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Introduction. Definitions. Repair and Regeneration. Sequence of events. Primary wound healing.

Secondary wound healing.

Wound strength and factors affecting the wound strength. Factors influencing wound healing. Complications of wound healing. Conclusion. References.

 Injury to tissues is inevitable and is a part of life.

Healing is the bodys response in an attempt to restore

normalcy.

 A wound is a disruption of the anatomic structure

and function of the tissue. wound more superficial form of tissue damage Injury deeper structures Wound may be further classified as being open or closed.

 Healing is the sustained restoration of structure and

function of a tissue. Dynamic process of restoring cellular structures and tissue layers. Consists of complex events including chemotaxis, phagocytosis, neocollagen synthesis, collagen degradation, angiogenesis, epithelization .

 Healing by proliferation of parenchymal cells. Results

in complete restoration of original structure and function.

Regeneration Repair

Healing proliferation of connective tissue cells. Results

in fibrosis and scar formation

Labile Epithelial cells Bone marrow cells

Stable Parenchymal cells of kindney, pancreas, liver,adrenals, thyroid. Mesenchymal cells like, smooth muscle cells, fibroblasts, vascular endothelium, osteoblasts and chondroblasts.

Permanent Neurons. Skeletal muscle cells, cardiac muscle cells

Two phases:
Proliferation and migration of the original cells

from the margins of the wound. Proliferation of the migrated cells with subsequent differentiation and maturation of the cells.

 Healing by proliferation of cells that are not native of a

particular tissue.

 Granulation tissue formation

Contraction of the wound

Phase of inflammation

Phase of clearance
Phase of in growth of

granulation tissue

 Angiogenesis:

proliferation of endothelial cells from the marjins of

cut blood vessels Leaky

Fibrogenesis: Collagen fibrils are seen after 6 days May lead to cicatrisation.

 Starts after 2- 3 days, continues till 12 16th day.

The amount of contraction is related to the size of the

wound and mobility of the tissue. Wound is reduced by 80% of its original size. Greatest in the trunk, least on the extremities, and intermediate on the head and neck. Dehydration Contraction of collagen Myofibroblasts intermediate cells between smooth muscle cells and fibroblasts.

 Healing of a wound which is clean, uninfected,

surgically incised, with out much loss of cells and tissues, and edges of the wound are approximated by sutures.

 Initial haemorrhage. Seals the wound against

dehydration and infection Acute inflammatory response. Starts with in 24 hrs. Epithelial changes. With in 48 hrs. by 5th day a well differentiated multi layered epithelium is formed.

 Healing of a wound that is open with large tissue

defect, infected, and is not approximated by surgical sutures. Healing is slow. Leaves a large ugly scar.

 An open wound too contaminated to heal and close by

normal means and needs surgical closure Also called delayed primary closure, Wound closes when there is initial debridement and sutured

 During remodeling, wounds gradually become

stronger with time.

 Collagen

Adhesive glycoprotiens: fibronectin, tenascin,

thrombosponding Elastic fibres Proteoglycans.

 Size and site.

Infection: delays healing. A threshold number of

bacteria in the wound is necessary to overcome host resistance and cause clinical infection. Bacterial contamination results in clinical infection and delays healing if more than 105 organisms /gm of tissue are present in the wound. Blood supply: Rich blood supply faster healing Movement: delays healing Foreign bodies: delays healing Exposure to UV light: facilitates healing

 Age: faster in young

Nutrition: proteins, vitamins, minerals

Systemic conditions: diabetes, ischemia Corticosteroids: impairs healing, especially when given

in the first 3 days X Rays: delays healing. Tobacco use: impairs healing

 Ultrasound causes degranulation of mast cells

resulting in the release of histamine. Histamine and other chemical mediators released from the mast cell attract neutrophils and monocytes to the injured site. Accelerate the acute inflammatory phase and promote healing. Stimulate fibroblasts to secrete collagen 1. This can accelerate the process of wound contraction and increase tensile strength of the healing tissue .

 Connective tissue will elongate better if both heat and

stretch are combined. Continuous ultrasound at higher therapeutic intensities provides and effective means of heating deeper tissue prior to stretch.

 Infection

Epidermal cyst
Pigmentation Hypertrophied scar

Excessive contraction
Neoplasia

 Surgical site should be kept clean.

Area should not be probed for at least 4 6 wks.

Changes in the color and texture is used to assess the

progress of healing clinically. When ever deemed necessary, a pack should be used.

 Understanding the mechanism of wound healing is of

utmost importance for patient comfort and better results.

 Text book of pathology. 5th edition. Harsh Mohan.

Cell tissue and disease. 3rd edition. Neville Woolf.

Wounds: biology, pathology and management. Peter

Lorenz Oxford hand book of applied dental sciences. Crispian scully Text book of oral pathology. 4th edition. Shafer, Hine, Levy