Process Of Wound Healing From The Point Of Wound Formation (Essay Sample)

WOUND HEALING
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WOUND HEALING
The human skin sustains injuries throughout life; this is brought by the concept that it is known to be a plastic organ. The skin can repair wounds, and this makes it paramount to surviving (Phillips, 2003). The ability to repair wounds is regulated by wound components which include; stem cells, extracellular matrix and mechanical force (Phillips, 2003). These pathways are combined across the different skin parts and are sort out on molecular and cellular levels. Wound healing is a dynamic and complex process that involves replacement of missing tissue layers and cellular structures. Shaw explains that wound repair is an essential physiological process for tissue homeostasis though it can be impaired in diseases and leads to the formation of numerous pathologies (Shaw, &Martin, 2009).
A wound can be as a result of internal or external damage. The internal damage is due to an impaired immune and nervous system function or a decrease in the supply of blood, insufficient oxygen supply or inadequate supply of nutrients to the affected areas. The external wounds are results of objects penetration or non-penetrating trauma (Kumar, Marianne, &Anthony, 2006).However, a wound can have an exposed underlying tissue, and they, therefore, form an open wound whereas closed wound do results as damages that occur without exposing the underlying tissue (Wilson, 1999). The ways in which skin is injured will always determine how the injured wound will get to heal. An incised wound will cause little damage to the surrounding tissue and so there will be no interruption of the blood supply, therefore, it will get to heal faster. The shearing injuries will cause minimal disruption of the skin surface, but it may lead to tissue necrosis with the risk of infections and prolonged healing if proper handling is not addressed (Nicholas, 2002).
However, a wound can be caused by different factors such as the natural disaster among others, and several factors can alter a wound from healing properly (Kumar, Marianne, &Anthony, 2006). So the possible causes of the tissue damage are to be identified before the wound healing process is carried out through the wound healing process takes time and slows with age. Depending on the time a wound takes to heal, a wound can be an acute or chronic injury (Broughton, Janis, &Attinger, 2006). Cases of chronic wounds are common among the older population, and it takes a longer time to heal. The process of wound healing can be put into three or four phases i.e. hemostasis, inflammatory phase, proliferation/granulation phase, and remodeling phase. A wound can be as a result of internal or external damage. The internal damage is due to an impaired immune and nervous system function or a decrease in the supply of blood, insufficient oxygen supply or inadequate supply of nutrients to the affected areas. The external wounds are results of objects penetration or non-penetrating trauma (Kumar, Marianne, &Anthony, 2006).However, a wound can have an exposed underlying tissue, and they, therefore, form an open wound whereas closed wound do results as damages that occur without exposing the underlying tissue (Wilson, 1999). The ways in which skin is injured will always determine how the injured wound will get to heal. An incised wound will cause little damage to the surrounding tissue and so there will be no interruption of the blood supply, therefore, it will get to heal faster. The shearing injuries will cause minimal disruption of the skin surface, but it may lead to tissue necrosis with the risk of infections and prolonged healing if proper handling is not addressed (Nicholas, 2002).
A healing process of a wound involves wound contraction, synthesis of collagen and epithelization process. However, the ability of the skin to heal depends on the depth of the damage to the skin which can be classified as; The superficial, partial thickness and full thickness. According to Percival, the superficial wounds involve the epidermis and papillary dermis, and they heal by epithelialization from surviving pilosebaceous units such as sweat glands and hair follicles (Broughton, Janis, &Attinger, 2006).The partial thickness heals with a combination of re-epithelialization from pilosebaceous units with the ability of wound contraction and scar formation. The full thickness wounds, however, involves two healing stages, Primary, and secondary healing.
Immediately after tissue injury through an incision, the first response is usually bleeding.It is the body's natural response which is then triggered by chemical release from endothelial cells and pain receptors. Coagulation and vasoconstriction start with clotted blood covering the wound. The wound undergoes dehydration and a layer forms (Günter, &Machens, 2014). The healing process is systematic and goes in the events as follows.
