**5. Factors affecting wound healing [14]**

The World Health Organisation (WHO) considers wound healing a multi-factorial process and each factor contributes to the healing process either directly or indirectly.

A. Patient-related factors

a. Age

b. Nutritional status

c. Underlining co-morbidity including diabetes, anaemia and compromised immunity

d. Patients' physiological status, for instance, multi-organ dysfunction, inotropic/vasopressor support

B. Wound-related factors

contamination of abdominal cavity with faecal matter and when one is not sure of complete removal of contaminating agent it is better to leave the abdomen open and covered with wet packs for 48 hours and then re-checking the abdomen under general anaesthetic by removing the pack. If the abdominal cavity looks clean and there is no dead tissue or bowel then the closure can be attempted. These wounds are best closed in one layer with whole thickness

This refers to old traumatic wounds with necrotic tissue, ongoing infection or perforation and presence of known organisms in the wound prior to intervention. Primary closure is not advisable and debridement is essential. Examples include abscesses, perforated bowel and faecal peritonitis. In cases of gross contamination of abdominal cavity with faecal matter and when one is not sure of complete removal of contaminating agent it is better to leave the abdomen open and covered with wet packs for 48 hours and then re-checking the abdomen under general anaesthetic by removing the pack. If the abdominal cavity looks clean and there is no dead tissue or bowel then the closure can be attempted. These wounds are best closed in one layer with whole thickness suture with either nylon or prolene as tension sutures.

In this technique, approximation of wound edges and deeper tissue layers is meticulously carried out with appropriate sutures in layers. Skin is approximated by sub-cuticular sutures or staples. Sterstrips™ are used to relieve tension on suture line and to give more aesthetically pleasing and functional scar. Elimination of dead space minimises new tissue formation, and

This is considered an adequate alternative to primary intention closure, particularly in cases where major tissue loss or gross contamination is expected. It might include closure of deeper

The World Health Organisation (WHO) considers wound healing a multi-factorial process and

c. Underlining co-morbidity including diabetes, anaemia and compromised immunity

each factor contributes to the healing process either directly or indirectly.

sutures with either nylon or prolene as tension sutures.

348 Wound Healing - New insights into Ancient Challenges

careful epidermal alignment minimises scar formation [11, 12].

D. Dirty wounds

Techniques of wound closure:

A. Closure by primary intention

B. Closure by secondary intention

A. Patient-related factors

b. Nutritional status

a. Age

facial planes while leaving the skin open [13].

**5. Factors affecting wound healing [14]**

a. Type of organ or tissue

b. Extent/severity of injury

c. Nature of injury, e.g. clean laceration versus crushing injury

d. Wound contamination

e. Time lapse between the injury and initiation of treatment

C. Local factors related to the surgical technique itself

a. Appropriate haemostasis to ensure viable and well vascularised wound edges is a necessity but at the same time there should be no continuous oozing

b. Decision to perform (or not to perform) wound debridement as part of the surgical wound management does affect the final outcome

c. Timing of closure can be as important as any of the above factors in determining the fate of the wound
