Pathophysiology of Wound Healing

Dr jayneshthra rao HTF

Wound Healing
Replacement of destroyed or lost tissue by a viable tissue

Regeneration is the replacement of

the lost tissue by a tissue of the same type. Repair is replacement of the destroyed tissue by a fibrous scar.

Stages of wound healing by primary intention Day 1 Wound filled with blood clot. Acute inflammation in the surrounding tissue . Proliferation of epithelial cells.

Day 5 Collagen deposition Day 7 Sutures removed

Delayed primary Closure

Wound initially left open & later primary closure.

Dirty and infected traumatic wounds Extensive tissue loss. High risk of infection.

Healing by

nd 2

intention

No formal wound closure. Heal by granulation tissue formation. Tissue loss / gross wound contamination.

Wound healing by 2nd intention

The process is similar to healing by primary intention but only slower due to massive loss of tissue. The inflammatory reaction is more intense. There is more scarring.

Wound healing by 2nd intention

Wound left open & heals largely by:
Formation of granulation tissue. Contraction

Occurs in a wound with extensive loss of soft tissue.

Severe burns. Abscess cavities & ulcer.

Ingrowth of granulation tissues from wound margin followed by accumulation extracellular matrix with laying down of collagen).

STAGE 1 HEMOSTASIS STAGE 2 INFLAMMATION STAGE 3 GRANULATION STAGE 4 MATURATION

Phases of Wound Healing

Carefully regulated systemic cascade of overlapping processes that require coordinated completion of variety of cellular activities. This process involves 4 overlapping phases.
Hemostasis (immediate) Inflammation (early day 1-2, late day 2-3) Proliferation (day 3 to week 2) Remodelling & Scar maturation (1 to several weeks)

Phases of Wound Healing

Inflammatory Phase
Haematoma formation Infiltration by neutrophils Infiltration by macrophages

Proliferative Phase
Epidermal regrowth Dermal repair

Remodelling Phase
Replacement of the granulation tissue by a fibrous tissue Remodelling of connective tissue to achieve wound strength Extracellular matrix > collagen > scar

Wound Strength
After sutures are removed at one week, wound strength is only 10% of unwounded skin ( Walkers Law) By 3-4 months, wound strength is about 80% of unwounded skin (Walkers Law)

Factor That Impedes Wound Healing

Local
Inadequate blood supply Increase skin tension Poor venous drainage Presence of foreign body Presence of slough or non viable tissue Infection Excess local mobility Underlying osteomyelitis Malignant transformation (Marjolins ulcer)

Factor That Impedes Wound Healing

Systemic
Advancing age and general immobility Obesity Malnutrition Deficiency in protein and vitamins Systemic malignancy and terminal illness Anemia Chemotherapy/ Radiotherapy Immunosuppresion drugs (corticosteroid) Organ failures.

Abnormal Wound Healing

Non healing wound
Chronic wound which normal process of healing is disrupted at one or more points. Predisposing factors:
Changes in the profile and activities of the cells Alteration in the composition ECM Failure of epithilialization Presence of free radicals and microorganism.

Abnormal Wound Healing

Excessive wound healing
Hypertrophied scar:
wound crosses tension line Areas of increase tension & movement in skin. Deep dermal burns Wounds heal by secondary intention ( >3 weeks)

Keloids
Do not have specific cause although genetic predisposition is implicated

Hypertrophic scar
Excessive build up of scar tissue confined to the initial boundary of the wound

Keloid
Excessive build up of scar tissue that invades the normal skin beyond the original boundary of the wound

Thank you