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WOUND HEALING

PRINCIPLES OF (Formation of scar tissue)


WOUND
HEALING VS.

REGENERATION
(Complete restoration of
OSCAR V.A. TAGULINAO, M.D., FPCS, FPAPRAS
Section of Plastic & Reconstructive Surgery
Department of Surgery
University of Santo Tomas physical integrity)

WOUND HEALING WOUND HEALING

1. PRIMARY INTENTION 1. INFLAMMATORY PHASE


closed immediately
2. PROLIFERATIVE PHASE
2. SECONDARY INTENTION
left to heal spontaneously
3. COLLAGEN FORMATION
3. DELAYED CLOSURE
closed after some delay 4. SCAR MATURATION

WOUND HEALING WOUND HEALING

1. INFLAMMATORY PHASE 2. PROLIFERATIVE PHASE


Humoral phase-
Histamine (mast cells, Epithelialization – basal cells
granulocytes & platelets) at the margin start multiplying &
Kinins & Prostaglandins migrating to wound center
cause vasodilatation &
pemeability
Fibroblastic activity –
Cellular phase-
fibroblasts appear by third day as
greanulocytes,
collagen precursors
monocytes &
macrophages

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WOUND HEALING WOUND HEALING

3. COLLAGEN FORMATION
Appear starting 5th day
Tensile strength parallels collagen WOUND CONTRACTION
deposition
Centripetal advance of wound
4. SCAR MATURATION edge
Collagen fibers realign Resulting scar smaller than
Collagen cross-linkages original wound
(chemical bonding)
Myofibroblasts
Remodelling - collagenase
removes excess collagen

WOUND
CONTRACTURE

Excessive scar
Functional disability

WOUND HEALING

Wound strength
increases rapidly within 6
weeks & then plateaus. ABNORMAL
Tensile strength of scar WOUND
is only 30% of HEALING
unwounded skin

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ABNORMAL WOUND HEALING
Keloid at sternal area
from scratching

EXCESSIVE COLLAGEN
FORMATION
Hypertrophic scars
asymptomatic thick scar

Keloidal scars
symptomatic scars beyond
the original borders

ABNORMAL WOUND HEALING ABNORMAL WOUND HEALING

CHRONIC NON-HEALING
WOUNDS POOR PERFUSION &
OXYGENATION
Arterial insufficiency
Tobacco use
Diabetes

Squamous cell cancer – Marjohlin’s Ulcer

ABNORMAL WOUND HEALING ABNORMAL WOUND HEALING

AGEING MALNUTRITION
Wound ruptures Hypoproteinemia
Ischemia Vitamin C deficiency
Delayed healing

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ABNORMAL WOUND HEALING

INFECTED WOUND
Adequate debridement
Antibiotics
Delay closure