ASSIGNMENT: CASE STUDY

Wound Closure: Sutures and Tapes

INTRODUCTION:
Sutures, or stitches, are the foremost unremarkably used technique to repair a cut
or wound. ... These delayed stratagies of closing a wound are performed solely once
thorough irrigation, or washing, of the laceration and exploration and removal of any foreign
waste or dirt. Once applicable, sutures are accustomed shut the wound.

Sutures are of 2 types;

 Absorbable
 Non-absorbable

Absorbable sutures are sutures that are digested by enzymes in body itself. There is no need
of a doctor to remove it.

Non-absorbable sutures are the ones which cannot be digested by enzymes. In this case
doctors are required to remove the suture after some period or they are left there itself.

Healing wounds by tapes is much better than mistreatment tapes is far higher than using
sutures as a result of quick and straightforward healing is by tapes. And also by this we can
avoid damaging good and healthy skin too and there’ll be no scars that are caused by stitches.
Also eliminating the risk of infection in point of entering an d leaving the stitch needle
and in dipping anesthetic syringe needle into the wound and separation of wound edge.

Wound healing is a fancy method within which the skin and the tissues thereunder it, repair
themselves after injury. wound healing is portrayed in a exceedingly timeline of physical
attributes (phases) constituting the post-trauma repairing process. In undamaged skin,
the epidermis (surface layer) and dermis (deeper layer) form a protecting barrier against the
external surroundings. Once the barrier is broken, a regulated sequence of biochemical
events is set into motion to repair the damage. This process is divided into predictable phases:
blood coagulation, inflammation, tissue growth tissue transforming , Blood clotting may be
considered to be part of the inflammation stage rather than a separate stage.
The wound healing method is not solely complicated however additionally fragile, and its
vulnerable to interruption or failure resulting in the formation of non-healing chronic
wounds. Factors that contribute to non-healing chronic wounds are polygenic disease, blood
vessel or blood vessel malady of maturity. Wound care encourages and speeds wound healing
via cleanup and protection from re-injury or infection. Counting on every patient's needs, it
will vary from the simplest first aid to entire nursing specialties such as wound continence
nursing and burn center care.

KEYSTAGES IN HEALING OF WOUND

Hemostasis (blood clotting):

Inside the primary jiffy of injury, platelets in the blood begin to stay to the injured site. This
activates the platelets, inflicting a few things to happen. They transform into an amorphous
shape, more suitable for clotting, and they release chemical signals to increase clotting. This
results in the activation of fibrin, which forms a mesh and acts as "glue" to bind platelets to
each other. This makes a clot that serves to plug the break in the blood vessel, preventing
further bleeding.

Inflammation:

Throughout this phase, damaged and dead cells are cleared out with bacteria and other
pathogens ordust. This happens through the process of phagocytosis , where white blood
cells "eat" waste by engulfing it. Platelet-derived growth factors  are released into the
wound that cause the migration and division of cells during the proliferative phase.
After the wound has been inflicted, homeostasis begins .The blood vessels constrict and seal
themselves off because the platelets produce substances that form a clot and halt
haemorrhage. Once equilibrium is achieved the blood vessels dilate, letting nutrients, white
blood cells, antibodies, enzymes and other useful components into the affected area to
support good wound healing and stave off infection. This is when someone would begin
to experience the physical effects of inflammation.

Proliferation (growth of new tissue):

In this phase, angiogenesis, collagen deposition, granulation tissue formation,
epithelialization, and wound contraction occur. In development , vascular endothelial cells
form new blood vessels . In fibro-plasia and granulation formation,  fibroblasts  grow and
form a new, provisional extracellular matrix (ECM) by releasing collagen and fibro-
nectin.At the same time , re-epithelialization of the stratum happens , in which epithelial
cells proliferate and 'crawl' atop the wound bed, providing protection for the new tissue. In
wound contraction,  decreasing the size of the wound by gripping the wound edges and
contracting using a mechanism that resembles that in smooth muscle cells. When the cells
roles are close to complete, unneeded cells undergo apoptosis.

In this wound healing stage, the wound begins to be remodeled with new, healthy
granulation tissue. For the granulation tissue to be shaped , the blood vessels should receive a
enough t amount of nutrients and oxygen. This new tissue is formed up of a mixture of
extracellular matrix and collagen, which allows for the development of a new network of
blood vessels to change the damaged ones (a process called angiogenesis), In line with the
AWMA. The color of the granulation tissue is an indicator of the health of the wound. For
example, a reddish or pinkish color generally means that it is healthy, while a darker tissue is
often an indicator of infection or inadequate delivery of blood to the wound bed.

In addition to developing granulation tissues, the body transforms dead mesenchymal cells
into fibroblasts, which function as bridges that facilitate cells to move round the affected
site . If your wound is healthy, these fibroblasts begin to appear within three days of the
wound and will secrete liquids and collagen. This secretion helps to strengthen the wound
site. During proliferation, the wound continues to grow stronger as the fibroblasts regularly
reorganize aiding in the development of new tissue and accelerate the healing method.

Maturation (remodeling):

Throughout maturation and remodeling, scleroprotein is realigned on tension lines, and cells
that aren’t any longer required are removed by programmed death, or apoptosis.
Maturation, additionally called reworking , is that the last stage of the wound
healing process. It happens once the wound has closed up and may take as long as 2 years.
Throughout this phase, the dermal tissues are overhauled to reinforce their strength and non-
functional fibroblasts are replaced by purposeful ones. Cellular activity declines with time
and also the range blood vessels within the site decreases.

While it should seem that the wound healing process is finished once maturation begins, it’s
necessary to stay up the treatment plan. If the wound is neglected, there’s risk of it breaking
down dramatically because as it isn’t at its best strength. Even after maturation, wound areas
tend to stay up to 20 percent weaker than they were at the beginning .

CONCLUSION:
The stages of wound healing are categorised into four serial and overlapping  phases –
hemostasis phase, inflammation phase , proliferative phase and remodeling phase. The
events of healing are controlled and coordinated by living matrix, hemostatic system,
inflammatory cells or mediators and fibrinolytic system.

The wound in some cases are so deep that sutures are used. And in some cases the depth
isn’t so deep and can be easily healed with the help of wound tapes. Wound tapes are
straightforward to use.

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