question: When your stabbed or shot and veins are split, how do you heal internally?
comment: If it is a large artery or vein cut without medical attention you’d probably bleed out. If it is a smaller one the veins can clot the ends off and build scar tissue over it. The blood supply would then be rerouted through other veins. The body can even enlarge smaller veins to make up for the loss.
passages: BULLET::::- Surgery is employed occasionally for longstanding vitreous hemorrhage and other serious complications such as epiretinal membrane and retinal detachment.
  
  BULLET::::- Arteriovenous sheathotomy has been reported in small, uncontrolled series of patients with BRVO. BRVO typically occurs at arteriovenous crossings, where the artery and vein share a common adventitial sheath. In arteriovenous sheathotomy an incision is made in the adventitial sheath adjacent to the arteriovenous crossing and is extended along the membrane that holds the blood vessels in position to the point where they cross, the overlying artery is then separated from the vein.
  
  Section::::Prognosis.
   Section::::Vascular access.
   Reconstructive ladder
  
  The reconstructive ladder is the set of levels of increasingly complex management of wounds in reconstructive plastic surgery. The surgeon should start on the lowest rung and move up until a suitable technique is reached.
  
  There are several small variations in the reconstructive ladder in the scientific literature, but the principles remains the same:
  
  BULLET::::1. Healing by secondary intention
  
  BULLET::::2. Primary closure
  
  BULLET::::3. Delayed primary closure
  
  BULLET::::4. Split thickness graft
  
  BULLET::::5. Full thickness skin graft
  
  BULLET::::6. Tissue expansion
  
  BULLET::::7. Random flap
  
  BULLET::::8. Axial flap
  
  BULLET::::9. Free flap
  
  Section::::See also.
  
  BULLET::::- List of plastic surgery flaps
  
  BULLET::::- Perforator flaps
   BULLET::::4. Vascular sprouting: With the breakdown of endothelial basement membrane, detached endothelial cells from pre-existing capillaries and post-capillary venules can divide and migrate chemotactically towards the wound, laying down new vessels in the process. Vascular sprouting can be aided by ambient hypoxia and acidosis in the wound environment, as hypoxia stimulates the endothelial transcription factor, hypoxia inducible factor (HIF) to transactivate angiogenic genes such as VEGF and GLUT1. Sprouted vessels can self-organise into luminal morphologies, and fusion of blind channels give rise to new capillary networks.
   BULLET::::- Faculty technique of wound closure
  
  BULLET::::- Ischemia and necrosis
   BULLET::::- Intentionally created (for example, Cimino fistula as vascular access for hemodialysis). Blood must be aspirated from the body of the patient, and since arteries are not easy to reach compared to the veins, blood may be aspirated from veins. The problem is that the walls of the veins are thin compared to those of the arteries. The AV fistula is the solution for this problem because, after 4-6 weeks, the walls of the veins become thicker due to the high arterial pressure. Thus, this vein can now tolerate needles during hemodialysis sessions.
  
  Section::::Mechanism.
   Surgical procedures include:
  
  BULLET::::- Arterial bypass surgery to create another source of blood supply
  
  BULLET::::- Embolectomy, to remove the embolus, with various techniques available:
  
  BULLET::::- Thromboaspiration
  
  BULLET::::- Angioplasty with balloon catheterization with or without implanting a stent Balloon catheterization or open embolectomy surgery reduces mortality by nearly 50% and the need for limb amputation by approximately 35%.
  
  BULLET::::- Embolectomy by open surgery on the artery
   The main advantages of using the interventional cardiology or radiology approach are the avoidance of the scars and pain, and long post-operative recovery. Additionally, interventional cardiology procedure of primary angioplasty is now the gold standard of care for an acute myocardial infarction. It involves the extraction of clots from occluded coronary arteries and deployment of stents and balloons through a small hole made in a major artery, which has given it the name ""pin-hole" surgery" (as opposed to ""key-hole" surgery").
  
  Section::::Procedures.
  
  BULLET::::- Angioplasty: is an intervention to dilate either arteries or veins.
   BULLET::::3. Degradation of endothelial basement membrane: The wound macrophages, mast cells and the endothelial cells themselves secrete proteases to break down existing vascular basal lamina.
   Access to the patient's femoral arteries can be with surgical incisions or percutaneously in the groin on both sides. Vascular sheaths are introduced into the patient's femoral arteries, through which guidewires, catheters and the endograft are passed.
   BULLET::::- The aorta and pulmonary artery are detached from their native roots and reattached to the opposite root; thus, the pulmonary root becomes the neo-aorta, and the aortic root becomes the neo-pulmonary artery.
  
