LAKSHITA PRAJAPATI 7 SEMESTER

22/BPT/17/DPSRU

ASSIGNMENT-3

INFLAMMATION & HEALING OF SOFT & HARD TISSUE

Inflammation is a protective response by the body to variety of etiologic
agents (infectious or non-infectious).Inflammation involves 2 basic
processes - early inflammatory response and later followed by healing.

SIGNS OF INFLAMMATION i) rubor (redness);

ii) tumor (swelling)

iii) calor (heat)

iv) dolor (pain)

fifth sign functio laesa (loss of function) was later added by Virchow.
The word inflammation means burning.

TYPES OF INFLAMMATION -->Acute inflammation usually lasts for only

a few hours to a few days. By the end of this time the accumulated fluid
and degraded proteins in the extracellular spaces will have been drained
by the lymphatic system, the phagocytic cells will have removed the
exudates, debris and fibrin, and the inflammatory cells themselves will
undergo cell death or 'apoptosis'.For example, following a surgical
incision.

Chronic inflammation is characterised by a persistence of the

inflammation usually beyond 10-14 days and is accompanied in most
instances by fibrosis (the accumulation of synthesised collagen in the
tissue).Chronic inflammation can occur when the acute inflammatory
process is not achieved, possibly through the causative agent not being
removed; hence the inflammation becomes prolonged. Rheumatoid
arthritis is an example of a chronic inflammatory condition.

HEALING IF SOFT TISSUE-->>

 1. PHASE 1: BLEEDING (0–10 HOURS)

The type of tissue involved and the type of injury will determine the degree of
bleeding in terms of amount and duration.If very vascular tissue is damaged (e.g.
muscle) a larger amount of bleeding will occur in comparison with less vascular
tissues, for example ligament and tendon. The bleeding phase may only last a period
of a few minutes or hours, but in large muscle contusion injuries, for example,
bleeding may continue to a small degree for up to 24 hours.

2. PHASE 2: INFLAMMATION (0–4 DAYS)

redness, swelling, pain and loss of function will occur There is an initial
vasoconstriction that lasts only a period of seconds, followed by a more prolonged
vasodilation response. There is also an increase in the permeability of the capillary
walls allowing migration of large plasma proteins into the interstitial space. This
alters the osmotic pressure in the tissue and exudate will gather in the interstitial
space causing swelling. As cells migrate across the vessel wall into the interstitial
fluid this will become cellular exudate. This exudate will contain mainly neutrophils
initially and then lymphocytes and monocytes as the inflammatory process
progresses.

3. PHASE 3: TISSUE PROLIFERATION(FIBROUS REPAIR) (1–10+ DAYS

POST-INJURY)
Cellular processes during this stage include:

• ongoing phagocytosis;

• angiogenesis (formation of new blood vessels);

• proliferation of fibroblasts;

• production of collagen fibres (initially these are produced in an unordered and

random fashion);

• absorption of inflammatory exudate.

4.PHASE 4: TISSUE REMODELLING (10 DAYS + POST-INJURY)

• ongoing fibroblast activity and collagen production(usually peaking 2–3

weeks following injury);

• absorption of older fibrous tissue

• deposition of new fibrous tissue;

• scar tissue contraction;

• type III collagen fibres being replaced by type I collagen fibres.

HEALING IN SPECIALISED TISSUES--->>>FRACTURE HEALING

I. PROCALLUS FORMATION Steps involved in the formation of procallus are as follows:

1. Haematoma forms due to bleeding from torn blood vessels, filling the area surrounding
the fracture. Loose meshwork is formed by blood and fibrin clot which acts as framework
for subsequent granulation tissue formation.

2. Local inflammatory response occurs at the site of injury with exudation of fibrin,
polymorphs and macrophages. The macrophages clear away the fibrin, red blood cells,
inflammatory exudate and debris. Fragments of necrosed bone are scavenged by
macrophages and osteoclasts.

3. Ingrowth of granulation tissue begins with neovascularisation and proliferation of

mesenchymal cells from periosteum and endosteum. A soft tissue callus is thus formed
which joins the ends of fractured bone without much strength.

4. Callus composed of woven bone and cartilage starts within the first few days. The cells of
inner layer of the periosteum have osteogenic potential and lay down collagen as well as
osteoid matrix in the granulation tissue. The osteoid undergoes calcification and is called
woven bone callus.

II. OSSEOUS CALLUS FORMATION The procallus acts as scaffolding on which osseous
callus composed of lamellar bone is formed. The woven bone is cleared away by incoming
osteoclasts and the calcified cartilage disintegrates, newly-formed blood vessels and
osteoblasts invade, laying down osteoid which is calcified and lamellar bone is formed by
developing Haversian system concentrically around the blood vessels.

III. REMODELLING During the formation of lamellar bone, osteoblastic laying and
osteoclastic removal are taking place remodelling the united bone ends, which after
sometime, is indistinguishable from normal bone. The external callus is cleared away,
compact bone (cortex) is formed in place of intermediate callus and the bone marrow cavity
develops in internal callus.