DR TILAK
WOUND HEALING
The word HEALING means replacement of destroyed tissue by living tissue. Two terms to be understood1. Regeneration means replacement of lost tissue by tissue similar in type. 2. Repair means replacement of lost tissue by granulation tissue, followed by fibrosis &scar tissue formation.
WOUND HEALING
Types of wound healing 1. Primary intention 2. Secondary intention
WOUND HEALING
PRIMARY HEALING Occurs in a clean incised wound such as a surgical incision wherein there is only a potential space between the edges. It produces a clean , neat, thin scar. SECONDARY HEALING Refers to a wound which is infected,discharging pus or wound with skin loss . Such wounds heal with an ugly scar.
Hemostasis [cont]
Cytokines in wound healing 1. TGF-B 2. PDG-F 3. EGF 4. B-FGF
WOUND HEALING
2.
WOUND HEALING
TIME 30 SECS-2 MINS EVENTS Neutrophils adhere to vessel wall
3 hrs
10 hrs
RBCs & WBCs escape out of vessel, fibrin network over wound, lymphocytes are predominant
Wound collagen synthesis
24 hrs
3- 5 days
5 days
8 10 days >20 days
WOUND HEALING
3.
REPAIR Final stage in the healing process although it starts as early as 24 hrs after injury. Its components are-
Granulation tissue formation Collagen / matrix formation Remodelling / scar tissue formation
WOUND HEALING
STAGES OF SCAR FORMATION Scar is a metabolically active & dynamic tissue. STAGE-1[0-4 WKS] Soft , fine & weak scar. STAGE-2 [4 12 WKS] Red , hard &strong scar. STAGE-3 [12 40 WKS ] Soft , white &supple scar. Wound contraction is essential in scar formation. 2 theories to explain this-
Blood supply Infection Exposure to ionizing radiation Adhesions to bony surfaces Lymph drainage Faulty technique of wound closure