Wound granulation. Prevention of the development of complications at the stage of healing of damaged tissues. Granulation and other phases of wound healing What is granulation tissue

The body is a complex biological system that has a natural ability to regenerate. One of the indicative evidence of the existence of a self-healing mechanism is wound healing.

Each wound has a natural reparative potential, which is presented in the form of a clear, long-studied by researchers, staged healing mechanism based on physiological processes. That is, if during the treatment of a wound, measures and preparations contribute to the physiological course of a staged wound process, the wound will heal in the shortest possible time. It is the consideration of the physiology of the wound process that is the most important condition for the effective treatment of wounds.

As you know, wound healing can take place by primary and secondary intention. In the first case, due to the fit of the wound edges, its linearity and the minimum area of ​​the wound surface, the wound, as a rule, heals quickly and without inflammation. Therefore, if possible, they try to subject any wound to surgical treatment by applying a skin suture. Treatment of such a treated wound in the vast majority of cases is not particularly difficult.

In the case of extensive wounds, with non-closure of the edges of the wound and the presence of areas of tissue necrosis, healing occurs by secondary intention. It is in the management of such wounds that heal by secondary intention that the stage of the wound process should be taken into account very carefully, carrying out differentiated treatment.

Treatment of wounds: stages of the course of the wound process

Regardless of the type of wound and the degree of tissue damage, the wound process goes through three physiological stages of healing in accordance with morphological changes at the level of cells and tissues. More N.I. Pirogov identified 3 stages. Today, the most commonly used approach is M.I. Cousin to the staging of the wound process.

Stage 1. Stage of exudation (vascular reaction and inflammation)

The wound at the stage of exudation is characterized by perifocal edema, slight hyperemia and specific discharge.

At the stage of exudation, all physiological processes are aimed at separating damaged tissues that can no longer be restored and can potentially become a source of infection and intoxication. Thus, the inflammatory process at the stage of exudation contributes to the removal of dead tissues and cleansing of the wound. All processes in the wound at this stage are due to the activation of complex enzyme-catalyst systems (kallikrein-kinin, Hageman factor, fibrinogen, C-reactive protein, prostaglandins, biogenic amines, etc.)

Wound discharge at the stage of exudation, as a rule, is initially serous, serous-fibrinous, with blood clots. Then the discharge becomes purulent, contains leukocytes and cells of necrotic tissues.

If at any stage of the wound process an infection is attached, the discharge becomes larger, and it acquires the appearance, color and smell characteristic of a certain type of microorganisms.

Stage 2. Stage of proliferation (regeneration)

Under ideal conditions, when the wound heals by primary intention, the proliferation stage (in particular, the synthesis of collagen by cells) begins already on the second day.

When a wound heals by secondary intention, at the regeneration stage, foci of cell division begin to appear in the most cleansed areas - granulation tissue. Usually they are pale pink in color, moist, easily injured and therefore require protection from damaging factors.

As the granulation progresses, a parallel decrease in the area (size) of the wound gradually begins due to its transition in the zone of the edges of the wound to the third stage.

The discharge from the wound at the stage of regeneration is scanty, serous-hemorrhagic, and at the slightest traumatization of the granulation tissue, the discharge becomes hemorrhagic.

Stage 3. Stage of epithelialization (stage of differentiation)

Sometimes the stage of epithelization is called the stage of scar formation or final healing, as well as the stage of formation and reorganization of the scar. The discharge is already absent or practically absent, the wound is dry. A discharge can occur in case of injury to the wound, as well as when an infection is attached.

Additionally, it should be taken into account that the wound process in the same wound (especially if it has a large area) is almost always characterized by a single-stage multi-stage process. That is, the stages usually move smoothly from one to another, and it is not always possible to clearly tell at what stage the wound is during such a transition. After all, sometimes in some areas the wound is in one stage, and in others - in another.

Most often, epithelization begins along the edges of the wound or from the zone of the so-called islands of epithelization. In this case, the rest of the wound may be in the stage of proliferation.

Also, often the cleansing of the wound does not occur simultaneously over the entire surface. In some cases, the edges of the wound are cleaned more slowly than the central part, if there is more damaged tissue left along the edge. Therefore, differentiated wound treatment should take into account the possibility of having several stages of healing of one wound at once, and not slow down progress.

Treatment of wounds depending on the stage of the wound process: the choice of the drug in the optimal dosage form

To understand how the medical support of a wound can be as physiological as possible, stimulating the natural processes of wound healing, it is necessary to understand the essence of the changes that occur at different stages of the wound process.

So, although we are talking about the stage of exudation as the first stage of wound healing, it, in fact, is the stage of decay (necrosis) of tissues, which is characterized by inflammation.

What are the needs of the wound at the stage of exudation?

• Prevention of drying of the wound surface.
• Possibility of free allocation of exudate.
• Improvement of wound trophism to prevent increased necrosis.
• Stimulation of the beginning of the formation of granulation tissue (transition to the second stage).
• Mechanical assistance in the removal of necrotic tissue.
• Prevention of infection penetration into the wound.