  BULLET::::- The coronary arteries are transplanted from the aorta/neo-pulmonary artery to the pulmonary artery/neo-aorta.
  
  BULLET::::- Length of procedure, from initiation of anaesthesia to post-operative cease thereof, is approximately 6–8 hours.
  
  Section::::Method.:Preparatory.
   Section::::Proliferative phase.
  
  About two or three days after the wound occurs, fibroblasts begin to enter the wound site, marking the onset of the proliferative phase even before the inflammatory phase has ended. As in the other phases of wound healing, steps in the proliferative phase do not occur in a series but rather partially overlap in time.
  
  Section::::Proliferative phase.:Angiogenesis.
   Surgical intervention may be required but it depends on what organ systems are affected by the wound and the extent of the damage. It is important for care providers to thoroughly check the wound site inasmuch as a laceration of an artery often results in delayed complications sometimes leading to death. In cases where there is no suspicion of bleeding or infection, there is no known benefit of surgery to correct any present injuries. Typically a surgeon will track the path of the weapon to determine the anatomical structures that were damaged and repair any damage they deem necessary. Surgical packing of the wounds is generally not the favored technique to control bleeding as it be can less useful than fixing the directly affected organs. In severe cases when homeostasis cannot be maintained the use of damage control surgery may be utilized.
   Section::::Endovascular devices.:Embolization.
  
  Embolization is a minimally invasive technique used in EVTM of selected hemodynamically unstable patients with both traumatic and non-traumatic injuries. It is the artificial creation of a thrombus by the introduction of various substances to intentionally occlude a vessel with the aim to stop or diminish blood extravasation and is a critical part of the modern management of arterial injuries.
  
  Section::::Endovascular devices.:Stent grafts.
   BULLET::::- Foreign bodies. Sharp, small foreign bodies can penetrate the skin leaving little surface wound but causing internal injury and internal bleeding. For a glass foreign body, "frequently, an innocent skin wound disguises the extensive nature of the injuries beneath". First-degree nerve injury requires a few hours to a few weeks to recover. If a foreign body passes by a nerve and causes first-degree nerve injury during entry, then the sensation of the foreign body or pain due to internal wounding may be delayed by a few hours to a few weeks after entry. A sudden increase in pain during the first few weeks of wound healing could be a sign of a recovered nerve reporting internal injuries rather than a newly developed infection.
   Also called neovascularization, the process of angiogenesis occurs concurrently with fibroblast proliferation when endothelial cells migrate to the area of the wound. Because the activity of fibroblasts and epithelial cells requires oxygen and nutrients, angiogenesis is imperative for other stages in wound healing, like epidermal and fibroblast migration. The tissue in which angiogenesis has occurred typically looks red (is erythematous) due to the presence of capillaries.
  
  Angiogenesis occurs in overlapping phases in response to inflammation:
   BULLET::::- Anticoagulants (such as warfarin or heparin) and antiplatelet medication (such as aspirin, ticlopidine, and clopidogrel) can prevent new clots from forming
  
  BULLET::::- Thrombolytics (such as streptokinase) can dissolve clots
  
  BULLET::::- Painkillers given intravenously
  
  BULLET::::- Vasodilators to relax and dilate blood vessels.
  
  Appropriate drug treatments successfully produces thrombolysis and removal of the clot in 50% to 80% of all cases.
  
  Antithrombotic agents may be administered directly onto the clot in the vessel using a flexible catheter ("intra-arterial thrombolysis"). Intra-arterial thrombolysis reduces thromboembolic occlusion by 95% in 50% of cases, and restores adequate blood flow in 50% to 80% of cases.
   Another example in humans and some other animals is after an acute myocardial infarction (heart attack). Collateral circulation in the heart tissue will sometimes bypass the blockage in the main artery and supply enough oxygenated blood to enable the cardiac tissue to survive and recover.
  
  Section::::Eye.
  
  After central retinal vein occlusion, neovascularization may restore some blood flow to the retina, but the new vessels' bulk also presents a risk of causing acute glaucoma by blocking the drainage of aqueous humour.
  
