I have chosen to continue my education courtesy of the web. I like to understand what is going on with my body. I have had this article on the phases of wound healing for some time. Being close to midway in my marathon seems a good time to share it. I've noted how I've renamed each phase in my blog. Following the article I will take a look at where my past 10 miles are today. A reminder the pictures may be graphic. Reality is truly more real than fiction.
This is surgery day stuff
Hemostasis:
Once the source of damage to a house has been removed and before work can start, utility workers must come in and cap damaged gas or water lines. So too in wound healing damaged blood vessels must be sealed. In wound healing the platelet is the cell which acts as the utility worker sealing off the damaged blood vessels. The blood vessels themselves constrict in response to injury but this spasm ultimately relaxes. The platelets secrete vasoconstrictive substances to aid in this process but their prime role is to form a stable clot sealing the damaged vessel. Under the influence of ADP (adenosine diphosphate) leaking from damaged tissues the platelets aggregate and adhere to the exposed collagen. They also secrete factors which interact with and stimulate the intrinsic clotting cascade through the production of thrombin, which in turn initiates the formation of fibrin from fibrinogen. The fibrin mesh strengthens the platelet aggregate into a stable hemostatic plug. Finally platelets also secrete cytokines such as platelet-derived growth factor (PDGF), which is recognized as one of the first factors secreted in initiating subsequent steps. Hemostasis occurs within minutes of the initial injury unless there are underlying clotting disorders.
This is what I call "swellin"
Inflammation Phase:
Clinically inflammation, the second stage of wound healing presents as erythema, swelling and warmth often associated with pain, the classic “rubor et tumor cum calore et dolore”. This stage usually lasts up to 4 days post injury. In the wound healing analogy the first job to be done once the utilities are capped is to clean up the debris. This is a job for non-skilled laborers. These non-skilled laborers in a wound are the neutrophils or PMN’s (polymorphonucleocytes). The inflammatory response causes the blood vessels to become leaky releasing plasma and PMN’s into the surrounding tissue. The neutrophils phagocytize debris and microorganisms and provide the first line of defense against infection. They are aided by local mast cells. As fibrin is broken down as part of this clean-up the degradation products attract the next cell involved. The task of rebuilding a house is complex and requires someone to direct this activity or a contractor. The cell which acts as “contractor” in wound healing is the macrophage. Macrophages are able to phagocytize bacteria and provide a second line of defense. They also secrete a variety of chemotactic and growth factors such as fibroblast growth factor (FGF), epidermal growth factor (EGF), transforming growth factor beta (TGF-__ and interleukin-1 (IL-1) which appears to direct the next stage.
This is what I call "gellin"
Proliferative Phase ( Proliferation, Granulation and Contraction):
The granulation stage starts approximately four days after wounding and usually lasts until day 21 in acute wounds depending on the size of the wound. It is characterized clinically by the presence of pebbled red tissue in the wound base and involves replacement of dermal tissues and sometimes subdermal tissues in deeper wounds as well as contraction of the wound. In the wound healing analogy once the site has been cleared of debris, under the direction of the contractor, the framers move in to build the framework of the new house. Sub-contractors can now install new plumbing and wiring on the framework and siders and roofers can finish the exterior of the house. The “framer” cells are the fibroblasts which secrete the collagen framework on which further dermal regeneration occurs. Specialized fibroblasts are responsible for wound contraction. The “plumber” cells are the pericytes which regenerate the outer layers of capillaries and the endothelial cells which produce the lining. This process is called angiogenesis. The “roofer” and “sider” cells are the keratinocytes which are responsible for epithelialization. In the final stage of epithelializtion, contracture occurs as the keratinocytes differentiate to form the protective outer layer or stratum corneum.
This is well into what I call "getting to go naked"
Remodeling or Maturation Phase:
Once the basic structure of the house is completed interior finishing may begin. So too in wound repair the healing process involves remodeling the dermal tissues to produce greater tensile strength. The principle cell involved in this process is the fibroblast. Remodeling can take up to 2 years after wounding and explains why apparently healed wounds can break down so dramatically and quickly if attention is not paid to the initial causative factors.
Facts courtesy of Curad Products.
I am going to recap all my previous miles. This will be the last we focus on Miles #1 to #5.
