WOUND HEALING
Forms of wound healing:
1. First intention
2. Second intention.
First intention (primary) healing
occurs when tissue is cleanly incised
and re approximated and repair
occurs without complication.
Second intention (secondary) healing
occurs in open wounds through
formation of granulation tissue* and
eventual coverage of the defect by
spontaneous migration of epithelial
cells. Most infected wounds and
burns heal in this manner
Granulation tissue is the red,
granular, moist tissue that appears
during healing of open wounds.
Microscopically, it contains new
collagen, new blood vessels,
fibroblasts, and inflammatory cells,
especially macrophages.
Primary healing is simpler and
requires less time and material than
secondary healing. It sometimes
happens that primary healing is
possible but there is insufficient
reserve to support secondary healing.
Eg. Ischemic limb may heal
primarily, but if the wound opens and
becomes secondarily infected, it may
not heal.
Healing phases
Injury profoundly disrupts the
chemical environment and
architecture of tissues.
The postinjury environment,
characterized by impaired perfusion
During inflammation, vessels
become porous and release cells and
blood plasma into the injured area.
The newly arrived inflammatory cells
increase metabolic demand. Since the
local microvasculature has been
damaged, PO2 falls while CO2 and
lactate accumulate. Lactate in
produce more vasodilatation and
attract more inflammatory cells.
Vicious cycle is thus set with
macrophages taking the role of
releasing chemo attractants as
coagulation derived factors
decrease.
Macrophages release more lactate
even in the presence of oxygen,
thereby maintaining the environment
of injury. The environment causes
them to release growth promoters and
more lactate, which in turn stimulates
angiogenesis and collagen deposition.
By 2nd -3rd day Unless the wound
becomes infected, its granulocyte
population, which dominated on the
first day, has diminished.
Macrophages now cover the cut
surface.
In 3rd-4th Immature fibroblasts, the
product of growth signals, lie just
beneath, mixed with bud of new
vessels. More mature fibroblasts are
scattered behind
2.FIBROPLASIA & MATRIX
DEPOSITION
Fibroplasia
Replication of fibroblasts is
stimulated by PDGF, IGF-1, and TGF