Tissue Repair &

wound healing

To By
Manana Gogoli Vikash Choudhary
 Tissue Repair/Healing
• Repair, sometimes called healing refers to the
restoration of tissue architecture and function after an
injury.

• Repair of damaged tissues occurs by two types of

reactions:
1. Regeneration.
2. Connective tissue deposition (scar formation).
 Tissue Repair/Healing
• Regeneration: is complete restitution of lost tissue
components identical to those removed or killed by
proliferation of residual (uninjured) cells and
maturation of tissue stem cells.

• Connective tissue deposition (scar formation): If the

injured tissues are incapable of regeneration, or if the
the tissue is severely damaged, repair occurs by the
deposition of connective tissue.
 Tissue Repair/Healing

• Regeneration occurs for example, in the rapidly

dividing epithelia of the skin and intestines, and in
some parenchymal organs, notably the liver.

• Scar formation takes place in fibrosis of the lungs,

liver, kidney and in Myocardial Infarction.
Tissue Repair/Healing
 Components of wound healing
1. Inflammation.

2. Proliferation and migration of parenchymal
and connective tissue cells.

3. Formation of granulation tissue.

4. Wound contraction.

5. Acquisition of wound strength.
Tissue Repair/Healing
 Tissue proliferative activity

1.Continually dividing cells (labile tissues): These

cells proliferate throughout life.
Epithelium of the skin, GIT and cells of bone marrow.
2.Quiescent cells (Stable tissue):
Have a low level of replication. Cells from these tissue can
undergo rapid division in response to stimuli. parenchymal
cells of liver and kidneys.
3.Non-dividing (permanent cells):
Cells that can not undergo mitotic division in the post- natal life.
Neurons and cardiac muscle cells.
 Granulation tissue
• Granulation tissue is the hallmark of healing.
Granulation tissue progressively invades the site of
injury.

• The term granulation tissue derives from its pink,

soft, granular appearance seen an area of going
wound healing.
 Granulation tissue
• Granulation tissue is:
i. the proliferation of fibroblasts
ii. new thin-walled, delicate
capillaries (angiogenesis), in a loose
extracellular matrix.
iii. admixed inflammatory cells, mainly
macrophages.
 Healing of skin wound

• Healing of skin wound is a process that involves

both epithelial regeneration and the formation of
connective tissue scar.

• Based on the nature and size of the wound, the

healing of skin wounds occurs by first or second
intention.
 Difference between
Primary intension
1. Inflammatory reaction is
less marked.
2. No wound contraction.
3. Margins are apposed
together.
4. Minimal tissue
damage
5. Minimal bleeding
6. Heals quickly
7. Small scar.
Secondary intension
1. Intense inflammation.
2. Much granulation tissue
formation.
3. Gap persists between
margins.
4. Marked damage of
tissues.
5. More bleeding.
6. Takes time to heal.
7. Large scar
Healing by first VS second intension
 Factors influencing wound healing
Systemic factors:
1. Nutritional status: Protein deficiency and vitamin C
deficiency inhibit collagen synthesis and delay wound
healing.
2. Metabolic status: DM is associated delay in wound
healing.
3. Circulatory status, poor perfusion: Inadequate blood
supply impair wound healing.
4. Hormones: Glucocorticoids have anti-
inflammatory effects and inhibits collagen synthesis
causing delay.
 Factors influencing wound healing
Local factors:
1. Infection (one of the most important cause of delay
in healing).
2. Mechanical factors (increased local pressure, high
mobility delays healing).
3. Foreign bodies (splinter, steel, glass delays
healing).
4. Size and shape of wound (clear cut surgical wound
heals quickly).
5. Location of the wound (wound in the face heals
quickly)
 Complications of wound healing
Complications of wound healing are grouped into
three categories:
i. Deficient scar formation.
ii. Excessive scar formation.
iii. Exuberant granulation tissue formation
iv. Formation of contractures.
 Wound Contracture
• An exaggeration of contraction of wound gives rise
to contracture and results in deformities of the
wound and the surrounding tissues.

• Common areas affected palms, the soles and the

anterior aspect of the thorax.

• Contractures are commonly seen after serious

burns which compromise movement of joints.
Wound Contracture
 Remodeling of Connective Tissue
• The outcome of the repair is influenced by a balance
between synthesis and degradation of ECM proteins.
• The connective tissue in the scar continues to be
modified and remodeled.

• Scar modified and remodeled by an enzyme called

matrix metalloproteinases (MMPs) produced by a
variety of cell types (fibroblasts, macrophages,
neutrophils.
 Stem cell
• Stem cell is characterized by prolonged self renewal
capacity .
Embryonic Stem cells:
Are pluripotent that is they can generate all tissues of
the body.
Adult Stem Cells:
1. Bone marrow stem cells
2. Skin  hair follicle bulge, inter-follicular area and
sebaceous glands
THANK

YOU