Departamento de Ciruga

Programa Acadmico 2011

Internado medico

Curacin de
heridas :
biologia

Ponente : IM
Choque Acua

Nelson

Curacin de
heridas :
biologia
Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

Wound Healing

Restoration of integrity to
traumatized tissue.
http://www.ncbi.nlm.nih.gov/mesh/68014945

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

Google
scholar
Requerimiento de bsqueda :
allintitle: "wound healing" review
http://scholar.google.com/scholar?hl=en&num=100&q=allintitle%3A+%22wound+healing
%22+review&btnG=Search&as_sdt=0%2C5&as_ylo=&as_vis=0

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

http://www.worldwidewounds.com/2002/april/Vowden/images/WBP-Figure-8.jpg

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

Hunt T: Fundamentals of wound management in surgery, Disorders of Repair. South Plainfield, NJ,
Chirugecom, Inc, 1976

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

. .
.
.

.
.

Hunt T: Fundamentals of wound management in surgery, Disorders of Repair. South Plainfield, NJ,
Chirugecom, Inc, 1976

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

Introducc
ion
definicin

Curacion de
heridas
fases

problema

Aspecto celular

bsqueda

Aspecto molecular

Referenci
as

Inflammatory
Phase

Immediate to 2-5 days

Hemostasis
Vasoconstriction
Platelet aggregation
Thromboplastin makes clot
Inflammation
Vasodilation
http://www.medicaledu.com/phases.htm
Phagocytosis

Proliferative Phase

2 days to 3 weeks
Granulation
Fibroblasts lay bed of collagen
Fills defect and produces new
capillaries
Contraction
Wound edges pull together to
reduce defect
Epithelialization
http://www.medicaledu.com/phases.htm
Crosses moist surface

Remodeling Phase
3 weeks to 2 years
New collagen forms which
increases tensile strength to
wounds
Scar tissue is only 80 percent
as strong as original tissue
http://www.medicaledu.com/phases.htm

http://t0.gstatic.com/images?q=tbn:ANd9GcSQUTsZI6fWwExgG5gvzghvFbmQ1XEctGuFsZWe
dJiFFmHInSNw

http://t1.gstatic.com/images?q=tbn:ANd9GcSyrvq0fNe0IJUAaAA93a6NmbGfdw35aS0XmThO
h8ISW6gldUvylA

http://t2.gstatic.com/images?q=tbn:ANd9GcSo3oCjDv1v_b6GMigx1lvpY4Hi57mFWLz3z91
JCZEw8PXWsou05w

http://t3.gstatic.com/images?q=tbn:ANd9GcSt6Dupj3IkV47qNL7bTOyz-36YpGoCCrohVUFs
vOxiZJ2Fkeg33Q

http://upload.wikimedia.org/wikipedia/commons/thumb/7/76/Wound
_healing_phases.png/701px-Wound_healing_phases.png

http://t3.gstatic.com/images?q=tbn:ANd9GcQNgi8luboXbg_S04BQZBkXDG92TsObX5OKOVKf
_2AfhtJANiQG

http://t2.gstatic.com/images?q=tbn:ANd9GcSuHykSrlrWDaY51d-Hyk_Uo8vhs0dvWZq2dd1KCys
I6fNuNCaA

http://t3.gstatic.com/images?q=tbn:ANd9GcRTdHRAOV4oThjXZL3HMdKJexBbyQvMAJ8KjUxea3j6T7nUIUq9Q

http://t2.gstatic.com/images?
q=tbn:ANd9GcTtZnf6k08qbz538TouEilKCydEnscb8U1KFfeZGa4BadEMC5ePgw

signal transduction pathways

Cotran RS, Kumar V, Collins T. Cotran: Robbins pathologic basis of disease, 6th ed. Philadelphia: WB Saunders, 1999

Platelets
Epidermal growth factor

EGF

Stimulates epithelial cell

proliferation and granulation
tissue formation

Macrophages ,
keratinocytes
Transforming growth factor
TGF-
Similar to EGF

Macrophages, endothelial cells

Acidic fibroblast growth factor
aFGF
Basic fibroblast growth factor
bFGF
Angiogenesis, fibroblast proliferation, collagen
deposition

