Department of Otorhinolaryngology Head and Neck Surgery

Faculty of Medicine - Andalas University

Dr. M. Djamil Hospital, Padang 2014

WOUND HEALING

Chandra - Nur
Facial Plastic and Reconstructive Surgery SubDivision
 INTRODUCTION

Wound repair is the effort of injured tissuaes to restore their

normal function and structural integrity after injury.

• Inflammation - fibrinous exudate

reflects
The three phases of
• Proliferation - the granulation tissue
wound healing
• Maturation - the contracting or
advancing edge
Facial Plastic & Reconstruction Surgery SubDivision
 Facial of
Schematic diagram Plastic
the& Reconstruction
wound-healing Surgerycontinuum.
SubDivision Hemostasis
Inflammatory Phase
 Inflammatory Phase
This phase • Stopping the bleeding
represents an • Sealing the surface of the wound
• Removing any necrotic tissue, foreign debris,
attempt to or bacteria present.
limit damage :

• Increased vascular permeability

• Migration of cells into the wound by
Characterized chemotaxis, secretion of
• Cytokines and growth factors into the wound
• Activation of the migrating cells

Facial Plastic & Reconstruction Surgery SubDivision

 Inflammatory Phase

There were :
cellular Reached
Days 4 - 6 response and maximum after Remain for weeks
vascular 24 hours
response

Facial Plastic & Reconstruction Surgery SubDivision

 Inflammatory Phase

Cutaneous wound 3 days after injury. The cells and growth factors necessary to facilitate cell migration into the
wound are shown. (From Singer
FacialAJ, Clark
Plastic RAF: Mechanisms
& Reconstruction ofSubDivision
Surgery disease: Cutaneous wound healing. N Engl J Med
341:738–746, 1999.)
Facial Plastic & Reconstruction Surgery SubDivision
Time course of the appearance of different cells in the wound during healing. Macrophages and neutrophils are predominant during the
inflammatory phase (peak at days 3 and 2, respectively). Lymphocytes appear later and peak at day 7. Fibroblasts are the predominant
cells during the proliferative phase. (Adapted
Facialfrom Witte
Plastic MB, Barbul A: General
& Reconstruction principles
Surgery of wound healing. Surg Clin North Am 77:509–
SubDivision
528, 1997.)0
Proliferative Phase
 Proliferative Phase
Responses for repair of the wound
• angiogenesis,
• fibroplasia
• Epithelialization
Characterized :
• Formation of granulation tissue:
• Capillary bed,
• Fibroblasts
• Macrophages,
• Arrangement of collagen,
• Fibronectin,
• Hyaluronic acid.
Facial Plastic & Reconstruction Surgery SubDivision
 Proliferative Phase
Day 4 through 14

Activated Macrophage:
• Essential for progression into Proliferative
Phase
• Mediate:
• Angiogenesis: FGF, PDGF, TGF-a&b and TNF-a
• Fibroplasia: IL’s, EGF and TNF
• Synthesize NO
• Secrete collagenases
Facial Plastic & Reconstruction Surgery SubDivision
MATURATIONAL PHASE
 Maturational Phase
• Day 8 through years
• Wound may increase in strength for up to 2 years after injury
• Wound contracture, is a physical constriction or limitation of
function and is a result of the process of wound contraction.
• Contractures occur when excessive scar exceeds normal
wound contraction, and it results in a functional disability..
• Wound contraction appears to take place as a result of a
complex interaction of the extracellular materials and
fibroblasts, which is not completely understood.

Facial Plastic & Reconstruction Surgery SubDivision

 Remodeling
• The fibroblast population decreases

• The dense capillary network regresses

• Wound strength increases rapidly within 1 to 6 weeks and

then appears to plateau up to 1 year after the injury.

• When compared with nonwounded skin, tensile strength is

only 30% in the scar.

Facial Plastic & Reconstruction Surgery SubDivision

Facial Plastic & Reconstruction Surgery SubDivision
 Factors Inhibit Wound Healing

Vitamin
deficiencies
Infection • Vitamin C
Ischemia • Vitamin A
Mineral
Malnutritio • Circulation deficiencies
n • Respiration • Zinc
• Local tension • Iron
Exogenous
drugs
Advanced Diabetes • Doxorubici
age mellitus n
(Adriamyci
Ionizing n)
radiation • Glucocorti
costeroids
ABNORMAL WOUND HEALING
 Abnormal Wound Healing
Ekstrinsik factor
• The amount of tissue lost or damaged,
• Amount of foreign material or bacterial inoculation
• Length of exposure to toxic factors affect the time to
recovery.
Intrinsic factors
• Age
• chemotherapeutic agents
• Atherosclerosis
• Cardiac or renal failure
• Location on the body all affect wound healing.
Facial Plastic & Reconstruction Surgery SubDivision
 Hypertrophic Scars and Keloids
• Keloids and hypertrophic scars
• Characterized :
– Excessive collagen deposition versus collagen
degradation
– Keloids are defined as scars that grow beyond the
borders of the original wounds, and these scars
rarely regress with time.
– Hypertrophic scars
Prolonged inflammation,
Insufficient resurfacing,

Facial Plastic & Reconstruction Surgery SubDivision

Chronic Nonhealing Wounds
Wounds that have failed to
proceed through an orderly
and timely reparative process
to produce anatomic and
functional integrity over a
period of 3 months.

Chronic wound healing and have

unusually elevated or depressed levels
of cytokines, growth factors, or
proteinases.

Facial Plastic & Reconstruction Surgery SubDivision

 Referensi

• Phillips G. Linda. Leong Mimi. Wound Healing. In

: Townsend Courtney, Evers M.B, Beuchamp
Daniel R, Mattox kennet, edditor. Sabiston
texbook surgery. 19th ed New york. 2012. p-151-
177.

Facial Plastic & Reconstruction Surgery SubDivision

Thank you

Facial Plastic & Reconstruction Surgery SubDivision