نشریه التیام
سال پنجم شماره 2 (پاییز و زمستان 1397)

Skin (also known as the integument) is the largest organ of the body accounting for 12% to 20% (different ratio in various texts) of total body weight. Skin consists of two basic regions, the superficial epidermis and deep dermis. Beneath the dermis is the subcutaneous or hypodermis layer of loose connective tissue. Generally, the main architecture of the skin similar in all mammals, but there are differences between various species. The skin is thickest over the dorsal surface of the body and is thinnest on the ventral surface of the body. The skin could have ridges on its surface or be smooth in some areas. Epidermis consists of Stratum basale, Stratum spinosum, Stratum Granulosum, Stratum lucidum, Stratum corneum. Dermis consists of papillary and reticular layers and has a lot of blood and lymphatic vessels also sensitive and neurogenic receptors. Hair is a long, thin and elastic skin derivation that internal envelopment is from epidermis and loose connective tissue of external envelopment derived from dermis. Footpads are changed skin structures in cranial and caudal limbs. There are another structures like horn and hook that derived from skin. Abdominal cavity consists of these layers from inside to outside: skin, superficial fascia, skeletal muscles, deep fascia and serosa. Tunica serosa consists of a mesenchymal layer that forms from one layer of simple squamous epithelial cells and stroma connective tissue.

The inflammatory phase is the body´s natural response to injury. After initial wounding, the blood vessels contract and a clot is formed. Followed by hemostasis has been achieved, blood vessels then dilated to allow essential cells, antibodies, white blood cells, growth factors, enzymes and nutrients to reach the wound area. Erythema, heat, edema, pain and functional disturbance are the characteristic signs of inflammation that seen at this stage. The duration of the inflammatory phase usually lasts several days.

Wound debridement in open wounds is one of the most necessary actions to be performed for wound healing achievement. It can reduce the amount of non-viable tissues, microbial contamination and foreign bodies in the wound’s bed. As a result, wound healing will be accelerated and facilitated. There are different methods for wound debridement using various instruments or substances or even endogenous secretions. Each of these methods has its own benefits and drawbacks and for the best choice the wound condition evaluation, facilities and the performer’s ability should be considered. The key point is to choose the method with most positive and least negative effects on wound healing process.

The two phenomena of wound contraction and reepithelialization which occur as stages of the repair phase in healing of the wound play an important role in closing the damaged site. Contraction is formed by the transformation of the modified fibroblast cells called myofibroblasts, and these cells, through their tensile properties, pierce the wound's environment and cut the edges together, and after contacting the two healthy regions, this process stops. Epithelialization also covers the damaged area by migrating epithelial cells at the wound surface. These cells, by secretion of the enzymes, open their path of movement on the wound surface and, after reaching the same cells, stop and thus the location of the ulcer is covered and problems such as fluid loss and the entry of microbial objects to the body will be disappeared.

Wound healing is an important concern in clinical medicine. Wound healing including skin wounds is a dynamic complicated procedure which involves many different molecular and cellular agents that occur after a tissue lesion in order to repair the injured tissue. Poor wound healing after trauma, surgery, or chronic disease such as diabetes affects human and animal life. Well understanding this process is necessary for developing therapeutic strategies and wound management to help treatment of normal healing procedure. The repair of wounded skin is included hemostasis and inflammation, proliferation, and maturation and remodeling. These steps have considerable overlaps with each other.

The integrity of healthy skin plays a crucial role in maintaining physiological homeostasis of the body. Wound management is the most important issue in medicine and constantly evolving with the advances. The overall increase of different kind of wounds, and chronic wounds take a long time to heal makes wound care more complicated and important. Thus, there is a growing need to use of best methods for wound healing therapies to improve cutaneous wound healing. This article offers an overview of common methods of wound management, including physical, chemical and biological methods.

Optimum healing of a cutaneous wound involves a cascade of biologic cellular and molecular processes. When the normal biological process fails for any reason, healing process can cease resulting in chronic wounds. In Addition, the body cannot repair some extensive wounds without problem. These Issues surrounding wound healing as well as increased medical healthcare in this field, developed novel wound therapies. Regardless of the type of these specific advanced wound care methods, the ideal goal would be to regenerate tissues such that both the structural and functional properties of the wounded tissue are restored to the levels before injury. Tissue engineering and stem cells may be the solution. A range of cell based therapies and tissue engineered scaffolds have begun to cross the rift from bench to bedside. These therapies have been heralded as a promising means by which to surpass current limitations in wound management. The wide differentiation potential of stem cells allows for the possibility of regenerating lost or damaged skin, while their ability to immunomodulate the wound bed from afar suggests that their clinical applications need not be restricted to direct tissue formation. The data suggests that the appropriate application of stem cells and scaffolds can accelerate wound healing. The clinical utility of stem cells and tissue engineering has been demonstrated across dozens of clinical trials in wound therapy.

Wound healing has been a major medical challenge in recent decades and it increase motivation of researchers to develop various therapeutic approaches. Along with the latest developments in science and technology, diverse approaches have been created and improved. Although Traditional management, including wound dressings and skin grafts, is still commonly used in current practice but newer technologies found their roles in wound management, such as using stem cells in skin grafts or combining traditional treatments with anti-bacterial nanoparticles. Various upcoming technologies, such as nanotechnology, biotechnology, stem cell therapy and telemedicine have emerged in recent years and are being used to assist wound healing, or even to replace traditional methods. However, many of these methods still lack assessment by large-scale studies and extensive application. Also, studies should design to explore cost-effectiveness, conveniency and efficacy of them. In this review, authors focus on and summarize recent developments involving hi-tech therapeutic methods that lead to both rapid healing and better cosmetic results.

The two phenomena of wound contraction and reepithelialization which occur as stages of the repair phase in healing of the wound play an important role in closing the damaged site. Contraction is formed by the transformation of the modified fibroblast cells called myofibroblasts, and these cells, through their tensile properties, pierce the wound's environment and cut the edges together, and after contacting the two healthy regions, this process stops. Epithelialization also covers the damaged area by migrating epithelial cells at the wound surface. These cells, by secretion of the enzymes, open their path of movement on the wound surface and, after reaching the same cells, stop and thus the location of the ulcer is covered and problems such as fluid loss and the entry of microbial objects to the body will be disappeared.

Open wound management in small animals is a common event in veterinary practice. It is economically significant and can cause considerable distress and pain to the animal. The aim of wound management is to provide conditions that allow for optimal wound healing or to prepare the wound for definitive closure by reconstructive techniques. First of all, wound lavage which is the single most important aspect of open wound management with its solutions and technique was explained then Wound debridement is done Following copious lavage, the wound is reinspected for remaining debris, contamination or necrotic tissue with its surgical and non-surgical techniques explained. Systemic treatments containing Antibiotics and analgesic briefly introduced and at last bandage and dressing layers and its common topical medications explained.