Healing Times - PowerPoint PPT Presentation

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Healing Times

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A surgical procedure to open the abdomen, separate the muscles and lower segment ... Primary intention (closed by sutures, needs little new tissue) ... – PowerPoint PPT presentation

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Title: Healing Times


1
Healing Times
  • Barbara Hastings-Asatourian

2
Pregnancy, childbirth and the post natal period
  • These periods bring enormous changes in physical,
    mental, emotional, social and spiritual terms
  • Hormonal changes bring about adaptations to body
    shape and function irrespective of surgical
    interventions
  • When surgery is then super-imposed a number of
    additional considerations are required
  • This presentation will focus on episiotomy and
    Caesarean section

3
Outline of session
  • The procedures
  • The structures affected by the procedures
  • The Healing Process
  • Factors contributing to healing

4
Episiotomy
  • A surgical incision into the perineum between the
    vagina and anus.
  • Sometimes performed during the second stage of
    labour (pushing stage)
  • Prior to instrumental delivery (forceps, vacuum)
    to widen the vagina

5
Caesarean Section
  • A surgical procedure to open the abdomen,
    separate the muscles and lower segment of the
    uterus to deliver a baby cannot be born
    vaginally. (LSCS)
  • May be Elective (planned) e.g. in dysproportion
  • Or Emergency e.g. in foetal distress

6
Types of Healing
  • Wounds heal by
  • Primary intention (closed by sutures, needs
    little new tissue)
  • Secondary intention (new tissue fills the damaged
    area and is covered by new epithelium)

7
Deeper tissues affected by episiotomy (and tears)
  • Beneath the skin and fatty layers, superficial
    and possibly deep pelvic floor muscles

8
Basic physiology of healing
  • A number of different processes contribute to
    healing
  • Blood Clotting ( platelet activity)
  • Inflammation (production of cytokines from white
    blood cells)
  • Granulation (fibroblasts and new blood vessels)
  • Increased blood supply
  • Contraction of the scar
  • Migration of epithelial cells over granulation
    tissue

9
Healing times
  • Three overlapping phases
  • Inflammation
  • Proliferation
  • granulation
  • angiogenesis
  • epithelialisation
  • Maturation (7-100 days)

10
Returning to exercise
  • Every person is an individual
  • Dependent on type of class/activity
  • Screening
  • Post partum blood loss?
  • Sutures (dissolved or removed)?
  • Infection?
  • Involution?
  • Wound healing?
  • Pain?
  • Rec check

11
Factors affecting the rate of wound healing
  • Blood supply (O²)
  • smoking, diabetes, shock, swelling, trauma,
    anaemia
  • Dietary factors
  • malnutrition, eating disorders, inflammatory
    bowel disease, vitamin deficiency
  • Infection
  • dead tissue, excessive suture material, location
    of wounds (anus, skin creases)
  • Drugs (POM and recreational)
  • e.g. Steroids (lower resistance to infection),
    Tobacco (CO)

12
And finally... to stimulate healing
  • From day 1, mobility and changes of position,
    flexion and pointing of feet ( prevention of
    thrombosis)
  • Normal well balanced eating to accommodate both
    breast feeding and demands of healing.
  • Extra fluid - avoid constipation (straining)
  • Breathing effectively (to increase supply of 0²
    to damaged tissues)
  • Deep transversus abdominal and back work -
    pulling in, correcting posture, engaging lats
  • Pelvic floor exercises - slow and fast twitch
    (improves perfusion)
  • Relaxation, massage, other alternatives
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