Wound Healing

Quamila F.A & Yesy Marianna N.

1. Inflammatory phase
2. Proliferative phase
3. Remodelling phase
Inflammatory phase
 Time : immediate to 2-5 days
 It can be divided into several phases 
 Hemostasis
 Inflammation
 Hemostasis (immediate-15 mins)
 Vasoconstriction
 Platelet aggregation
 Thromboplastin makes clot/ Fibrinous clot
 Inflammation
 Vasodilation
 Increasing vascular permeability
 Increasing inflammation mediator  phagocytosis
 Initial phase  vasoconstriction occurs immediately 
control hemorrhage, followed within by vasodilation.
 Vasodilatation  margination, extravasation and migration
mediator cellular
 Second phase  cells adhere to the vascular endothelium.
 Within 30 min  leukocytes migrate through the vascular
basement membrane into the newly created wound. Initially,
neutrophils predominate (as in the peripheral blood);
 The neutrophils die off and monocytes become the
predominant cell type in the wound.
 Debridement is the next phase of wound healing.
 Monocytes  essential for wound healing  considered
macrophages, which then phagocytose necrotic debris.
Proliferative Phase
 Time : 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
 Crosses moist surface
 Cell travel about 3 cm from point of origin in all directions
 It consists of fibroblast, capillary, and epithelial proliferation.
 Mesenchymal cells  fibroblasts, which lay fibrin strands to
act as a framework for cellular migration.
 In a healthy wound  fibroblasts begin to appear ∼3 days
after the initial injury.
 Fibroblasts  secrete glycorotein and later collagen.
 The early collagen secretion  increase in wound strength,
which continues to increase more slowly as the collagen
fibers reorganize according to the stress on the wound.
 Migrating capillaries deliver a blood supply to the wound.
 The center of the wound  area of low oxygen tension that
attracts capillaries following the oxygen gradient.
 Because of the need for oxygen  fibroblast activity depends
on the rate of capillary development.
 Capillaries and fibroblasts proliferate  granulation tissue is
produced.
 Epithelial cell migration begins within hours of the initial
wound.
 Basal epithelial cells flatten and migrate across the open
wound :
 Slide across the defect in small groups,
 “leapfrog” across one another to cover the defect.
 Migrating epithelial cells secrete  mediators, such as
transforming growth factors α and β, which enhance wound
closure.
 Epithelial cells migrate across the open wound and can cover
a properly closed surgical incision within 48 hr.
 In an open wound, epithelial cells must have a healthy bed of
granulation tissue to cross.
 Epithelialization is retarded in a desiccated wound.
 Migration stops  when contact is made with other
epithelial cells on all sides (ie, contact inhibition).
Remodelling Phase
 Time : 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
 Multifactorial
 Remodelling phase  the final stage of wound healing.
 The newly laid collagen fibers and fibroblasts reorganize
along lines of tension.
 Fibers in a nonfunctional orientation are replaced by
functional fibers  allows wound strength to increase slowly
over a long period (up to 2 yr).
 Most wounds remain 15–20% weaker than the original
tissue.
 However, the urinary bladder and bone regain 100% of their
original strength after wounding and repair.
Thank You