Mechanical removal of necrotic tissues and prevention of infection penetration is achieved by primary surgical treatment of the wound and, in the future, frequent dressings using sterile dressings and washing the wound and antiseptics. The rest of the needs of the wound can only be met by using the most effective preparation for local treatment of the wound at this stage.

The requirements for a topical treatment for early stage wounds are quite simple. The drug should have a hydrophilic base, retain moisture for a long time and be easy to use. Dosage forms that meet these requirements include solutions and gels. Solutions, unfortunately, are not able to retain moisture for a long time, therefore, when using solutions, dressings must be done every 1.5-2 hours. That is, they are not very convenient to use.

Gels are much more promising in this sense. They are easy to use, retain moisture better, provide exudate outflow, and do not create a fatty film. The active substance of the gel preparation for the treatment of a wound in the first stage should have a trophic effect, which will protect the wound from excessive necrosis and stimulate its transition to the second stage.

At the second stage (proliferation), as the wound is cleansed, the formation of a new tissue begins, on the basis of which healing begins. This new, granulation tissue is very sensitive to damage and trophic disturbance. It can regress and even collapse. Therefore, when managing a wound, it must be protected as much as possible. To do this, on the islets of granulation tissue and on the edges of the wound, where the most intensive proliferation processes also take place, a drug with the same trophic effect that stimulates collagen synthesis and cell division should be applied, but already on an ointment basis.

As the second stage of the wound process progresses, more and more of the wound surface must be treated with ointment. And as a result, when the wound becomes dry and significantly decreases in size due to marginal epithelization, it is necessary to completely switch to the use of ointment. Due to the creation of a fatty film on the surface of epithelialization areas, the ointment will protect young skin cells from drying out and provide them with greater resistance to environmental factors.

At this stage, it is also important to stimulate the patient's permitted motor activity: this tactic is justified by the fact that the activation of the patient also increases blood circulation in the wound area, which improves healing processes.

If the wound is large in area, due to the rather slow mitosis of the epidermal cells of the edges of the wound, it will be difficult to achieve complete epithelialization. So, on average, the epidermis can grow by 1 mm per month. Therefore, with large clean wound surfaces at the second or third stage, auto-transplantation of the skin is often resorted to, which will make it possible to obtain new, additional, areas of wound epithelialization and accelerate its complete healing.

Treatment of wounds: differentiated use of wound healing drugs for the local treatment of non-infected wounds at different stages of the wound process

Sometimes wound healing is a lengthy process. The duration of healing (and, accordingly, the course of treatment) depends on the nature of the wound, its area, the state of the body, the infection of the wound, and other factors. Therefore, when managing a wound, the doctor must constantly analyze at what stage of the wound process it is at the moment.

So, if a regression occurs during the healing process, you should stop using the ointment and again return to prescribing, for example, gel forms of drugs and wait for the wound to clear and new granulations to appear. When dry areas appear, on the contrary, it is necessary to treat them with ointments.

Differential treatment of wounds is one of the main conditions for their healing. And the right choice of drugs for the treatment of wounds directly ensures the speedy healing of the wound.

Treatment of wounds: differentiated use of wound healing drugs for the local treatment of non-infected wounds at different stages of the wound process

Note. When treating non-infected wounds in the first two stages of the wound process, before using local agents, the wound should be washed with an aqueous solution of one of the antiseptics to prevent infection. In addition, the skin around the wound at the beginning of each dressing is treated with an alcohol solution of antiseptics.

Rapid healing of scars

Active substance:

Hemoderivat, ointment base.

Indications:

• Venous ulcers
• burns
• Injuries
• Frostbite

Fast healing without scars

Active substance:

Hemoderivat, hydrophilic base.

Indications:

• At the stage of weeping for the treatment of erosions, ulcers, of various origins, including radiation
• Bedsores, burns
• Trophic ulcers of atherosclerotic and/or diabetic origin

Wound healing of various areas and organs, similar in general characteristics, proceeds according to general patterns, but their morphological characteristics vary depending on the nature of the damage, the size of the defect, the presence of infection, etc.

According to long ago rooted According to ideas, wound healing is carried out in two ways: according to the type of primary and according to the type of secondary intention. Both of them lead to the replacement of the defect with young connective tissue, which later acquires the character of cicatricial tissue, and nevertheless, both of these processes not only quantitatively, but also qualitatively differ from each other (IV Davydovsky, 1959). Each of them is preceded by a different state of the tissue, especially with regard to the nature of the inflammation that always accompanies the wound process; they have a different length in time, and the young connective tissue that arises during this period has functional and structural differences. Not all young connective tissue is granulation; the latter characterizes only the secondary intention and is not typical for the primary tension of wounds.

This classification is more complete and is now widely used by everyone. Usually the hole is on the outside. There is a slight lesion of the soft parts. It is especially characterized among sportsmen and military men. Most often the tibial segment. This is due to unusual, intense and repetitive restrictions. In this case, bone scan, which is very sensitive, shows localized hyperfixation. Fracture stage or actual fracture of fatigue, when acute facultative pressure pain occurs, inability to continue sports activities.

