Wound Healing Center in Hyderabad,india
chronic wounds healing
chronic wounds healing,The normal skin, with the help of the epidermis (outermost layer) and dermis (inner or deeper layer) , forms a protective barrier against the external environment. Once this barrier is broken, means when the injury happens,the normal (physiologic) process of wound healing is immediately set in motion.
The classic stages of wound healing
(1)Stage of Hemostasis
When an injury happens , platelets (thrombocytes) aggregate at the injury site to form a clot. This is happened by the release of non-globular Protein called Fibrin, which is polymerized to form a “mesh” that forms a hemostatic plug or clot, over the site. This clot prevents further bleeding.
(2)Stage of Inflammation
In this stage cell debris and pathogens like bacteria are phagocytoed and removed. Some factors helping for the migration and division of cells involved in the proliferative phase are also starting to be released in this stage.
(3)Stage of proliferation
In this stage new blood vessels are formed( angiogenesis).Collagen deposition,Granulation and Epithelial tissue formations are taking place to re build the wound tissue. These processes will lead to contraction of wound. This leads to re-epithelialization of the epidermis, which grows atop the wound bed, covering the new tissue.
The wound is made smaller by the action of myofibroblasts which make a grip on the wound edges and contract themselves using a mechanism similar to that in smooth muscle cells.
(4) Stage Remodeling.
After closing of the wound the collagen is getting deposited more and remodeled and realigned along tension lines. The unwanted cells undergo apoptosis and are removed from the site.
Involved growth factors and Their Main Functions
- Epidermal GF( Granulation Tissue formation)
- Transforming GF (Epithelial Cell Proliferation and Expression of antimicrobial peptides)
- Hepatocyte GF(Epithelial and Endothelial proliferation)
- Vascular endothelial GF (Vascular permeability and Endothelial cell proliferation)
- Platelet Derived GF(Granulocyte, macrophage and fibroblast activation and Fibroblast, endothelial cell and smooth muscle cell proliferation
- Fibroblast GF 1& 2(Fibroblast and keratinocyte proliferation; Angiogenesis; Wound contraction; Matrix (collagen fibers) deposition)
- Transforming GF Angiogenesis, Keratinocyte proliferation)
- Keratinocyte GF (Keratinocyte migration, proliferation and differentiation)
Non-healing, or chronic wounds, are complex wounds that do not progress through the usual phases of healing. Almost all of them may remain in inflammatory stage.The degradation of the tissues will be more and production of new healthy tissues will be low.
Chronic wounds may never heal or may take years to do so
Factors which may contribute to this include diabetes, venous or arterial disease, old age, and infection.
Types of Chronic Wounds
Venous and arterial ulcers
Usually occur in the legs, account for about 70% to 90% of chronic wounds and mostly affect the elderly
Have a higher risk of amputation due to chronic wounds
Usually occur in people with conditions such as paralysis that inhibit movement of body parts that are commonly subjected to pressure such as the heels, shoulder blades,and sacrum,mainly due to ischemia.
Major Factors Leading To Chronic Wounds
There is a restriction in blood flow to tissues causing lack of oxygen and glucose leading to cell death. It is generally caused by problems with blood vessels, like vaso constriction, thrombosis or embolism.
The lack of oxygen will decrease white blood cells to fight against Bacteria.So the immune response comes down and the bacteria prolongs the inflammation, delays healing, and damages tissue. Eventually this will end up in gangrene and more damage and destruction. Patients carrying drug resistant bacterial strains have more chronic wounds.
Growth factors and proteolytic enzymes
In chronic wounds, the proteolytic enzymes are higher, leading to low proteins helping in healing and Growth factors are lower. the factors may be prevented from proper functioning of wound healing and new cell production or degraded in excess by cellular or bacterial proteases
Factors affecting Wound Healing
Many factors controlling the efficacy, speed, and manner of wound healing fall under two types: Local and Systemic Factors.
Mechanical Factors,Edema, Ischemia and Necrosis, Foreign Bodies, Low Oxygen Tension, Repeated Trauma,
Inadequate Perfusion, Inflammation, Nutrient, Metabolic Diseases, Immuno suppression, Connective Tissue Disorders, Smoking
PRP in Healing
Autologus PRP have platelets enriched with clotting and growth factors which are helpful in producing new cells and in removal of the debris. It has both mitogenic and chemotactic properties.
PRP wound repair by releasing locally active growth factors via a granules degranulation. The growth factors will help healing by providing undifferentiated cells in the new Extra Cellular Matrix and Boosting the new cell division.
It can suppress cytokine release and reduce inflammation. It will help in production of capillaries and epithelial growth.
With the help of leucocytes present in them and by releasing signaling proteins which attacks the macrophages, it will improve the immune system also.