الفهرس 
Infection and wound healingOnly 14 pages are availabe for public view
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Abstract
Injury triggers an organized and complex cascade of cellular and biomechanical events that result in a healed wound. For didactic purposes, the wound healing response can be divided into three distinct but overlapping phases: (1) heamostasis and inflammation, (2) proliferation, and (3) maturation or remodeling (Leaper, 2004). Failure or prolongation in one phase may result in delay of healing or non-closure of the wound. Wound healing failures remain a significant clinical problem with large impact on health care casts. A better grasp of the fundamental physiology of healing results in a clearer understanding of the patho physiologic processes that impair healing (Witte & Barbul, 2001).
These classical phases of inflammation, proliferation, connective tissue deposition, and remodeling have been described extensively in cutaneus healing and suitably from the basis of understanding of tissue repair in a variety of tissues and organs (Leaper & Simmons, 2000).
The alimentary tract is frequently encountered is surgical practice; proper healing of this hollow tract is essential for the prevention of the significant morbidity and mortality associated with complications (Coleman, 2004).
Normal mucosa of gastrointestinal is under constant renewal in the same manner that cutaneus epithelium is regenerative. Superficial epithelial injury can be repaired by fast and efficient epithelial migration without proliferation (Coleman, 2004). Deep injuries that penetrate the basal lamina lead to an inflammatory response by virtue of injury to blood vessels and lymphatics (Watson & Coleman, 2003).
Healing in gastrointestinal tract is rapid when free of complications; for some reasons complications occur and require re-operation. Patients at risk of complications are: (1) those that pre-operatively develop physiologic problems that lead to shock, hypoxia and resultant anastomotic ischemia, (2) those with radiation induced tissue injury, (3) those with sepsis, and (4) those with pre-operative bowel obstruction. Malnourishment, malignancy, diabetes mellitus and age also influence outcome in varying degrees (Coleman, 2004).
Growth factors applied topically to wound can accelerate healing by stimulating granulation tissue formation and enhancing epithelization. Po2 this has been suggested by several different studies of topically applied growth factors. It is clear that topically growth factors therapy should not be considered as a substitute for good wound care including surgical debridement or revascularization (Watson & Coleman, 2003).
Wound healing can be enhanced and wound infections prevented, often by simple, inexpensive, readily available mean. Pre-operative evaluation for impediments to healing, such as malnutrition, vasoconstriction, hyperglycemia, and steroid use, allows correction prior to operation. Intraoperativelly the surgeon should concentrate on surgical technique, appropriate antibiotic use, and prevention of vasoconstriction through pain relief, warming and adequate volume resuscitation and on maintaining nutrition and normoglycemia.
These approaches apply as well to chronic wounds. Additionally, maintenance of a moist environment, correction of local vaso-spasm with sympathetic blockade or warming and stimulation of angiogensis through aggressive debridement or hyperbaric oxygen therapy enhance healing of chronic wound (Hunt & Hopf, 2001).