Primary Tension represents is a process of organization (that is, replacement by connective tissue) of the contents of the wound channel (blood clots, partly necrotic masses that have not undergone decay - I. E. Esipova, 1964).

The condition of the tissues pre-primary tension, can be characterized as serous inflammation or traumatic edema, accompanying to some extent each injury. Swelling of the walls of the wound channel or defect leads to their convergence and partly to the displacement of foreign bodies, that is, to mechanical cleansing of the wound. Nevertheless, in the latter there are always free masses of coagulated blood, and, consequently, fibrin, which is a nutrient medium for the development of cellular elements of the mesenchyme. The proliferation of the latter begins already at the very beginning of the wound process, that is, it coincides in time with the development of wound inflammation.

In this case, x-rays show a fracture line, associated or not with images of the bone structure. The treatment combines sports recreation, orthopedic treatment at the stage of preliminary fracture. Surgical treatment is indicated in cases of delayed consolidation, recurrence, or in the specific case of an isolated fracture of the anterior cortical tibia that has a bad reputation for non-return.

The importance of the meniscus in articular and well-known physiology. General menisectomy includes the onset of well-known articular degenerative phenomena. Currently, most of the sightings of a syringe in the meniscus are as follows. While contraindications are presented.

Wound inflammation represents is the first step in the wound healing process. Its morphological manifestations include the expansion of the vascular network in the circumference of the wound, the phenomena of exudation and edema of the edges of the wound defect, leukocyte infiltration. Active expansion of arterioles occurs very quickly, almost instantly, and the closer to the edge of the wound, the more pronounced it is. The venules also dilate in the early period. Capillaries react somewhat later (F. Marchand, 1901).

Vascular disorders of systemic metabolic diseases that affect the synthesis of collagen congenital disorders of the collagen syndrome of the kidneys in the post-lateral region of the lateral meniscus. But not all meniscus injuries need to be sutured, spontaneous healing has been described. The meniscus is a suture and some warnings must be followed. The sutures should not be wide so as not to choke the synovium and therefore limit the blood supply to the meniscus. Other proposed ways to speed up and facilitate the healing process of the meniscus is to reverse the synovial all internal leaflets of the injury before the suture, to interrupt the fibrin clot, possibly by associating it with the fascia flap in complex meniscal lesions.

Following hyperemia begins exudation of serous fluid, which impregnates the edges of the defect and penetrates the wound. On the wound surface, the exudate mixes with blood and lymph, which poured out during the injury, and with torn tissue particles. It soon collapses. This is how a scab is formed.

Leukocyte infiltration begins 2-3 hours after injury. First, in small vessels and capillaries, leukocytes located parietal are observed. Then they actively penetrate through the capillary wall. Polymorphonuclear neutrophilic leukocytes emigrate earlier than others and in greater numbers. Simultaneously with the emigration of polynuclear cells, monocytes, polyblasts, and lymphoid elements of tissue origin accumulate in the edges of the wound; further cellular elements differentiate towards macrophages, absorbing decay products, and fibroblasts.

You can use absorbable or non-absorbable wires for suturing. According to Miller, there are no significant differences in the type of seam. Meniscal cartilage requires healing over a longer period of time than other tissues; however, you don't know exactly how long a full healing lasts. Arnocki and Warren showed that scarring is completed between 8 and 12 weeks with disorganized fibrocartilaginous tissue that is mechanically and less valid than the original structure.

The seam can be done with horizontal or vertical dots. The latter are mechanically more efficient. The suture points must be evenly spaced above and below the meniscus so that the lesions are completely repaired and in contact. According to Lindelfeld, it is preferable to place suture points on the surface of the tibia, as there is no movement between the meniscus and the lamina of the tibia. According to Pouget, the dots can protrude uniformly on the two surfaces of the outer meniscus, since they are concave; in the inner meniscus, only the femoral and concave surface, therefore, it is preferable that dots be applied to it.

During 1-2 days among fibrin fibers that stick together the wound, strands of fibroblasts and crevices appear due to the drying of fibrin, which are further lined with endothelium proliferating from cut, injured vessels (I. K. Esipova, 1964). In the formation of such vessels, as well as in the very process of germination by fibroblasts, there is much in common with recanalization and the organization of blood clots.

The inside-out technique, developed by Henning and used by many authors, allows the placement of suture points under direct arthroscopic control. Use straight needles or other bending radius, single or double cannula. This method can be dangerous for neighboring noble structures, since it is not possible to perfectly control the exit point of the needle. To avoid such complications, it is recommended to make a small skin incision at the exit point of the needle, knocking out the main tissues until the capsule and follow some technical devices, recalling that the risk group structures are: in the middle part of the nerve and saphenous vein, which side is the common peroneal nerve, posterior-laterally to the popliteal artery, some authors use a femoral distractor for augmentation. joint space, which improves endocytic vision, facilitates suture tissue, and reduces the risk of cartilage damage.

