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Armstrong, D., Meyr, A. (2 de julio de 2020). Principios básicos de la cicatrización de heridas. UpToDate. Citado: 03 de agosto de 2022. Disponible en: https://www.uptodate.com/contents/basic-principles-of-wound-healing

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A wound represents a disruption of the normal structure and function of the skin with its associated underlying soft tissue structures [ 1]. Wounds might be caused by a variety of mechanisms, including both acute and chronic etiologies. Acute injuries are generally caused by trauma and include abrasions, punctures, crush injuries, thermal injury, gunshots, animal bites, and surgery, among others. However, any mechanism that decreases blood flow within the skin for a prolonged period has the potential to cause ischemic breakdown. Skin perfusion may be impaired due to chronic proximal arterial obstruction (eg, peripheral artery disease), vascular compression (eg, hematoma, immobility causing focal pressure), or microvascular occlusion and thrombosis (eg, vasculitis, cholesterol crystals).

Wound classifications and the basic principles of wound healing are reviewed here. The factors responsible for impaired wound healing and wound complications, as well as the clinical assessment and management of wounds, are reviewed elsewhere. (See "Risk factors for impaired wound healing and wound complications" and "Clinical assessment of chronic wounds" and "Basic principles of wound management".)

WOUND ETIOLOGY AND CLASSIFICATION

Wounds are generally classified as acute or chronic in nature ( figure 1).

Acute wounds - Acute wounds usually have an easily identifiable mechanism of injury leading to disruption or skin integrity and are typically due to some form of trauma. Acute traumatic skin disruption can result from blunt or penetrating mechanisms with an array of wound sizes, depths, and locations. Because of these varying mechanisms, individualized management and care are required. (See "Basic principles of wound management", section on 'Acute wounds'.)

Surgical wounds are a controlled form of acute wound that are created in the operating room. Surgical wounds are classified into four categories according to the degree of bacterial load or contamination. The four categories are clean, clean-contaminated, contaminated, and dirty. The majority of clean and clean-contaminated wounds are closed primarily at the completion of surgery, while contaminated and dirty wounds as well as surgical wounds are generally left open and require wound care. The classification of surgical wounds is presented in more detail separately. (See "Antimicrobial prophylaxis for prevention of surgical site infection in adults", section on 'Wound classification' and "Overview of the evaluation and management of surgical site infection".)

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2022 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

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Basic principles of wound healing - UpToDate

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A wound represents a disruption of the normal structure and function of the skin with its associated underlying soft tissue structures. Wounds might be caused b

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Isquemia tisular local

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Neuropatía: altera quimiotaxis durante hemostasia e inflamación

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Necrosis tisular e infección: alteran equilibrio de la inflamación

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Edema perilesional descontrolado e inestabilidad de la herida: interrumpen la actividad de los miofibroblastos y la deposición y reticulación de colágeno

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Luego de una lesión en la piel, los pequeños vasos se contraen para proporcionar hemostasia durante 5 a 10 minutos. Las plaquetas desencadenan la cascada de coagulación y liberan factores de crecimiento y citocinas. La matriz de fibrina resultante estabiliza la herida

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Es la interrupción de la estructura y función normales de la piel y la arquitectura de la piel

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Generalmente se completa dentro de 3 días
Componentes clave: mayor permeabilidad vascular y reclutamiento celular
Tejido necrótico, material extraño y bacterias= alteran esta fase

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Cicatrización se da como respuesta celular a la lesión tisular e implica la activación de queratinocitos, fibroblastos, células endoteliales, macrófagos y plaquetas

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Para una cicatrización adecuada:  lecho de la herida bien vascularizado, libre de tejido desvitalizado, libre de infecciones y húmedo

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Proliferación de células basales y migración de células epiteliales que se producen en el puente de fibrina dentro de un coágulo. Se completa dentro de las 48 horas luego de la cirugía.

Puede alterarse por: presencia de biopelículas y células senescentes en el borde o la base de la herida.

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Proliferación de fibroblastos, la acumulación de sustancia fundamental y la producción de colágeno. Fibroblastos presentes en la herida dentro de las 24 horas y predominan al décimo día postoperatorio.

Fibrosis patológica: miofibroblastos persisten y causan fibrosis por mayor síntesis de matriz y  contracción de la herida

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Elementos clave: entrecruzamiento del colágeno, la remodelación del colágeno, la contracción de la herida y la repigmentación.
Resistencia a la tracción: directamente proporcional a la cantidad de colágeno presente.