Fibroblasts
Keratinocyte growth factor

KGF/FGF-7

Epidermal cell motility & proliferation

Platelets, macrophages
Transforming growth factor B1, B2 TGF-1,
2
Epidermal cell motility, fibroblast
proliferation,
chemotaxis, extracellular
matrix synthesis

Macrophages
Transforming growth factor 3
TGF-3
Antiscarring effects

Platelets, macrophages
keratinocytes
Platelet-derived growth factor PDGF
Fibroblast proliferation, chemotaxis,
collagenase production, macrophage
activation

Macrophages,
keratinocytes
Vascular endothelial growth factor
VEGF
Angiogenesis, vascular
permeability

Fibroblasts
Angiopoietin-1-4

Ang-1-4

Angiogenesis, stabilization of blood

vessels

Fibroblasts, keratinocytes
Insulinlike growth factor-1

IGF-1

Synthesis of sulfated proteoglycans &

collagen, cell proliferation

Macrophages,
neutrophils
Interleukin-1

IL-1

Fibroblast proliferation

Macrophages, keratinocytes
Interleukin-10

IL-10

Antiinflammatory, antiscarring effects

Proliferation of keratinocytes, endothelial
cells

Macrophages, mast cells

Tumor necrosis factor-
Fibroblast proliferation

TNF-

Keratinocytes, fibroblasts
Nerve growth factor

NGF

Nerve ingrowth, keratinocyte

proliferation, fibroblast migration

Sundeep G. Keswani Timothy M.

Crombleholme
Chapter 12 Wound Healing: Cellular and
Molecular
Mechanisms
Oldham, Keith T., Colombani, Paul M., Foglia,
Robert P., Skinner, Michael A.
Principles and Practice of Pediatric Surgery
(2nd Edition)Lippincott Williams & Wilkins,
2005

Platelets

Platelet-derived growth factor

PDGF
Fibroblast proliferation, chemotaxis,
collagenase production, macrophage
activation
...................................................................
......................
Epidermal growth factor
EGF

Stimulates epithelial cell proliferation and

granulation tissue formation
................................................................
......................
Transforming growth factor B1, B2

Macrophages

Platelet-derived growth factor

PDGF
Fibroblast proliferation, chemotaxis, collagenase
production, macrophage activation
...........................................................................................
......................
Transforming growth factor
TGF-
Stimulates epithelial cell proliferation and granulation
tissue formation
........................................................................................
.....................
Acidic fibroblast growth factor
Basic fibroblast growth factor

aFGF
bFGF

Angiogenesis, fibroblast proliferation, collagen deposition

........................................................................................
....................
Transforming growth factor B1, B2
TGF-

Transforming growth factor 3

TGF-3
Antiscarring effects
...........................................................
....................
Vascular endothelial growth factor
VEGF
Angiogenesis, vascular permeability
..............................................................
....................
Interleukin-1
IL-1
Fibroblast proliferation
............................................................
....................
Interleukin-10
IL-10

Keratinocytes
Platelet-derived growth factor
PDGF
Fibroblast proliferation, chemotaxis,
collagenase production, macrophage
activation
..............................................................
................
Transforming growth factor
TGF-
Stimulates epithelial cell proliferation
and granulation tissue formation
..............................................................
................

Insulinlike growth factor-1

IGF-1
Synthesis of sulfated
proteoglycans & collagen, cell
proliferation
....................................................
...............
Interleukin-10
IL-10
Antiinflammatory, antiscarring
effects
Proliferation of keratinocytes,
endothelial cells

Endothelial cells
Acidic fibroblast
growth factor
aFGF
Basic fibroblast
growth factor
bFGF
Angiogenesis ,
fibroblast proliferation,

Fibroblasts

Keratinocyte growth factor

KGF/FGF-7
Epidermal cell motility & proliferation
...............................................................
.................
Angiopoietin-1-4
Ang-1-4
Angiogenesis, stabilization of blood
vessels
...............................................................
.................
Insulinlike growth factor-1
IGF-1

Neutrophils
Interleukin-1
IL-1
Fibroblast
proliferation

Mast cells
Tumor necrosis
factor- TNF-

Fibroblast
proliferation