As it germinates fibrinous masses fibroblasts, fixing the edges of the wound instead of fibrinous gluing, the latter (fibroblasts) are gradually replaced by collagen and argyrophilic fibers, which are much more than cellular elements, already in the early period of wound healing. This is what distinguishes the contents of a wound that heals by primary intention from granulations, which are characterized by a long-term predominance of cells over the paraplastic substance.

The external technique was proposed by Warren and was less used than the previous one. Small incision 10 mm. practiced after medially in the lesion. The capsule is cut through the skin incision, and then a special cannula needle is pulled into the capsule, so that under arthroscopic control it penetrates the joint at the posterior end of the lesion, and then crosses the flap to the desired point. The suture wire is inserted into the extra-articular end of the needle and glided until it appears at the intra-arterial junction.

The second needle is first inserted first with the same technique so that it crosses the lesion to 6-7 mm. from this. A special spindle with an end "metal end" is introduced inside. The wire passes through a metal bend that retracts outward from the joint, carrying it along with the filament itself. The two ends of the thread, as extracapsular, are then stretched and tied.

By the end of 5-7 days phagocytosis and resorption of dead tissue elements ends, the wound gap is filled with young connective tissue. At the same time, the regeneration of nerve fibers begins. Epithelialization of the wound occurs quickly, since wounds glued with fibrin and fibroblasts reduce the defect, the conditions for epithelization are favorable.

The operation is repeated several times until the seam is completed. When using the all-in-one method, the risks of damage to the neurovascular side are canceled, since the suture is completely intracapsulated. The method uses an appropriate instrument, consisting of curved needles that pass through the meniscus of the lesion without exceeding the capsule, and instruments that allow "knotting all" expansion of the hinged wires. This method is suitable for the most central meniscus lesions.

Postoperative treatment of meniscal sutures, as can be seen from the literature in this regard, is very diverse. Avoid exercise over 90° for 3 months. Scott immobilizes the knee at 30° flexion by stretching the load for two months to cancel the shear forces acting on the meniscus. After the third month and allowed to use the bike, race after 5-6 months, sports recovery after 9-12 months.

During wound healing primary intention and healing under the scab, which fundamentally differs little from healing by primary intention, all processes of reparative regeneration occur in the depth of the wound, that is, below the level of its edges, which also distinguishes primary intention from healing by secondary intention.

One of the phases of healing of damaged tissue is wound granulation. A wound is a violation of the integrity of the skin, muscles, bones or internal organs. The type of wound complexity varies depending on the degree of damage. On this basis, the doctor makes a prognosis, prescribes treatment. A huge role in the healing process is played by granulation tissue, which is formed during wound healing. How is it formed, what is it? Let's take a closer look.

Knee removal after 8 weeks. Partial load at 4 weeks, total load at 6 weeks, muscle improvement at 8 weeks, stallion at 9 weeks, squat at 4 months, race at 5 months, sport at 6 months. Jacob turns white at 30° for 5-6 weeks. with partial load. Morgan is immobilized for 4 weeks at full stretch because in this position he has the best injury healing and gives immediate loading.

Partial load for 6 weeks with retractable knee. In case of unstable damage, such as bucket handles, rehabilitation protocol and more careful: reduction from 20 ° to 70 ° C for 1 month without load, car racing straight for 4-5 months, winding and jumping up to 7-8 months. Sommerlat, in a 7-year review of arthrotocomic sutures, ends with a recommendation for early functional rehabilitation in order not to have a flexible expansion deficit.

What does granulation tissue look like?

Granulation tissue is called young connective tissue. It develops during the healing of a wound, ulcer, with the encapsulation of a foreign body.

Healthy, normal granulation tissue is pink-red, granular, and firm in texture. A cloudy grayish-white purulent exudate is separated from it in small quantities.

This patient was again operated on with a meniscal suture and then immobilized for 6 weeks, thus healing. Partial load for 5 weeks with retractable knee. In the case of unstable injuries such as dental pens, the most reassuring and cautious protocol is bending between 10° and 80° for 1 month without loading and then partial loading for another 30 days. Complete motion capture in the first 3 months.

We did not use orthopedic surgeons except in special cases. We advise you to resume straight line racing no earlier than 3 months and to play sports no earlier than 6 months later. The results of meniscal sutures reported in the literature are not uniform in lesion type, associated lesions, surgical technique, postoperative management, and remote evaluation. The results of arthrotomic sutures of the menstrual cycle are superimposed on the results of arthroscopic sutures. Crashes are more likely to occur in unstable knees.

Such tissue arises at the borders between the dead and the living, after being wounded on the 3-4th day. The granulation tissue consists of many granules that are closely pressed to each other. They include: amphora substances, loop-shaped vascular capillaries, histiocytes, fibroblasts, polyblasts, lymphocytes, multinuclear wandering cells, argyrophilic fibers and segmented leukocytes, collagen fibers.

