin is used during tooth extraction to quickly stop bleeding and reduce the inflammatory process. The reason is the violation of the first phase of regeneration, which contributes to the clogging of damaged vessels with the further appearance of a crust, rather than granulation. This is the stage of inflammation, the development of which is aimed at hemostasis with the formation of a blood clot. Duration up to 7 days.

The second phase is the formation of a new tissue with the participation of fibroblast, leukocytes, and plasma cells. The granulation layer protects, replaces the defect and promotes the maturation of new epithelial cells with filling the wound cavity. It forms sequesters and rejects necrotic contents. Granulation tissue consists of 6 layers: superficial leukocyte-necrotic, from loops of vessels and polyblasts, maturing fibers, fibroblast, fibrous-protective. The duration of the period is determined by the characteristics of the organism, the rate of regeneration with replacement by scar tissue.

Formation of the epithelium - complete healing occurs by surface tension from the edge to the center of the wound. Depending on the severity, the final completion of epithelialization can last from several weeks to one year after granulation. The damage is filled with new fiber. In the epidermal layer formed, the initial number of vessels decreases due to the formation of scar tissue, which causes a bright scarlet hue. The process transforms into a coarse fibrous tissue, acquires the usual pale pink color.

Types of granulating wound

A process with delayed healing or, conversely, with growths outside the edges, requires treatment in the department of surgery. The rate of healing of the wound surface with the formation of granulations depends on the initial state of the body, regenerative capabilities and the presence of complications.

Sluggish wound healing process: massive blood loss or weakened immune forces of the body. Hypertrophic: proliferation of granulation tissue due to a violation of the epithelialization process.

hypergranulation

The development of pathology hypergranulation of the wound with the formation of tuberous layers that can grow into healthy tissues and, if the atypical ones are not removed, the inflammatory process spreads. Hypertrophic granulations hang over the edges of the wound focus, slowing down epithelialization. Removal is carried out by a specialist doctor. When trying to eliminate it yourself, you can severely injure the superficial, deep layers of the wound or provoke bleeding.

To restore and heal, the doctor cuts out excess granulations or cauterizes with silver nitrate concentrate, a solution of potassium permanganate.

Slow-granulating

The granulation process slows down:

• insufficient blood supply;
• lack of adequate oxygenation of damaged tissue;
• in the stage of decompensation of organs, systems;
• re-layering of pathogenic microflora;
• immunodeficiency.

The wound surface is pale, bluish-purple, there is no contraction, the turgor is reduced in the lesion. The granulation tissue becomes pathologically thin, and the surface is covered with a coating of fibrin and pus - this indicates the development of such a pathology as a sluggish granulating wound.

Treatment of injured areas in the granulation phase

Treatment methods can be external (application of solutions and ointments), surgical (suturing to tighten wounds), physiotherapy (impact with stimulation of epithelialization), folk methods(applied after consultation with the attending physician).

It is dangerous to treat pathological disorders of granulations on your own. This tissue is sensitive and easily damaged. After treatment, the doctor applies dry sterile dressings on top, which absorb excess exudative effusion and prevent external factors.

Medical

Treatment of a wound in the granulation phase with drugs includes topical application of:

• irrigation of wounds with warm solutions to provide antiseptics, wash out desquamated particles and stimulate epithelialization (hydrogen peroxide 3%, isotonic sodium chloride, potassium permanganate in a small amount);
• application medications, which stimulate wound healing, dry and prevent the formation of erosion (Acerbin, Solcoseryl, Hemogerivat, Ebermin, Zinc Hyaluronate).

Surgical

When purulent exudate is formed, pus flows into adjacent cavities of the body, surgical intervention is used in the phase of wound granulation. During the operation, an incision is made.

Purulent contents are removed by drainage, excision of necrotic areas, washing with antiseptic solutions, followed by suturing to accelerate healing.

Physiotherapy

Granulating lesions that heal slowly are subjected to physiotherapy treatment. Most favorable in this phase ultraviolet irradiation. Under the influence of which the wound surface is cleansed of pathogenic microflora, the regeneration of sluggish-granulating tissue is accelerated.

Folk methods

In the presence of small wounds in the granulation phase, without complications and after consulting a doctor, treatment with traditional medicine recipes is possible:

• St. John's wort oil: mix 50 g of a dry plant and 350 g of any vegetable (olive, sunflower, corn);
• pine resin, in its pure form, is applied to the wound under a bandage in the granulation phase.

Possible Complications

In case of violation of the wound healing process and the absence of adequate therapy, complications of the granulation phase can be observed:

• the formation of purulent cavities;
• the formation of fistulas with leakage of pus;
• suppuration of healthy tissues with ingrowth of pathogenic granulations;
• formation of gaping wounds;
• the formation of rough keloid scars in violation of the regeneration process;
• necrosis of large areas of the skin.

In order to avoid negative reactions and the development of serious complications, it is necessary to seek qualified medical help in the sluggish phase of wound granulation.