By Deepak Kalaskar
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Extra info for Textbook of Plastic & Reconstructive Surgery
P rinci pl es of Recons t r u ct iv e Su rgery 7 The inflammation phase typically lasts between 3 and 5 days. It is important for limiting wound contamination and induction of the proliferative phase of healing. Vasodilatation and increased capillary leakiness occur, promoting delivery of nutrients and immune cells to the site of injury and thus causing tissue oedema. The stimulus for this is provided by prostaglandins, kinins, histamine, serotonin and bacterial components. g. platelet-derived growth factor, tumour necrosis factor α, interleukin-1) attract granulocytes to the site of injury soon after the injury has occurred.
Macrophages participate in phagocytosis and are essential in the wound healing process via the release of growth factors. Regulation of the inflammatory phase is important because overstimulation or prolonged stimulation can damage local tissues and, in severe cases, can trigger the systemic inflammatory response syndrome. Conversely, insufficient inflammation and failure to induce proliferation can lead to development of a chronic wound. The proliferative phase begins soon after an injury and lasts between 4 days and 2 weeks.
Thus, experts are advising a shift toward more advanced dressings. 4. Edge of wound In a healing wound, a healthy edge promotes migration of epithelial cells to form a pearly white extension of tissue across the wound bed (epithelialisation). The success of this process correlates with the successful management of the previous three aspects of DIME. An unhealthy edge can occur when there is failure of migration or when tissue beneath the wound edge is destroyed – a process known as ‘undermining’.