Their incidence and 13% according to Ryu. The importance of the knee menu is known to everyone and does not require any confirmation. Similarly, it is well known that meniscus suture, when possible, is preferable to meninctomies, albeit partial ones. Some authors have shown that there is no difference in response. mechanical stresses between healthy and sutured meniscus good results of meniscus sutures persist for a long time, this is confirmed by a low percentage of articular degenerative phenomena, as the stone claims, which brings in 75% of cases, in the absence of signs of Fairbank distance four years after meniscus sutures.

Formation of granulation tissue

Already after two days, on areas free of blood clots and necrotic tissue, pink-red nodules can be seen - the size of a millet grain granule. On the third day, the number of granules increases significantly, and already on the 4-5th day, the surface of the wound is covered with young granulation tissue. Well, this process is noticeable on an incised wound.

In terms of results, there are no differences between arthrosomal and arthroscopic sutures; however, postoperative and minor pain symptoms in arthroscopic sutures, as well as minor ones, are problems associated with wound healing. This results in the patient being able to recover faster and faster, with fewer disruptions. The arthroscopic technique, which we prefer, allows more accurate diagnosis of the lesion and the possibility of repairing these central lesions without suture with arthroctectomy.

Healthy strong granulations of a pinkish-red color, they do not bleed, have a uniform granular appearance, a very dense texture, emit a small amount of purulent cloudy exudate. It contains a large number of dead cellular elements of the local tissue, purulent bodies, impurities of erythrocytes, segmented leukocytes, one or another microflora with its own waste products. Cells of the reticuloendothelial system, white blood cells migrate into this exudate, vascular capillaries and fibroblasts also grow here.

This may be due to endoscopic reconstruction of the anterior cruciate ligament without the need to practice arthrotomy. Ultimately and by far the most aesthetic benefit. On the one hand, it has undoubted advantages, it does not avoid neuro-vascular complications, but it is easily avoided with some technical details. In posterior horn swords, a small skin incision must be made to reach the capsule to prevent such complications. On the lateral side, it is preferable to identify and protect the peripheral nerve.

Due to the fact that in the gaping wound it is impossible for the newly formed capillaries to connect with the capillaries of the opposite side of the wound, they, bending, form loops. Each of these loops is a framework for the above cells. Each new granule is formed from them. Every day, the wound is filled with new granules, so the entire cavity is completely contracted.

The most difficult period for the purse-string suture of the meniscus is understood in the first weeks after interventions in the early stages of rehabilitation until complete healing is achieved. Vertical lesions have the best results. All authors agree that ligamentous location, especially the frontal pectinate ligament, is a fundamental requirement for the success of mandisk sutures. Rosenberg reports a complete healing rate of 96% for stable knee sutures versus 33% for an unstable knee. The Crusader must be reconstructed with an intra-articular plasty.

Layers

The layers of granulation tissue are separated:

• on superficial leukocyte-necrotic;
• the layer of granulation tissue itself;
• fibrous deep layer.

Over time, the growth of capillaries and cells declines, and the number of fibers increases. Granulation tissue begins to turn first into fibrous, and then into scar tissue.

The main role of granulation tissue is barrier functions, it prevents microbes, toxins, decay products from entering the wound. It inhibits the vital activity of microbes, liquefies toxins, binds them, and helps to reject necrotic tissues. Granulations fill the cavity of the defect, wound, a tissue scar is created.

wound healing

Granulations are always formed at the boundaries between living and dead tissue. They form faster when there is good blood circulation in the damaged tissue. There are cases when granulations are formed at different times, develop unevenly. It depends on the amount of dead cells in the tissue and the timing of their rejection. The faster the granulation occurs, the faster the wound healing. After cleansing the wound of dead tissue and inflammatory exudate, the granulation layer becomes clearly visible. Sometimes in medical practice, the removal of granulation tissue is required, most often this is used in dentistry for gingivotomy (gingival incision).

If there are no reasons preventing healing, the entire wound cavity is filled with granulation tissue. When the granulations reach the level of the skin, they begin to decrease in volume, become slightly paler, then become covered with skin epithelium, which grows from the periphery to the center of the damage.

Healing by primary and secondary intention

Wound healing can occur by primary or secondary intention, depending on their nature.

Primary tension is characterized by a reduction in the edges of the wound due to the connective tissue organization of granulation. It firmly connects the edges of the wound. After the initial tension, the scar remains almost invisible, smooth. Such tension is able to tighten the edges of a small wound if the opposite sides are at a distance of no more than one centimeter.

Secondary tension is characteristic of the healing of large wounds, where there are many non-viable tissues. Significant defects or all purulent wounds pass the way of healing by secondary intention. Differing from the primary type, the secondary tension has a cavity, which is filled with granulation tissue. The scar after secondary tension has a pale red color, protrudes slightly beyond the surface of the skin. As the vessels gradually thicken in it, fibrous and scar tissue develops, keratinization of the skin epithelium occurs, the scar begins to turn pale, becomes denser and narrower. Sometimes scar hypertrophy develops - this is when an excess amount of scar tissue is formed.