Mile #10 Surgery date October 22, 2013
Stitches are always awesome to deal with. Pain is normally a two day ordeal requiring prescription pain meds. After that regular Tylenol is fine. This is how it looks today.
 |
| Mile #10 left and back |
 | |||||||||
| Mile #10 right |
Four spots all with stitches. Had a resident in the office that stitched me for the first time. All other surgeries where stitches were an option were done by my regular nurse. Not sure whyI have puffiness and gaps on the sites. Hopefully it is just because the neck is always moving and not due to a different "stitcher". Not entirely happy with this look. But hey it is naked and that is always a blessing. I use a thin layer of antibiotic ointment on these for the next week. At two weeks post op I switch to cocoa butter cream on my sites that had stitches.
Mile #9 Surgery date October 8, 2013
This is how it looks today. Both sites are gellin nicely and the one on the left is close to being naked during the day. My wound care is petroleum jelly, non stick gauze pads and regular gauze for padding. I completely enclose the bandage with tape to seal the sites until they can go naked.
 |
| Mile #9 right scalp |
 | ||||
| Mile #9 left scalp behind ear |
Mile #8 Surgery date September 24, 2013
There were two sites for mile #8. The first being under my left eye. That site is not recognizable in photographs. WooHoo. The second site is my left jaw area pictured below.
The faint line from my side burn down is all that remains of Mile #8. Good makeup and you won't know its there.
 |
| Mile #8 along the front of ear |
This wound site is still gellin. You may recall it was very large compared to other sites. When we tackled this area it was a solo act due to its size. It has not produced much new hair along its edges. This concerns me.
 |
| Mile #7 right scalp towards crown |
Mile #6 Surgery date August 20, 2013
This site is naked during the day and is healing nicely. I use antibiotic ointment day and night and cover this site with a nonstick pad at night. According to my husband, Mile #2 at the top edge of Mile #6 makes the site look like a paisley. The temple area of this site is growing new hair. The area above my ear not yet. We will be looking closer at the area with hair over my ear as there is something there the surgeon may want to biopsy. At first this site had my brow line raised but it has since relaxed.
 |
| Mile #6 bottom of site & Mile #2 top of site |
Mile #5 Surgery date July 30, 2013
This site is only partially visible now. I use cocoa butter cream on it. No I do not know of any scientific evidence of this helping to lessen scarring. To me it appears to make the skin less tight and stiff. Mile #5 is the two dimpled areas on my cheek the third site you can no longer see in pictures. The long suture line in front of my ear is the second part of Mile #2. There is more cancer remaining in front and over my right ear that is visible in this picture. That will be a future surgery mile. The scar on my right side almost mimics my left giving me a mini facelift. Thi is an unforeseen bonus.
 |
| Mile #5 dimples in cheek & Mile #2 suture line |
Mile #4 Surgery date July 16, 2013
My chin. It is no longer visible in pictures.
Mile #3 Surgery date July 2, 2013
My right forehead goes naked during the day. I do cover this site at night with antibiotic ointment and a nonstick pad. There is new skin visible between Mile #3 and Mile #7. There is however, no new hair growth visible between the two. To date there are four areas on my head that may or may not grow new hair due to the depth of the wound sites.
Yet another reason NOT TO IGNORE ANYTHING ABNORMAL ON YOUR BODY.
 |
| Mile #3 showing Mile #7 at the top |
Mile #2 Surgery date June 18, 2013
See pictures from miles #5 and #6. Both of these sites have been naked for some time and get the cocoa butter cream treatment.
Mile #1 Surgery date June 4, 2013
 |
| Mile #1 right side of my nose |
The area between the bottom two spots is the deepest and wrapped slightly into my nostril. That area is what is pulled taught today and will require reconstruction in the future. All three of these spots shared what I call the basement condo. Without removing a stage at a time and doing the pathology you cannot tell how far the cancer goes. With a Q-tip in my nostril I could see a small area where it went all the way thorough. Lovely. My co workers told me I should have taken advantage of the situation and gotten a diamond stud for my nose. I just did not see diamonds on this.
Take Away Nugget: Happiness is not something you postpone for the future; it is something you design for the present.
No comments:
Post a Comment
Let me know your thoughts. Please don't leave self serving or ugly comments.