DERMATOLOGY >> WOUND MANAGEMENT

WHAT IS SKIN?

The skin forms the continuous external layer also known as the body’s integument. It is the largest organ of your body and has 4 important functions: protection, sensation, thermoregulation and metabolic function. It consists of 3 layers: epidermis, dermis and hypodermis¹.

WHAT ARE THE SKIN TYPES?

Skin is often described using the Fitzpatrick Skin Type. This classification of skin type depends on the amount of melanin pigment in the skin. There are six types of skin.

  • Skin type I individuals have pale white skin which burns easily and tans slowly. Also, it needs more protection against sun.
  • On the other hand, skin type VI individuals have dark brown or black skin which burns less and tans more easily, but it is also more prone to develop post-inflammatory pigmentation after injury2

 

WHAT ARE THE TYPES OF WOUNDS?

There are two types of wounds: acute and chronic. Acute wounds follow the normal stage of wound healing to achieve complete repair within 12 weeks. A chronic wound occurs when acute wound healing fails. The process of repair continues on for greater than 12 weeks.

WHAT IS WOUND HEALING?

Wound healing is a physiological process in which the skin (or another organ – tissue) repairs itself after injury. The classic model of wound healing is divided into three sequential (yet overlapping) phases:

Regardless of the type of wound or amount of lost tissue, the healing process goes through three dynamic steps: the inflammation phase, the proliferation phase, and the remodeling phase. In the case of chronic wounds – those that do not show visible signs of healing in an acceptable amount of time despite adequate treatment (6 weeks) – this healthy healing process is disrupted, and tissue regeneration is delayed.

 

Phase 1: Haemostasis and the Acute Inflammatory Phase

This first phase of wound healing achieves haemostasis and inflammation of the local area through a combination of vascular and biochemical mediated events.

Once the initial bleeding stops, leukocytes can migrate more easily to the wound, as the blood vessels dilate, and the vascular walls become more permeable. Their task is to protect the wound of infection and to clean it.

 

Phase 2: Fibroblast Proliferation and Tissue Formation

Phase 2  consists of 5 important steps with granulation( fibroplasia) considered the  hallmark of tissue healing. Fibroplasia, cell hypoxia, angiogenesis,  epithelialization and wound contraction.

Severely injured tissue cannot be regenerated, so this phase marks the filling of a wound with new tissues. The granulation phase involves tissue regeneration.

The priority is to protect these new tissues and prevent wound dehydration. If the wound dries, the cells die. Hydration sustains the healing process.

Phase 2 fibroblast replication requires cell hypoxia which is achieved  through reduced oxygen tension at the edge of the wound.

Angiogenesis, or the formation of new blood vessels to the traumatised  area occurs in parallel with fibroplasia, as the two components are  interdependent.

Resurfacing of the wound bed is called epithelialization’

 

Hydration is also important in the last phase of healing. Connective-epithelial functions are restored as much as possible (often not achieving complete regeneration). Surface cells are in the process of closing the wound, still vulnerable to the detrimental effects of dehydration; so, we have to keep moisture and protect the wound from the harmful influences of the environment.

 

WHAT ARE THE TYPES OF WOUND HEALING?

There are two types of wound healing: moist and dry. In dry wound healing all repair and regenerative processes take place under a protective scab. In a moist environment, cells can grow divide and migrate at an increased rate to optimize the formation of new tissue.

WHAT ARE THE CHARACTERISTICS OF THE IDEAL WOUND DRESSING?

An ideal wound dressing should create a moist environment for fast and proper wound healing and block micro-organisms from entering the wound. It should allow CO2 and water vapor out.

Also, it has to be removed without pain and without harming the newly formed granulating tissue and it should minimize scarring 3

During all phases of the wound healing process, the products that help heal the wound must:

  • support the formation of granular tissue and activate the healing processes
  • balance the hydration level to maintain optimal healing conditions
  • protect the wound and prevent the infection

The choice of the wound dressing after a wound has occurred (from clinical or aesthetic procedures) is of great importance. The best choice is a wound dressing which will give you the best results in both clinical and in aesthetic outcomes and reduce the pain and discomfort after the intervention.

Alhough, for clean wounds, the ideal level of moisture is the golden standard for fast wound healing, when the wound is infected, there is a need for an antimicrobial factor. Trials have shown that oils like Alkanna Tinctoria oily extract, due to its ingredients triple action (antimicrobial, antiinflammatory and strong healing) is very powerful for local use. The broad spectrum of activity against Gram (+) bacteria, such as Staphylococcus aureus, S. epidermitis and others, as well as against fungal pathogens, Candida albicans, make the extract particularly suitable for treating infected wounds.

RECOMMENDATIONS FOR WOUND MANAGEMENT
  1. Treatment should be initiated immediately after the wound formation, in order to help and shorten the healing process.
  2. Follow the doctor’s advice to prevent possible complications that may occur at the wound level.
  3. Do not apply non-sterile or healing products that have not been authorized to be applied directly to the wound. There is a very high risk that the wound will become infected.
  4. Apply direct treatment on the wound, do not combine with other products except at the advice of the treating physician.
  5. Do not expose yourself to the sun in the first months after surgery, there is a risk that the scar formed after the healing process to have a changed color due to extensive pigmentation.
REFERENCES
  1. Burkitt H. G, Young B, Heath J. Wheater’s Functional Histology. 1995. Churchill Livingstone.
  2. Fitzpatrick’s Dermatology in General Medicine. 2003.
  3. Elsevier – Bolognia, Jorizzo and Rapini: Dermatology 2003

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