الفهرس 
IntroducationOnly 14 pages are availabe for public view
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Abstract
Wounds can be categorized as partial-thickness wounds, full-thickness wounds or sutured wounds or as either acute or chronic wounds. Wound healing is a dynamic process involving soluble mediators, a variety of cells, and extra-cellular matrix. These components are involved in a number of different steps in healing, including coagulation, inflammation, fibroplasia, collagen deposition, epithelialization, wound contraction and remodeling. Recently these phases are greatly understood on the basis of cytokines and growth factors.
When the integrity of human skin is broken blood coagulates and platelets aggregate, forming a fibrin-rich plug to prevent further loss of blood. During the stage of inflammation, damaged parenchymal cells, platelets, and activated complement pathways produce vasoactive mediators. These mediators, with histamines and leukotrienes that are released from local mast cells, cause endothelial cell changes leading to the attraction, adherence, and passage of leukocytes between endothelial cells ‘and into the region of tissue damage. For proper wound healing to progress, this inflammatory response has to be shut down so as to allow for the re-establishment of the new matrix. Then tissue formation occurs via keratinocytes (epithelialization), fibroblasts (granulation tissue) and endothelial cells (angiogenesis). Several cytokines share in these steps of tissue formation as TGF-ct, TGF-J3, IL-I, IL-8, PDGF, FGF and VEGF.
Lastly restructuring of the newly synthesized tissue occurs depending on continued synthesis and catabolism of collagen at a low rate. This occurs via several mediators such as MMPs, TGF-43, TNF-a, TIMPs and IL-i.
Proper wound management begins with a proper patient history taking. Particular emphasis should be placed on several host factors which can adversely affect wound healing as extremes of age, diabetes mellitus, chronic renal failure, obesity, malnutrition, smoking and use of immunosuppressive medication. Also sepsis, whether present as local bacterial colonization of the wound site or as a systemic inflammatory response, is one of the most important obstacles to successful wound healing.
The treatment of wound starts by cleansing. This occurs either by swabbing, showering or irrigation using tap water or normal saline. The goal of cleansing is to decrease the bacterial inoculum in a wound to levels that can be managed by host defenses. After wound cleansing; the physical integrity and function of the injured tissue must be restored. Most wounds require primary closure. The commonly used method for closure is suturing. Staples, skin closure tap and tissue adhesive are alternative methods for suturing.
There are many trials to promote healing by the use of O2 and physical therapy which includes warmth, electrical stimulation, ultrasound, ultraviolet radiation therapy and laser.
Dressings are very important line for wound management either to acute or chronic wounds. They can be classified based on their construction and function into nonadherent fabrics, absorptive dressings, non biologic occlusive dressings (which include; films, hydrocolloids, alginates, and hydrogels), biologic occlusive — dressings, creams and ointments.
Healing is retarded if necrotic tissue is present in a wound. Eschar can create an environment that facilitates bacterial proliferation. Sharp debridement is the time-honored approach to removing devitalized and necrotic tissue from wounds. It can be achieved either by surgical method or non surgical methods as enzymatic, absorptive and biological débridement.
Skin grafts are a good method for treatment of wounds especially wounds with chronic or large defects. Skin grafts are classified into allografts, xenografts and autografts. These are further sub-classified to FTSGs and STSGs. Recent methods for treatment of wounds include cultured skin substitutes, growth factors and gene therapy. These recently adopted methods are considered a new hope for wound management especially for those of large area as wide bums and chronic ones.
The management of wounds has to be started by the treatment of any factors that delay the healing. Then cleansing the wound using normal saline or tap water. Disinfectants such as alcohol, providone-iodine, hydrogen peroxide, hexachlorophene, cetrimicle and chiorhexidine have been shown to cause tissue toxicity and impair wound healing.