Lecture : Definition The term 'wound' refers to a condition in which the normal skin structure is broken or destroyed, though the severity and depth may vary widely. In Pathology, the term is confined to cases in which the trauma sustained by skin structures has penetrated through the epidermis and inflicted damage on the dermis. 1. Phases of Wound Healing The repair process for acute wounds involove four major phases: Hemostasis, Inflammation, Proliferation(or regenerarion) and Maturation . 2. Types of Wound Closure Classification of repair as primary intention, secondary intention, or tertiary intention healing is based on the ideal of primary surgical closure for all wounds. 3. Acute versus Chronic Wounds Acute Wounds typically are traumatic or surgical in origin. Chronic Wounds fail to and proceed normally through the repair process. Chronic wounds frequently are caused by vascular compromise, chronic inflammation, or repetitive insults to the tissue, and they either fail to close in a timely manner or fail to result in durable closure 4. General Principles in Treatment Planning A comprehensive plan of care should address three areas: correction of etiologic factors, provision of systemic support for healing and topical treatment that creates and maintains an optimal healing environment. 5. Surgical site infections Surgical site infections (SSIs) complicate the recovery course of many patients. As defined by the Centers for Disease Control and Prevention (CDC), these infections typically occur within 30 days of an operation at the site or part of the body where the surgery took place, or within a year if an implant is left in place and the infection is thought to be secondary to surgery. SSIs may be classified as superficial/incisional if limited to the skin and subcutaneous tissue, deep incisional when involving the fascia and muscle, or organ space when involving a body cavity (eg, abdominal cavity following gastrointestinal surgery). 6. Wound Healing: Risk Factors for Nonhealing There is usually not one single factor that results in impaired healing. The factors known to impede wound healing can be categorized as intrinsic and extrinsic factors. Intrinsic factors include factors such as advanced age, immune compromise, psychological stress, hereditary skin disorders, and disease states/comorbidities. Extrinsic factors include factors such as infection, malnutrition, insufficient perfusion/oxygenation, smoking, chemotherapy, radiation therapy, and selected medications (e.g., steroids, anticoagulants, angiogenesis inhibitors)