Wound Management
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What regulates the process of wound healing
Soluble factors
What do abnormalities in wound healing cause?
Scarring Fibrosis
What six things does wound healing involve?
Initial acute inflammatory response Parenchymal regeneration Re-epithelialisation and cell migration Proliferation of parenchyma and stromal cells Synthesis of ECM proteins Remodelling
What are the three classic stages of wound healing?
Inflammation - 48 hours after injury New tissue formation - 2 to 10 days Remodelling/maturation - 1 year or more
Describe the basic process of inflammation in wound healing
Hypoxic with a fibrin clot Abundant bacteria, neutrophils and platelets
Describe the basic process of new tissue formation in wound healing
Surface scab Most inflammatory cells moved away New blood vessels predominate Epithelial cells migrate under scab
Describe the basic process of remodelling in wound healing
Disorganized collagen made by fibroblasts that move into wound Wound contracted near surface - widest part is deep Re-epithelialized wound raised
What are the first four things to happen during wound healing?
Bleeding Coagulation Platelet activation Complement activation
What two things care present or occurring during inflammation around day 1 of wound healing?
Granulocytes present Phagocytosis occurring
What two things are present around day 3 of inflammation?
Macrophages Cytokines
What four things are occurring around day 4-5 of new tissue formation?
Fibroplasia Angiogenesis Re-epithelialisation ECM synthesis
What is occurring between days 30-100 in wound healing and what is increased and decreased?
ECM remodelling - increased tensile strength - decreased cellularity and vascularity
What cells are involved in coagulation?
Platelets
What cells are involved in inflammation?
Platelets Macrophages Neutrophils
What cells are involved in new tissue formation?
Macrophages Lymphocytes Fibroblasts Epithelial cells Endothelial cells
What cells are involved in remodelling?
Fibroblasts
What are the initial events in wound healing that lead up to coagulation?
Death of some epithelial and dermal cells Damage to collagenous fibres in tissue Small vessel rupture - increased vasodilation and permeability Release of blood into wound and surrounding tissue Coagulation Formation of fibrin clot
What three things happen during coagulation?
Platelet deposition and aggregation Platelets degranulate PDGF, TGFb and fibronectin released
What are the key players in the inflammation stage of wound healing?
Monocytes Macrophages
When are lymphocytes recruited in wound healing and what are they important in?
Recruited later Important in early remodelling phase
What are the five roles of macrophages in wound healing?
Removal of wound debris Cell recruitment and activation Phagocytosis Angiogenesis Matrix synthesis regulation
Describe the process of re-epithelisation of the skin
Single keratinocyte layer migrates under fibrin clot Travels from wound edges across wound to re-surface area During and after this differentiation and stratification of neo-dermis occurs
What are the five roles of keratinocytes in skin healing?
Migration/proliferation ECM production Growth factor/cytokine production Angiogenesis Release of proteases
How does the fibrin clot help with re-epithelialisation and angiogenesis?
Secrete factors to promote re-epithelialisation Allows endothelial cell migration into wound