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HEALING
- 1. HEALING DR. ABHISHEK ANAND M.D.PATHOLOGY ASST. PROF 4TH CLASS
- 2. HEALING • Healing isthe body’s response to injury in an attempt to restore normal structure and function. • Tissue Repair sometimes called healing, refers to the restoration of tissue architecture and function after an injury.
- 3. The process ofhealing involves 2 distinct processes: A. REGENERATION B. REPAIR
- 6. REGENERATION Some parenchymal cellsare short lived while others have long lifespan. In order to maintain proper structure of tissues these cells are under the constant regulatory control of their cell cycle. These include growth factor
- 7. • All thecells divided into 3 groups : 1. Labile cells : The cells continue to multiply throughout life under normal physiological condition. 2. Stable cell: These cells decrease their ability to proliferate but retain the capacity to multiply in response to stimuli throughout the adult life. 3. Permanent cells : These cells lose their ability to proliferate around the time of birth.
- 9. So regeneration ofany type of parenchymal cells involve the following 2 processes : 1. Proliferation of original cells from the margin of injury with migration so as to cover the gap. 2. Proliferation of migrated cells with differentiation and maturation so as to reconstitute the original tissue.
- 10. REPAIR • It isa healing outcome in which tissues do not return to their normal architecture and function • Repair typically results in the formation of scar tissues • Two process involved in repair : 1. Granulation tissue formation. 2. Contraction of wounds.
- 11. STEPS IN REPAIR 1.Angiogenesis: It is formation of new blood vessels, which supply nutrients and oxygen needed to support the repair process 2. Formation of granulation tissue: Migration and proliferation of fibroblasts and deposition of loose connective tissue, together with the vessels and interspersed leukocytes, form granulation tissue. 3. Remodeling of connective tissue: Maturation and reorganization of the connective tissue produce the stable fibrous scar
- 13. HEALING BY FIRSTINTENTION STEPS • 1 st 24 hours – • Wounding causes the rapid activation of coagulation pathways, which results in the formation of a blood clot on the wound surface. • Neutrophils are seen at the incision margin. They release proteolytic enzymes that begin to clear the debris. • Epithelial cell proliferation starts at the edge of the wound.
- 14. • 3-7 days– • Neutrophils have been largely replaced by macrophages • Collagen fibers and fibroblasts are now evident at the incision margins. • Epithelial cell proliferation continues forming a covering approaching the normal thickness of the epidermis.
- 15. • Weeks – •The epidermis recovers its normal thickness • The process of “blanching” begins. • By the end of the first month: The dermal appendages destroyed in the line of the incision are permanently lost.
- 16. THE SEQUENCE OFEVENTS IN SECONDARY UNION IS I. Initial hemorrhage: immediately after injury, the space between the approximated surfaces of incised wound is filled with blood. II. Inflammatory phase: there is an initial acute inflammatory response followed by appearance of macrophages. III. Epithelial changes: the basal cells of epidermis from both the cut margins start proliferating and migrating towards incisional space in the form of epithelial action.
- 17. IV. Granulation tissue:granulation tissue is formed by proliferation of fibroblasts and neovascularization. V. Wound contraction: contraction of wound is an important feature of secondary healing, not seen in primary healing. VI. Presence of infection: bacterial contamination of an open wound delays the process of healing.
- 19. STAGES OF WOUNDHEALING 1. Stage of inflammation. 2. Stage of granulation tissue formation. 3. Stage of epithelialization. 4. Stage of scar formation. 5. Stage of maturation.
- 20. PHASES OF WOUNDHEALING For soft tissue wound healing: 1. Inflammatory phase: It can be broken down into further a) Clot formation b) Early inflammation c) Late inflammation 2.Proliferative phase 3.Maturation phase
- 21. FACTORS AFFECTING WOUNDHEALING
- 22. LOCAL FACTORS: i. Infection ii.Necrotic tissue & foreign body iii. Poor blood supply iv. Venous or lymph stasis v. Tissue tension vi. Hematoma vii. Large defect viii. Recurrent trauma ix. X-ray radiated area x. Site of wound xi. Underlying diseases
- 23. GENERAL FACTORS i. Age,Obesity, Smoking ii. Malnutrition iii. Vitamin deficiency iv. Anemia v. Malignancy vi. Jaundice vii. Diabetes viii. Immunosuppressive diseases ix. Steroids and cytotoxic drugs
- 24. COMPLICATION OF WOUNDHEALING 1. Infection 2. Epidermal cyst 3. Pigmentation 4. Deficient scar formation 5. Incisional hernia 6. Hypertrophied scar 7. Excessive contraction 8. Neoplasia