Healing under the scab

The third type of wound healing is the simplest - the wound heals under the scab. This is typical for minor wounds, damage to the skin (abrasions, scratches, abrasions, burns of the 1st, 2nd degree). The scab (crust) on the surface of the wound is formed from the blood that has coagulated there, lymph. The role of the scab is a protective barrier that protects the wound from infection, under this shield skin regeneration occurs. If the process goes well, no infection has got in, after healing, the crust leaves without a trace. There is no sign left on the skin that a wound was once present here.

Pathologies of granulation

If the wound process is disturbed, pathological granulations may form. Possible insufficient or excessive growth of granulation tissue, disintegration of granulations, premature sclerosis. In all these cases, and if the granulation tissue bleeds, special treatment will be required.

The development of granulations and epithelialization processes fade away if there are such unfavorable factors as worsening blood supply, decompensation of any systems and organs, oxygenation, repeated purulent process. In these cases, granulation pathologies develop.

The clinic is as follows: there is no wound contraction, the appearance of the granulation tissue changes. The wound looks pale, dull, loses turgor, becomes cyanotic, covered with a coating of pus and fibrin.

Tuberous granulations are also considered pathological when they protrude beyond the edges of the wound - hypergranulations (hypertrophic). Hanging over the edges of the wound, they impede the process of epithelialization. In these cases, they are cauterized with concentrated solutions of potassium permanganate or silver nitrate. The wound continues to be treated by stimulating epithelialization.

Importance of granulation tissue

So, summing up, we highlight the main roles played by granulation tissue:

• Replacement of wound defects. Granulation - plastic material that fills the wound.
• Protection of the wound from foreign bodies, penetration of organisms, toxins. This is achieved due to the large number of leukocytes, macrophages, as well as a dense structure.
• Rejection and sequestration of necrotic tissue. The process is facilitated by the presence of macrophages, leukocytes, as well as proteolytic enzymes that secrete cellular elements.
• In the normal course of healing, epithelialization begins simultaneously with granulation. Granulation tissue is transformed into coarse fibrous tissue, then a scar is formed.

Wound granulation is one of the phases of healing of damaged tissues. A wound is a violation of the integrity of the skin, muscles, tendons, internal organs or bones. Depending on the degree of damage, wounds are distinguished by the type of complexity, on the basis of which a forecast is made for further treatment and the healing process.

The healing process and its phases

• inflammatory (5-7 days);
• granulation (from the seventh day to four weeks);
• epithelialization (about a year).

There are also 3 types of wound healing:

1. Healing by first intention. It is characterized by fusion of the edges of the wound by the connective tissue organization of granulation tissue, which firmly connects the walls of the wound. The scar after wound healing by primary intention is even, smooth, almost imperceptible. By primary intention, a small wound is healed, the edges of which are located close to each other (no more than 1 cm).
2. Wound healing by secondary intention. Secondary healing is typical for wounds that have a large number of non-viable tissues. All purulent wounds or injuries with a significant tissue defect heal by secondary intention. Unlike the primary, the secondary differs in that there is a cavity between the edges of the wound, which is gradually filled with granulation tissue.
3. Healing under the scab. It is typical for those injuries when the resulting wound is insignificant (abrasion, scratch, abrasion, burns of 1 or 2 degrees). A scab or crust forms on the surface of the injury from the lymph and blood that has coagulated. The slump serves as a "shield" under which the regeneration process takes place. If the infection has not penetrated into the wound, then after its healing and removal of the crust, no traces remain.

The inflammation phase begins immediately after injury. Its duration is from 5 to 7 days. After injury, the body begins to produce a special substance that affects the process of blood clotting. The formation of blood clots contributes to the blockage of blood vessels, which allows the bleeding to stop. Further, a large number of intercellular reactions occur, which manifests itself in the form of inflammation. If necessary, stitches are applied to the damaged area. If pathogenic bacteria do not penetrate the wound, then skin regeneration gradually begins, accompanied by the formation of granulation tissue. The healing process enters the second phase - granulation. At this phase, the construction of granulation tissues continues, filling the entire damaged area. The duration of the phase varies within a month. During this period of time, the granulation tissue matures. For successful wound healing, it is necessary that cytokines be present in it, which regulate cell activity and promote the production of platelets.

After completion of the maturation process, the granulation tissue forms a lining that serves as a "base" for the settling epithelial cells. This is how the scar is formed and the next phase begins. This is the longest stage and can last up to a year. The entire space of the wound is filled with epithelium and connective tissue. The color of the scar changes. Initially, it has a bright red color, but due to the fact that in the process of regeneration there is a decrease in the number of scars and blood vessels, it acquires a flesh color. At the end of the final phase, the scar becomes strong enough, almost like healthy skin.

Significance of the granulation stage

Wound granulation is a very complex process, which is attended by:

• plasmacytes;
• histiocytes;
• fibroblasts;
• leukocytes;
• mast cells.

By itself, granulation appears as a temporary body tissue, which, after maturation, transforms into a scar.

From the point of view of morphology, granulation represents new glomeruli of vessels. In the process of regeneration, the vessels are enveloped by the newly formed tissue. In addition, granulation tissue affects the separation of dead tissue. If the treatment proceeds without complications, then non-viable tissues are separated on their own. During surgical treatment, the dead tissue is removed by the doctor using special medical instruments.

