WOUNDS AND WOUND HEALING

Definition

• A wound is an injury to the skin or underlying tissues caused by trauma, surgery, burns, infections, or accidents.

TYPES OF WOUNDS

1. Closed Wounds

• Abrasion: loss of top skin layer due to friction
• Bruise: blood collection under skin
• Contusion: deeper blood collection
• Laceration: skin tear due to trauma
• Puncture wound: small deep hole from sharp object

2. Open Wounds

• Incised wound: clean cut
• Laceration: irregular tear
• Puncture wound: deep narrow hole
• Avulsion: skin/tissue torn off
• Burns: thermal damage to skin layers

CAUSES OF WOUNDS

• Trauma
• Surgery
• Accidents
• Burns
• Infections

CLINICAL FEATURES OF WOUNDS

• Bleeding
• Swelling
• Pain
• Redness
• Signs of infection

INVESTIGATIONS

• History and physical examination
• Blood culture / wound culture
• Imaging: X-ray, CT scan

COMPLICATIONS

• Infection
• Abscess
• Scarring
• Keloid

WOUND HEALING PROCESS

Stages of Wound Healing

• Inflammatory phase: clot formation, WBC action
• Proliferative phase: granulation and new tissue formation
• Remodeling phase: collagen maturation, scar strengthening

TYPES OF WOUND HEALING

1. Primary Intention (detailed)

• Clean wound, minimal tissue loss
• Edges approximated with sutures/staples/glue
• Minimal gap and minimal granulation
• Rapid epithelialization
• Minimal scar
• Low infection risk
• Seen in surgical clean incisions

Steps

• Clot → Mild inflammation → Epithelialization → Collagen deposition → Scar maturation

2. Secondary Intention (detailed)

• Large tissue loss, edges not approximated
• Wound left open to heal naturally
• Large granulation tissue formation
• Slow epithelialization
• Wound contraction by myofibroblasts
• Large irregular scar
• Higher infection risk
• Seen in ulcers, burns, contaminated wounds

Steps

• Large clot → Intense inflammation → Granulation filling → Slow epithelialization → Contraction → Large scar

3. Tertiary Intention

• Wound kept open initially due to contamination
• Closed later after infection risk decreases

FACTORS AFFECTING HEALING

• Nutrition
• Age
• Infection
• Smoking

EXAMINATION OF WOUND

• Assess size and location
• Assess depth and width
• Look for foreign body
• Look for infection signs

SURGICAL SITE INFECTIONS (SSI)

Classification

• Superficial incisional: skin and subcutaneous tissue
• Deep incisional: muscle and fascia
• Organ/space: internal cavity or organ

Risk Factors

• Poor hygiene
• Poor wound closure
• Foreign material use
• Inadequate prophylactic antibiotics

Clinical Features

• Redness
• Swelling
• Pus discharge
• Foul smell
• Fever

MANAGEMENT OF WOUNDS

General Management

• Cleaning and dressing
• Antibiotics if needed
• Suturing or stapling
• Debridement of dead tissue

Cleaning and Dressing

• Clean with sterile saline
• Apply antibiotic ointment
• Cover with sterile dressing

TYPES OF SUTURE MATERIALS

• Catgut: absorbable
• Monocryl: absorbable
• Prolene: non-absorbable

TYPES OF SUTURES

• Simple interrupted
• Subcuticular
• Standard knotting techniques

HOMOEOPATHIC THERAPEUTICS

For Wound Healing

• Arnica montana: inflammation, bruising
• Calendula: clean healing, prevents infection
• Hypericum: nerve pain
• Silica: reduces scar/keloid tendency

For Surgical Site Infection

• Arsenicum album: superficial infection
• Bryonia: deep muscle infection
• Silica: organ/space infection

For Injuries

• Aconite: shock after injury
• Arnica: trauma
• Calendula: cuts, surgical wounds

SCARS AND KELOID (MSØV)

Meaning

• Scars and keloids are abnormal results of wound healing where excessive fibrous tissue is formed after an injury.

Scars

Definition

• A scar is a fibrous tissue formed after healing of a wound.
• It replaces normal skin with collagen-rich tissue.

Types of Scars

• Normal scar: flat, thin, soft
• Hypertrophic scar: raised, thickened scar within the wound boundary
• Atrophic scar: depressed scar (eg. acne scars)

Causes

• Deep wounds
• Burns
• Surgery
• Trauma
• Infection during healing

Clinical Features

• Thick, raised or flat line
• Itching or mild pain sometimes
• Stiffness if over joints

Pathology

• Excessive collagen type III deposition
• Increased fibroblast activity
• Reduced balance between collagen formation and breakdown

Complications

• Cosmetic disfigurement
• Restricted movement (if over joints)
• Recurrent itching or pain

Management

• Silicone gel or silicone sheets
• Pressure therapy
• Topical creams
• Steroid injections
• Laser therapy
• Surgical excision if needed

Homoeopathic Medicines for Scars

• Calendula: healthy healing
• Graphites: thick hard scars
• Silica: helps absorption of fibrous tissue

KELOID

Definition

• A keloid is an abnormal overgrowth of scar tissue that extends beyond the original wound boundary.

Causes

• Skin injury
• Burns
• Acne
• Piercing and tattoo wounds
• Genetic tendency in some individuals

Clinical Features

• Raised, shiny, smooth growth
• Firm and hard to touch
• Extends beyond site of injury
• Itching and burning sensation common
• Cosmetic concerns

Pathology

• Excess production of collagen type I and III
• Excessive fibroblast and keratinocyte activity
• Failure of normal control of wound healing
• Thick bundles of collagen in whorled pattern

Risk Factors

• Family history
• Darker skin tone
• Younger age group (10–30 years)
• Repeated trauma or irritation at site

Complications

• Cosmetic disfigurement
• Pain and itching
• Recurrence after removal

Management

• Silicone gel or silicone sheets
• Pressure therapy
• Intralesional steroid injections (first choice treatment)
• Cryotherapy
• Laser therapy
• Surgery (high recurrence if used alone)

Homoeopathic Medicines for Keloid

• Silica: hard fibrous tissue
• Graphites: thick, sticky, elevated scars
• Thuja: excessive tissue growth tendency
• Calcarea fluorica: hard nodular growths

DIFFERENCE BETWEEN HYPERTROPHIC SCAR AND KELOID