WOUND HEALING

Fitrian Hanif Zulkarnain

30101407191
 WOUND HEALING
• Definition
Wound healing is a complex cellular and
biochemical cascade that leads to restitution of
integrity and function
 PHASES OF WOUND HEALING
• hemostasis and inflammation
• proliferation
• maturation and remodeling.
 Hemostasis initiates wound
inflamation by releasing Hemostasis and
chemotatic factors inflammation
disrupts tissue integrity, leading to
division of blood vessels

direct exposure of extracellular Exposure of subendothelial

matrix to platelets collagen to platelets

activation of the
Platelet aggregation degranulation
coagulation cascade

Release platelet-derived growth factor (PDGF),

transforming growth factor-β (TGF-β), platelet Increase vascular Release
activating factor (PAF), fibronectin, and permeability prostaglandin
serotonin

Stimulate neutrofil migration

(PMN) (24-48 hours)
Phagocytosis by
activation and recruitment of other cells via
macrophages (48-96 mediators such as cytokines and growth
hours) factors
regulating angiogenesis and matrix
deposition and remodeling
PROLIFERATION

Proliferation
cytokines and growth
(4-12 days)
factors as TNF-α,
Cytokines & growth TGF-β, and VEGF
factors from
Restablishing of
macrophages
tissues continuity
Proliferation of
matrix synthesis endothelial cells
Activation fibroblast
remodeling
migration, replication,
and new capillary tubule
formation
 MATURATION Continues for (6 to gradually resulting in
12) months post a mature, avascular,
& REMODELING injury and acellular scar

Begins during
fibroplastic phase

Collagen fiber

synthesized collagen collagenolysis

Adaptive collagen
fiber to wound
tension
 CLASSIFICATION OF WOUNDS
• Wounds are classified as either acute or chronic.
Acute wounds heal in a predictable manner and
time frame.
• An incised wound that is clean and closed by
sutures is said to heal by primary intention.
Often, because of bacterial contamination or
tissue loss, a wound will be left open to heal by
granulation tissue formation and contraction; this
constitutes healing by secondary intention
• Primary intention
An incised wound that is clean and closed by sutures
• Secondary intention
Because of bacterial contamination or tissue loss, a
wound will be left open to heal by granulation tissue
formation and contraction
• Tertiary intention
Consisting of the placement of sutures, allowing the
wound to stay open for a few days, and the subsequent
closure of the sutures
Factors Affecting Wound Healing
 Excess Healing
Hipertrophic scar
• represent an over abundance of
fibroplasia
• HTSs rise above the skin level
(<4mm) but stay within the
confines of the original wound and
often regress over time
• HTSs usually develop within 4
weeks after trauma. The risk of HTS
increases if epithelialization takes
longer than 21 days
• Predilection: anywhere
• Symptoms: Raised, some pruritus,
respects wound confines
Excess Healing
Keloid
• represent an over abundance of
fibroplasia
• Keloids rise above the skin level
as well, but extend beyond the
border of the original wound and
rarely regress spontaneously
• Keloids tend to occur 3 months to
years after the initial insult
• Predilection: Neck, chest, ear
lobes, shoulders, upper back
• Symptoms: Pain, pruritus,
hyperesthesia, growth beyond
wound margins