Skin Wound Healing Process and New Emerging Technologies for Skin Wound Care and Regeneration
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| Figure 3. Schematic representation of Tissue (T), Infection (I), Moisture (M) and Epithelial (E) (TIME)
concept. 3.1.1. Tissue (T): Debridement Procedure Over the past decade, new therapies for wound debridement have been developed, such as low-frequency ultrasounds, hydro-surgery devices, larvae and enzyme agents. It is widely recognized that devitalized tissue removal is a fundamental process for tissue repair [39]. Debridement is optimal for preparing the wound bed, but in some cases is not recommended (i.e., in immunosuppressed patients). Once all injury assessment factors have been revised, and wound debridement has been decided as an appropriate option, the most appropriate debridement method should be selected [40], taking in consideration the amount of exudate produced by the wound. The most common debridement types are as follows. Autolytic: the body uses endogenous enzymes and moisture gradients to remove devitalized and necrotic tissue. This is a long process, more suitable for minor injuries. Wound care products such as hydrogels, films, honey and hydrocolloids can be used to support this natural process and allow wound healing in a humid environment [39]. Surgical: surgical removal allows us to identify the entire condition of the wound. Sterile instruments are used to remove devitalized or necrotic tissues; often, this procedure also removes some vital tissue. Surgical debridement is fast, safe, minimizes the risk of infection and chronic wound complications [41]. Mechanical: this is an effective and economical method of debridement. The disadvantages of this method are the lack of selectivity and pain. It can be applied through hydrotherapy, using water jets to wash residues from the wound surface. Another mechanical debridement method is wet–dry therapy, where a wet gauze is applied to a wound and then left to dry; once dried, the gauze that bound the necrotic or devitalized tissue is removed from the wound bed [42]. Biological: the application of sterile larvae-secreting enzymes, able to liquefy dead tissue; the liquid-containing bacteria is then ingested and neutralized by larval bowels. In addition, there is an increase in wound bed growth rates and advantageous changes to skin pH values. This procedure provides a safe and selective debridement method; however, it is poorly accepted by patients and doctors [43]. Enzymatic: this procedure involves the application of enzymes into the Baixar 2.23 Mb. Compartilhe com seus amigos:
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