Wound healing phases
Initial phase- hemostasis
The first result of an injury is followed by an outflow of lymphatic fluid and blood Hemostasis begins almost immediately after the wound has occurred. The affected blood vessels start to constrict to reduce blood flow to the wounded area. It is the body's natural response which is then triggered by chemical releases from endothelial cells and pain receptors. Both the extrinsic and intrinsic clotting mechanisms become activated (Steed, 2003). Following the platelets respond by discharging adenosine diphosphate (ADP) which help thrombocyte to clump, therefore covering the wound. The thrombocytes together with white blood cells release the other numerous factors to accelerate healing process (Günter, &Machens, 2014). Blood cells get caught in the mesh and strengthen the clot. While the fibrin meshes forms around the wounded area, the blood begins to coagulate into a gel. Here inflammation process, myoblastic creation, blood vessels growth have commenced.The interleukins here influences inflammation process. Vascular endothelial growth factor (VEGF) enhance the formulation of blood vessels.(Falabella, &Kirsner, 2005)
Second phase-inflammation
As inflammatory phase begins during hemostasis phase, the initial component of inflammatory phase is controlled by macrophages. The inflammation stage will also be followed by the passive leakage of circulating leukocytes from the damaged blood vessel into the wound accompanied by rapid activation of immune cells together with the Langerhans cells which release a quick pulse of chemokines and cytokines. Within 6-8hours, the next stage of the healing process is underway. The polymorphonuclear leukocytes (PMNS) extrude themselves from blood vessels, and they cleanse and clear debris from the wound. As this continues monocytes exude from vessels Once (Steed, 2003).when they leave vessels they are termed as macrophages and are responsible for continuous cleansing and manufacturing growth factors. The macrophages also secrete many of the factors that influence the process of wound healing (Falabella, &Kirsner, 2005).
Third phase- granulation/proliferation
In this phase, there are different sub-phases which don't happen in separate time frames but an ongoing process. These sub-phases are "matrix deposit in fibroplasia angiogenesis and re-epithelialization which can last even up to four weeks for a clean wound (Falabella, &Kirsner, 2005). The proliferation process depend on the size and the location of the wound, for example, a small skin wound will take a lesser time to heal, the cells within the wound form a permanent closure of the wound gap and replenish the lost tissues. Fibroblasts are connective tissue that helps promote the growth of new tissue in the injured area (Wilson, 1999). Angiogenesis is stimulated by growth factors and begins to form new blood vessels from the damaged blood vessels. Collagen proteins are deposited and increase the strength of the new tissue forming. The extracellular matrix is formed through secretions from other cells and provides more structural and biochemical support to surrounding cells. Granulation tissue forms on the surface of the wound (Wilson, 1999).During the epithelialization phase, epithelial cells migrate across the new granulation tissue to form a barrier between the wound and the environment. In the final phase of the regular wound healing process, collagen is rearranged and replaced with different types of collagen (Kumar, Marianne, &Anthony, 2006).
Fourth phase remodeling/maturation
In this phase, the wound goes through constant alteration called improvement. This process can even last for after the injury occurred (Garg, &Longaker, 2000).The wound contracts a great extent when secondary healing is taking place, unlike the primary healing. Finally the twelfth week, the resultant scar has 80% tensile strength replaced by the original skin. Remodeling and realignment of the collagen tissue occur to produce greater tensile strength then follows. Enoch explains that wound improvement takes place when the underlying contractile and connective tissue shrinks to bring the edges of the wounds together (Enoch, 2004).This contraction occurs between the interaction of the fibroblast and surrounding extracellular matrix (ECM).
Agents like platelet-rich plasma are factors that have positive effects on regeneration of tissues and successfully they have been used to facilitate wound healing (Günter, &Machens, 2014).Nutrition is also critical for wound healing. It correlates with fast with wound healing (Garg, &Longaker, 2000).
However, in some instances wounds do not undergo the above stages when the wound is much chronic. In this case, the wound has to be handled by a clinician.
Chronic wound healing
The chronic wound healing involves a search by a clinician for underlying causes that may have made a woun...