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The process of wound healing is generally divided into four stages:
inflammation, fibroblast proliferation, contraction, and remodeling.
There are three types of wound healing:
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- First intention. The wound
is closed by routine primary suturing, stapling, or gluing. Epithelialization
occurs in 24–48 h.
- Secondary intention. The wound
is not closed by suturing, stapling, or gluing but closes by spontaneous
contraction and epithelialization at a rate of 1 mm/d).
Most often used for wounds that are infected and packed open.
- Third intention (also called
delayed primary closure). The wound is left open for a time and
then sutured at a later date. Often used with grossly contaminated
wounds.
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Used for healing both acute and chronic wounds. Continuous negative
pressure is distributed over the wound surface. The system consists
of a soft sponge cut to fit and occupy the volume of the wound,
a plastic tube imbedded in the center of the sponge and extending
out of the wound to a controlled suction pump, and a gas- and fluid-impermeable
plastic outer film that adheres to the back of the sponge and the
surrounding normal skin. Vacuum-assisted closure allows “active” removal
of extracellular debris (exudate). Soft-tissue defects heal faster
when subatmospheric pressure is applied. Used for wounds resulting
from pressure, trauma, infection, IV extravasation, A–V
insufficiency, and skin grafting.
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Suture materials can be broadly defined as absorbable and nonabsorbable. Absorbable sutures can be thought
of as temporary and
include plain catgut, chromic catgut, and synthetic materials such
as polyglactin 910 (Vicryl), polyglycolic acid (Dexon), and ...