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Table 1: Factors influencing the wound healing both epithelial and dermal elements which results in
Local factors Systemic factors reepithelialization of the wound and laying down of the
[3]
primary extracellular matrix. Epidermal stem cells and
Oxygenation Age, gender bone marrow derived stem cells also play a role during
Foreign body Disease: diabetes, keloids, fibrosis, jaundice, uremia
Blood supply Medications: NSAIDs, glucocorticoids, chemotherapy this phase. Angiogenesis occurs secondary to endothelial
[9,10]
Stress, nutrition, alcoholism progenitor cells, a derivative of hematopoietic stem cells.
Immunocompromised status, AIDS, cancer, radiation Wound remodeling leading to scar formation
NSAIDs: Nonsteroidal anti‑inflammatory medications, AIDS: Acquired This phase marks the final step in tissue remodeling
immune deficiency syndrome and differentiation leading to recovery of the skin
and its aesthetic restoration. [8,11] Reconstruction of the
different interventions. Wound healing is evaluated by dermis occurs by reorganization of the matrix collagen.
[7]
both clinical features and biochemical and histological Fibroblasts differentiation into myofibroblasts, leading to
parameters. Nuclear medicine can assist in assessing the wound contraction and closure. [12]
vascularity of healing tissue, and hence plays a role in
recording inflammation. However, study of the histological ASSESSMENT OF THE WOUND
features appears to be more reliable as the findings can
be recorded photographically for evaluation by different Impaired wound healing occurs secondary to disordered
experts.
collagen formation and underlying predisposing
[13]
A literature search was performed on histological scoring conditions. In order to effectively manage chronic
[14]
of wound from 1993 to 2014. A total of 30 available wounds, periodic assessment of the healing process
relevant literatures on wound healing and histological is necessary. The insights gained from this type of
[15]
scoring based on various parameters from different stages assessment are expected to facilitate the development of
of wound healing were selected for review. novel therapies by stratifying their specific contributions
to the wound healing process in time and stage‑specific
NORMAL PROCESS OF WOUND manner. Hence, a standardized and reproducible model
[7]
HEALING is required to obtain information about the wound healing
process as well as to better understand the pathology and
[16]
The sequence of events in normal wound healing has improve medical technologies. Instruments to assess
[4]
been widely studied and described in literature. Wound wound healing can help to enhance communication
healing is a complex biological process that takes place among clinicians by defining a common language and
in all tissues in all organs of the body. Various cell standardizing assessment of wound characteristics. [15]
types, including keratinocytes, neutrophils, macrophages, Because healing is a dynamic process, it is difficult
lymphocytes, fibroblasts and endothelial cells, are involved to evaluate and requires consistent measurements.
[17]
in this process. The necrotic tissue is either removed A complete assessment of the wound must include the
[3]
by scavenger cells or separated from living tissue by the size, associated attributes, host factors and environmental
process of phagocytosis. factors, all of which impact optimal wound management.
[17]
The wound healing process consists of four phases: In addition, demographics and quality of care also provided
hemostasis, inflammation, proliferation and remodeling. [1] aid in assessing the repair process. [17]
Coagulation and hemostasis Various tools for assessing wound healing clinically have
The initial step assists in the protection of the vascular been described, including the Pressure Ulcer Score for
system to maintain the functionality of the organ. The clot Healing (PUSH), the Sussman Wound Healing Tool (SWHT),
formed as a result of coagulation provides a matrix for the Wound Healing Scale, the Leg Ulcer Measurement
[18]
the cells involved in subsequent steps of hemostasis and Tool (LUMT) and the granulometer. However, these
inflammation. Various pro‑inflammatory cytokines and instruments can only measure changes in wound
[1]
growth factors are released by the clot and wound tissue. healing and do not predict healing or measure wound
Inflammatory cells then migrate to the wound site by the characteristics. Additional tools to assess the status of
[18]
process of chemotaxis and promote the inflammatory the healing wound include Laser‑Doppler Flowmetry (LDF)
phase. [4‑6] to evaluate cutaneous blow flow and planimetry. [19]
Inflammation The assessment of the histological state of the healing wound
The goal of the inflammatory phase is to fight potential is important in clinical practice for postoperative patient
bacterial contamination of the wound and to activate management. Histological evaluation should include
[20]
cytokine secretion. Uncontrolled inflammation can destroy the basic components of the healing process including
[1,7]
the early migratory effect, leading to an arrest of the healing angiogenesis, inflammation, fibroplasia and restoration
process. [8] of the connective tissue matrix, wound contraction and
remodeling, epithelialization and differentiation. [17]
Proliferation
The proliferation phase overlaps with the preceding Comparison of histologic patterns with the known
inflammatory phase. It represents a proliferation of physiologic variation in tissue morphology assists in
240 Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015