Fibroblasts are of particular importance. Their function is that after the process of granulation of the wound reaches its edges, fibroblasts begin to provide collagen supply. In the event that there are extensive hematomas or a large amount of necrotic tissue at the site of injury, fibroblasts slow down their movement to the edges of the wound. With their poor movement, the healing process of damaged tissue increases.

Treatment of damaged tissue at the granulation stage

The granulation tissue is initially very thin and easily damaged. For this reason, during the treatment of the wound, one should be careful not to violate the integrity during sanitization. For washing and cleaning, irrigating solutions of hydrogen peroxide, potassium permanganate or saline are used. The temperature of the liquid used for disinfection should be pleasant for the body, within 37 degrees.

For a stable healing process, it is necessary that the wound has a balanced moist environment. Excessive moisture or drying of the wound leads to a slowdown in the formation of granulations, therefore, the healing process is suspended. A bandage helps to avoid such situations. It not only protects the wound from possible mechanical damage (bruises) and prevents the penetration of pathogenic bacteria, but also absorbs excess exudate and prevents drying out.

With deep wounds, there may be poor discharge of pus, accompanied by swelling. In such situations, surgical intervention is recommended, during which an incision is made that penetrates the purulent cavity, which facilitates the outflow of pus.

Regardless of the type of damage, the presence of infection in it is of great importance. If there is no infection, then the process of skin regeneration occurs much faster and without complications. Therefore, after receiving an injury, even if it is minor, you need to provide first aid (disinfect). If the area of ​​damage is extensive, then after first aid it is necessary to call a doctor or go to the hospital yourself.

Development of granulation tissue

After 2 days, in some areas of the wound, free from necrotic tissue and blood clots, pink-red nodules can be found - granules the size of a millet grain. During the 3rd day, the number of granules increases so much that on the 4th or 5th day the entire surface of the wound (for example, incised) is already covered with granulations, that is, young connective granulation tissue.

Healthy granulations do not bleed, are pink-red in color, have a uniformly granular appearance, are of a fairly firm consistency, and separate a small amount of cloudy, grayish-white, purulent exudate. It contains dead cellular elements of the local tissue, segmented leukocytes at various stages of their phagocytic activity, purulent bodies, detritus, often an admixture of erythrocytes, one or another microflora and its metabolic products. White blood cells, cells of the reticuloendothelial system emigrate into this exudate, fibroblasts and vascular capillaries grow in. Since in a gaping wound, the newly formed capillaries cannot connect with the capillaries of the opposite side of the wound, they bend and form loops. Each capillary loop serves as a framework for the above cells, from which a new granule is formed. Every day new numerous granules appear, with which the entire wound cavity is eventually filled.

Granulation tissue always occurs at the border between dead and living tissue. The better the blood circulation in the damaged tissue, the faster the granulations grow. Sometimes granulations appear on the surface of the wound at different times and develop unevenly. It depends on the presence of dead tissue in some parts of the wound and the different terms of its rejection.

Granulation tissue becomes clearly visible after complete cleansing of the wound from dead tissue and careful removal of inflammatory exudate from the wound surface. In the absence of reasons that impede the healing process, the granulation tissue that fills the entire wound cavity does not go beyond it. Having reached the level of the skin, the granulations decrease in volume, become somewhat paler and are covered with skin epithelium, growing from the periphery to the center of the wound. The scar formed after the wound has healed by secondary intention is pale red in color and protrudes somewhat above the surface of the skin. As the vessels become empty in it, the development of fibrous scar tissue and the keratinization of the surface layer of the skin epithelium, the scar turns pale, thickens and becomes narrower. Sometimes there is an excessive development of scar tissue - scar hypertrophy.

Further in the material, we will consider these stages of tissue regeneration in detail. Let us find out which therapeutic methods are used to activate the processes of tissue granulation, the speedy restoration of damaged areas and the renewal of healthy epithelium.

The presented stage of tissue healing is also known as the period of scar formation or reorganization of scar structures. At the presented stage, there is no loose matter that can be released from the wound. Surface areas at the site of damage become dry.

The most pronounced epithelization manifests itself closer to the edges of the wound. Here, the so-called islands of healthy tissue formation are formed, which differ in a somewhat textured surface.

In this case, the central part of the wound may still be at the stage of inflammation for some time. Therefore, at this stage, most often resort to differentiated treatment.

It promotes active cell renewal closer to the edges of the wound and prevents its suppuration in the central part.

Depending on the complexity of the wound, final epithelialization may take up to one year. During this time, the damage is completely filled with new tissue and covered with skin. The initial number of vessels in the scar material also decreases. Therefore, the scar changes from a bright red color to the usual skin tone.

Cells involved in wound granulation processes

What causes healing and its acceleration? Granulation of the wound is carried out due to the activation of leukocytes, plasmacytes, mast cells, fibroblasts and histiocytes.

As the inflammatory phase progresses, tissue cleansing occurs. Restriction of the access of pathogens to the deep layers of damage occurs due to their conservation by fibroblasts and fibrocytes. Then platelets come into action, which bind active substances and enhance catabolism reactions.