  Section::::Truncal venous system.
   BULLET::::- CHIVA method is the ambulatory conservative haemodynamic correction of venous insufficiency. As of 2015 there is tentative evidence of benefits with a relatively low risk of side effects compared to vein stripping.
  
  BULLET::::- Ambulatory phlebectomy
  
  BULLET::::- Vein ligation is done at the saphenofemoral junction after ligating the tributaries at the sephanofemoral junction without stripping the long saphenous vein provided the perforater veins are competent and absent DVT in the deep veins. With this method, the long saphenous vein is preserved.
   Many of these lower extremity amputations can be prevented through an interdisciplinary approach to treatment involving a variety of advanced therapies and techniques, such as debridement, hyperbaric oxygen treatment therapy, dressing selection, special shoes, and patient education. When wounds persist, a specialized approach is required for healing.
  
  Section::::Pathophysiology.
  
  To heal a wound, the body undertakes a series of actions collectively known as the wound healing process.
  
  Section::::Diagnosis.
  
  A wound may be recorded for follow-up and observing progress of healing with different techniques which include:
  
  BULLET::::- Photographs, with subsequent area quantification using computer processing
  
  BULLET::::- Wound tracings on acetate sheets
   BULLET::::- Treatment of underlying conditions.
  
  BULLET::::- Protection of periwound from damage, infection, and contaminants.
  
  Systemic treatment may include medication appropriate for patient’s condition. Local treatment may include wound care products that protect periwound and help maintain its healthy functionality, for example, moisture barriers (ointments, salves and films), topical corticosteroids, antiseptics and antifungal agents, as well as moisture balancing dressings, such as self-adaptive wound dressing.
   Treatment and prevention of periwound issues are becoming increasingly important as research continues to confirm the role of periwound in wound healing. The shared objective of treatment and prevention is maintenance and/or restoration of the integrity and healthy functionality of skin surrounding the wound.
  
  Main treatment and prevention strategies include the following:
  
  BULLET::::- Holistic wound assessment that includes periwound assessment.
  
  BULLET::::- Elimination of factors causing moisture-associated skin damage.
  
  BULLET::::- Maintaining optimal moisture balance over the wound and periwound: effective exudate management in heavily draining wounds as well as adequate hydration of dry wounds.
  
  BULLET::::- Proper patient nutrition.
   BULLET::::5. Vascular maturation: the endothelium of vessels mature by laying down new endothelial extracellular matrix, followed by basal lamina formation. Lastly the vessel establishes a pericyte layer.
  
  Stem cells of endothelial cells, originating from parts of uninjured blood vessels, develop pseudopodia and push through the ECM into the wound site to establish new blood vessels.
   BULLET::::- Percutaneous valve repair: An alternative to open heart surgery, percutaneous valve repair is performed on the mitral valve using the MONARC system or MitraClip system
  
  BULLET::::- Coronary thrombectomy: Coronary thrombectomy involves the removal of a thrombus (blood clot) from the coronary arteries.
  
  Open heart surgery of the heart is performed by a cardiothoracic surgeon. Some interventional cardiology procedures are performed in conjuction with a cardiothoracic surgeon. 
  
  Section::::Education.
   Many genes play a role in healing. For instance, in wound healing, P21 has been found to allow mammals to heal spontaneously. It even allows some mammals (like mice) to heal wounds without scars. The LIN28 gene also plays a role in wound healing. It is dormant in most mammals. Also, the proteins MG53 and TGF beta 1 play important roles in wound healing.
  
  Section::::Wound healing.
  
  In response to an incision or wound, a wound healing cascade is unleashed. This cascade takes place in four phases: clot formation, inflammation, proliferation, and maturation.
  
  Section::::Wound healing.:Clotting phase.
  
presuppositions: You will heal when shot or stabbed. It's possible to heal internally when a person is stabbed or shot and veins are split.
corrections: You don't always heal and could bleed out.  It's not possible to heal internally when a person is stabbed or shot and large veins are split.
raw_presuppositions: You will heal when shot or stabbed. It's possible to heal internally when a person is stabbed or shot and veins are split.
raw_corrections: You don't always heal and could bleed out.  It's not possible to heal internally when a person is stabbed or shot and large veins are split.