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Wound Healing

1st Hemostasis and Chemotaxis (Inflammation) Wounding rapid activation of coagulation pathways formation of blood clot in the wound surface Clot serves as: 1. Stop bleeding 2. Scaffold for migrating cells

Release of VEGF( Vascular Endothelial Growth Factor)

These cells are attracted by: 1. Growth factors 2. Cytokines 3. Chemokines

Neutrophils appear at the margins of the incision. Uses the scaffold provided by fibrin to march in

Increased Vessel permeability and Edema

dehydration occur at the external surface of the clot

forms a scab that covers the wound Release Proteolytic Enzymes that clean out debris and invading bacteria

2nd Eptheliaization, Angiogenesis, Provisional matrix (proliferation) Fibroblast and Vascular endothelial cells Proliferate (24-72hours) The new vessels are leaky allowing passage of plasma proteins and fluid into extravascular space (edematous) it forms a Granulation Tissue Hallmark of tissue repair

Angiogenesis Formation of new blood Vessels

Proliferation of Fibroblast Collagen fibrils become more abundant Bridge the Incision

Within 48-96 hours Neutrophils are replaced by Macrophages

TGF-B most important Fibrogenic Factor 3rd collagen disposition (maturation)

Replaced by Type I collagen

Provisional Matrix Fibrin Plasma fibronectin Type III collagen

Macrophages Clears: *extracellular debris *fibrin *foreign material Affects Wound Healing Systemic: 1. Nutrition (protein and Vitamin C) 2. Metabolic status (DM) 3. Circulatory status 4. Hormones (glucocorticoid)

The epidermis recovers its normal thickness and Architecture and surface keratinazation.

Local: 1. Infection 2. Mechanical factors 3. Foreign bodies 4. Size, location and type of wound