Wound care at the initial stage of healing

The optimal solution for the speedy recovery of damaged tissue is the regular use of dressings. Disinfection here is carried out with solutions of potassium permanganate and hydrogen peroxide. These substances are applied in a warm form on a gauze swab. Next, a careful impregnation of the wound is performed, in which touching the damage with the hands is excluded - this can lead to the development of infections.

At the initial stages of wound healing, it is strictly forbidden to forcibly separate dead tissue. You can only remove flaky elements, which are easily rejected with a slight impact with sterile tweezers. For the speedy formation of a dead scab in other areas, they are treated with a 5% iodine solution.

Treatment of open wounds in any case involves the passage of three stages - primary self-cleaning, inflammation and granulation tissue repair.

Primary self-cleaning

As soon as a wound occurs and bleeding opens, the vessels begin to narrow sharply - this allows the formation of a platelet clot, which will stop the bleeding. Then the narrowed vessels expand sharply. The result of such a "work" of the blood vessels will be a slowdown in blood flow, an increase in the permeability of the walls of the vessels and a progressive swelling of the soft tissues.

It was found that such a vascular reaction leads to the cleansing of damaged soft tissues without the use of any antiseptic agents.

Inflammatory process

This is the second stage of the wound process, which is characterized by increased swelling of the soft tissues, the skin turns red. Together, bleeding and inflammation provoke a significant increase in the number of leukocytes in the blood.

Tissue repair by granulation

This stage of the wound process can also begin against the background of inflammation - there is nothing pathological in this. The formation of granulation tissue begins directly in the open wound, as well as along the edges of the open wound and along the surface of the closely located epithelium.

Over time, granulation tissue degenerates into connective tissue, and this stage will be considered completed only after a stable scar forms at the site of the open wound.

Distinguish between the healing of an open wound by primary and secondary intention. The first option for the development of the process is possible only if the wound is not extensive, its edges are brought close to each other and there is no pronounced inflammation at the site of injury. And secondary tension occurs in all other cases, including purulent wounds.

Features of the treatment of open wounds depend only on how intensively the inflammatory process develops, how badly the tissues are damaged. The task of doctors is to stimulate and control all the above stages of the wound process.

Physiotherapy treatment

Among physiotherapeutic methods, ultraviolet irradiation can be prescribed at the stage when wound granulation is actively carried out. What it is? First of all, UVR assumes a moderate thermal effect on the damaged area.

Such therapy is especially useful if the victim has stagnation of granulations, which have a sluggish structure. Also, a gentle effect on the wound with ultraviolet rays is recommended in cases where a natural discharge of purulent plaque does not occur for a long time.

In the presence of a simple injury, in which only the superficial extreme layers of the epithelium are affected, alternative methods of treatment can be resorted to for recovery. A good solution here is the imposition of gauze bandages soaked in St. John's wort oil. The presented method contributes to the early completion of the granulation phase and active tissue renewal.

To prepare the above remedy, it is enough to take about 300 ml of refined vegetable oil and about 30-40 grams of dried St. John's wort. After mixing the ingredients, the composition should be boiled over low heat for about an hour. The cooled mass must be filtered through cheesecloth. Then it can be used to apply bandages.

It is also possible to heal wounds at the granulation stage with the help of pine resin. The latter is taken in its pure form, rinsed with water and, if necessary, softened by gentle heating. After such preparation, the substance is applied to the damaged tissue area and fixed with a bandage.

Drug treatment

Often, wound granulation is a rather lengthy process. The rate of healing depends on the state of the body, the area of ​​damage, and its nature. Therefore, when choosing a medication for the treatment of a wound, it is necessary to analyze at what stage of healing it is currently.

Among the most effective drugs, it is worth highlighting the following:

• ointment "Acerbin" - is a universal remedy that can be used at any stage of the wound process;
• ointment "Solcoseryl" - contributes to the speedy granulation of damage, avoids tissue erosion, the appearance of ulcerative neoplasms;
• Dairy calf blood hemoderivative - is available in the form of a gel and ointment, is a universal highly effective drug for wound healing.

Finally

So we figured it out, wound granulation - what is it? As practice shows, one of the determining conditions for accelerating the healing process is differentiated treatment. The correct selection of medications is also important. All this contributes to the speedy granulation of the damaged area and the formation of a new, healthy tissue.

9 "harmful" products that you should not give up Often, in pursuit of an ideal figure and health, we deny ourselves many products, considering them harmful. However, doctors advise against doing this.

10 Adorable Celebrity Kids Who Look Different Today Time flies and one day little celebrities become unrecognizable adults. Pretty boys and girls turn into s.

What does the shape of your nose say about your personality? Many experts believe that by looking at the nose, you can tell a lot about a person's personality. Therefore, at the first meeting, pay attention to the nose is unfamiliar.

11 Weird Signs That You're Good in Bed Do you also want to believe that you're giving your romantic partner pleasure in bed? At least you don't want to blush and apologize.