HEALING AND REAIR

 Healing
 Is the process whereby the body restores the
injured part to as near its pervious normal
condition as possible.
 REPAIR

 Repair involves two distinct processes

1- Repair by regeneration:
The lost cells and tissues are replaced by other
cells of the same type.
2- Repair by connective tissue
Replacement by connective tissue which its
permanent state constitute a scar
CELLS GROUPS
 The cells of the body are divided into three groups on the
basis of their regenerative capacity and their relation to the
cell growth cycle to
I- Labile cells: Labile cells are continuously dividing and dying, and
regenerating (short life spans) from a population of stem cells.
Examples :
– Epithelium of skin and mucosa – Lymphoid cells - Haematopoietic cells

2-Stable cells: Cells in this category generally have long life spans and are
capable of division following small tissue damage while repair by fibrosis
in large area of tissue damage.
Examples of tissues made up of stable cells include:
Liver, pancreas, and Kidney.

3- Permanent cells - never divide

 Brain, spinal cord and retina
 cardiac myocytes, skeletal muscle by the fibroblasts (fibrosis).
Out comes of inflammation
 Replacement of damaged tissue by granulation
tissue which matures to fibrous tissue. Granulation
tissue is formed in the healing processes of
inflammation, wounds, thrombus and infarction.
 It involves four important steps
 1-migration and proliferation of fibroblast cells
 2- Deposition of extracellular matrix
 3- formation of new blood vessels (
angiogenesis)
 4- maturation and organization of the scar (
Remodeling)
 The following 3 phases are observed in the formation of granulation
tissue:
1- Phase of inflammation: Following trauma, blood clots at the site of
injury. There is acute inflammatory response with exudation of plasma,
neutrophils and some monocytes within 24 hours.

2- Phase of clearance: Combination of proteolytic enzymes liberated

from neutrophils, autolytic enzymes from dead tissues cells, and
phagocytic activity of macrophages clear off the necrotic tissue, debris
and red blood cells.

3- Phase of ingrowths of granulation tissue: This phase consists of 2

main processes:
A-Angiogenesis B-Fibrogenesis.
 C-Maturation of granulation tissue
 Formation of new blood vessels at the site of injury takes
place by proliferation of endothelial cells from the margins
of blood vessels. This process is not only important in
healing but is also involved in the progressive growth of
parenchymatous tumors.
 It occurs in four basic steps:
 (1) Enzymatic degradation of the basement membrane of the
parent vessel.
 (2) Migration of endothelial cells toward the angiogenic
stimulus.
 (3) Proliferation of endothelial cells
 (4) Maturation of endothelial cells and organization into
capillary tubes.
 These newly formed vessels have leaky inter-endothelial
junctions, thus granulation tissue tends to be edematous
 The new fibroblasts originate from mitotic
division of fibroblasts and appear in histologic
section as large , plumb cells.
 They acquire increased amounts of rough
endoplasmic reticulum and actively synthesize
proteoglycans and collagen.
 The term granulation tissue derives from the pink
soft granular appearance on the surface of
wounds
WOUND HEALING

 Pattern of wound healing:

 1- Healing by (First Intention)

 Occurs in a clean incised wound with minimal

tissue destruction when the edges are
approximated e.g. surgical wounds.
 Healing by (Second Intention):

 Occurs in healing of gaping wounds, septic

wounds, or abscesses or ulcer and accidental
wound.
 Blood is clotted between the
wound edges and on the surface.
 Acute inflammation in the edges of
the wound.

The basal cell layer of the

epidermis on both edges of
the wound proliferates
across the clot to meet in
the center
 The gap of the wound under
the new epithelium gets
filled with granulation tissue
originating from both edges
of the wound.
 Maturation of granulation tissue to
fibrous tissue called scar.
(1) The gap of the wound is filled by blood clots,
necrotic debris or pus.
(2) Neutrophils, macrophages and inflammatory
fluid exudate appear to deal with any remaining
infection.
3) The gap gets filled from below upward and from
the sides by granulation tissue.
4) The epidermal cells at the margins proliferate
across the blood clot

5) The basal cell layer around the cavity proliferates

to cover the formed granulation tissue and divides
to form the whole epidermal thickness.
 DIFFERENCE BETWEEN 1ST INTENTION AND 2ND
INTENTION
Pont of difference 1st intention 2nd intention
margins Cutted edges gap
Surgical cut Accidental wound
infection absent present
Tissue damaged Less amount Large amounts
Inflammatory Less amount of Large amounts
cellular infiltrated cells
Granulation Less amount Large amounts
tissues
complications Small scar Ugly scar
 (1) Chronic ulcer: The cause is excess collagen
deposition at the edges of the wound decreasing
the blood supply to the regenerating epithelium.
 ( (2) Keloid: Large scar projecting on 'the surface
and covered stretched epidermis. It is due to
overdone repair.
 Keloid may be body reaction caused by the
introduction of hair, keratin, debris into the
wound. It may occur in healing of burns.
 (3) Contraction: in a scar on a flexure may
 interfere with movement
 (1) Central Nervous System: Regeneration does not
occur in the brain and spinal cord. The dead cells are
removed by microglia replaced by neuroglia cells, a
process called gliosis.

 (2) Peripheral Nerves: Regeneration may occur. Two types

degeneration affect both segments of the injured nerve:

 (a) Axonal degeneration: Affects the nerve cell. It swells

and Nissel granules disintegrate and disappear. Three
weeks later the cell recover.

 (b) Wallerian degeneration: the myelin sheath breaks

and cut of nerve fibers. If the two ends of the cut nerve are
not opposite each other, the growing nerve fibers and
Schwann cells mix together forming a painful mass called
traumatic neuroma (Stump neuroma).
FRACTURE HEALING

 Most fractures occur to the shaft of long bones.

 Bone is well vascularized and highly innervated.
 Heals relatively rapidly when ends are well
approximated (6 weeks or less).
 Healed bone often stronger than original due to
external calcification.
 4 days (acute inflammation)
 Hematoma forms in medullary
canal and surrounding soft tissue
in first 48-72 hours

 Dead bone and tissue =

inflammatory reaction including
vasodilatation, plasma exudate,
and inflammatory cells
 Osteoclasts for remove of bone
debris
 Macrophages for remove of
necrotic tissue
 The haematoma is then
invaded by capillary
loops and mesenchymal
cells derived from the
periosteum and the
endosteum of the
cancellous bone.
 The soft granulation
tissue formed is called
"soft callus".
 osteoblasts form both collagen fibers and the
ground substance osseomucin in which they are
embedded.

 The tissue produced is called soft osteoid callus.

 The osteoid callus undergoes calcification helped

by the enzyme alkaline phosphatase released by
the osteoblasts and formed hard osteoid callus.

 Formation of:

 1- External callus

 2- Intermediate callus

 3- Internal callus
 During lamellar bone
formation the external
and internal callus are
removed by osteoclasts.
 The intermediate
undergoes remodeling
by osteoclasts.
 Remodeling hard callus
to compact bone may
take a few years
 Bone marrow
regeneration.