HEALING

Healing is the body’s response to injury in an attempt to restore normal

structure and function

REGENERATION

HEALING
REPAIR
REGENERATION :

 When healing takes place by proliferation of parenchymal cells and

usually results in complete restoration of the original tissues

 The goal of all surgical procedure should be regeneration which returns

the tissues to their normal microstructure and function

 Depending upon their capacity to divide,the cells can be divided into

- labile cells
- stable cells
- permanent cells
REPAIR :

 It is a healing outcome in which tissues do not return to their normal

architecture and function

 Repair typically results in the formation of scar tissues

 Repair process takes palce by

- Granulation tissue formation
- Contraction of wounds
 FORMATION OF GRANULATION TISSUE

1)PHASE OF 2)PHASE OF CLEARANCE 3)PHASE OF IN GROWTH OF

INFLAMMATION GRANULATION
proteolytic enzymes from
(acute inflammatory neutrophils, autolytic
enzymes from dead tissue
 Angiogenesis
response within 24
hours) cells ,phagocytic activity of  Formation of fibrous
macrophages clear off the tissue
necrotic tissues, debris and
RBC
WOUND HEALING
WOUND:

A wound is a break in the integrity of the skin or tissue often which may
be associated with disruption of the structure and function

WOUND HEALING is a combination of repair and regeneration which

can be accomplished in two ways:

 Healing by first intention(primary union

 Healing by second intention(secondary union)
 PRIMARY UNION
 Wound is clean and uninfected
 Without much loss of cells and
tissues
 Edges of wound are
approximated by surgical
sutures
SECONDARY UNION
 Wound is open with large
tissue defect,at times infected
 Having extensive loss of
tissues
 The wound is not
approximated by surgical
sutures but is left open
 HEALING BY FIRST INTENSION (PRIMARY UNION)

1) INITIAL HAEMORRHAGE

 Immediately after injury,the space between the approximated

surfaces of incised wound is filled with blood
 The filled blood clots seals the wound against dehydration and
infection

2) ACUTE INFLAMMATORY RESPONSE

 This occurs within 24 hrs with appearance of PMN from the

margins of incised wound
 By 3rd day ,polymorphs are replaced by macrophages
3)EPITHELIAL CHANGES

 The basal cells of epidermis from both the cut margins start
proliferating and migrating towards incisional space in the form of
epithelial spurs
 These migrated epithelial cells separate the under lying viable dermis
from the overlying necrotic material and clot forming a SCAB
 By 5th day ,a multilayered new epidermis is formed which is
differentiated into superficial and deep layers
 A well approximated wound is covered by a layer of epithelium in
48hours
ORGANISATION:

 By 3rd day ,fibroblast also invade the wound area.

 By 5th day ,new collagen fibrils start forming which dominate till healing
is completed
 By 4th week,the scar tissue with scanty cellular , vascular elements with
few inflammatory cells and epithelialised surface is formed
 HEALING BY SECONDARY INTENTION(SECONDARY UNION)

1)INITIAL HAEMORRHAGE

As a result of injury ,the wound space is filled with blood and

fibrin clot which dries

2)INFLAMMATORY PHASE

There is an initial acute inflammatory response followed by

appearence of macrophages which clear of the debris as in primary
union
EPITHELIAL CHANGES

 As in the primary healing, the epidermal cells from both the margins
of the wound proliferate and migrate into the form of epithelial spurs
till they meet in the middle and reepithelialise the gap completely

 These proliferated epithelial cells do not cover the surface fully until
granulation tissue from the base has started filling the wound space

 After these epithelial cells meet in the middle they separate the
underlying viable tissues from necrotic tissue at the surface forming
scab
GRANULATION TISSUE FORMATION

 The main bulk of secondary healing is by granulation

 Granulation tissue is formed by proliferation of fibroblasts and

neovascularisation from the adjoining viable elements

 The newly formed granulation tissue is deep red,granular and very

fragile

 The specialised structure of skin like hair follicle and sweat glands are
not replaced unless their viable residues remain which may regenerate
WOUND CONTRACTION

 Contraction of wound is an important feature of secondary healing

,and not seen in primary healing
 Wound contraction occurs at a time when active granulation tissues
is being formed(approximately 4 to 5 days after wounding )
 Due to the action of myofibroblasts present in granulation tissue,the
wound contracts to one third of its original size
 Maximal contraction occurs for 12 to 15 days although it will
continue if wound remain opens
 FACTORS INFLUENCING WOUND HEALING

LOCAL FACTORS

 Infection
Delays wound healing
 Poor blood supply
slows healing process
 Foreign bodies
causes intense inflammatory reaction and infection
 Exposure of ionising radiation
Delays granulation tissue formation
 Type,size&,location of injury
Determines whether healing takes place by resolution or organisation
 SYSTEMIC FACTORS
 Age
wound healing is rapid in young age,and somewhat slow in aged
people
 Nutrition
Deficiency of constituents like protein,vitamin C ,zinc delays
wound healing
 Systemic diseases
Uncontrolled diabetis , Immuno suppressive diseases like HIV,
Auto immune diseases like SLE,Haematologic diseases like
anemia,neutropenia,bleeding disorders slows healing process
 Other factors
smoking,obesity,alcohol,stress,etc