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1. Attainment of homeostasis
• Fibrillar collagen and tissue factor act to
activate the clotting cascade prevent
hemorrhage
• Platelets degranulates and releases .. Fibrin
polymerization into a gelatin
1. Tissue proliferation
• Macrophages as a conductor of cell interaction
and mediators VEGF, FGF, TGF-α& β
• Fibroblast FGF-2 regeneration of
endothelial cells
• Endothelial cells IGF proliferation of
keratinocytes and fibroblast
• Keratinocytes TGF-α& β 1,2,3
keratinocytosis (centripetal)
MMP degrades damage ECM at wound edge wound cells to synthesize new ECM to cover raw
surface area
• Proliferative phase:
MMP degrades capillaries membrane neovascularization, also collagen new epithelial and
endothel could move across matrix.
• Maturation phase:
Plasmin was activated and subsequently activates prokolagenase to kolagenase. Decrease over
synthesized matrix.
TIMP: inhibit MMP activities to allow normal healing process, low TIMP chronic wound.
Resolved inflammation
So how do these processes turn off? Apoptotic Efferocytosis Proteases
neutrophils & apoptotic neutrophils are inhibitor
These events are programmed fibroblast eventually engulfed by a1-antitrypsin, a1-
gradual self-destruction of cellular macrophages antichymotrypsin, and
apoptosis. secretory leukocyte
protease inhibitor
Afterwards, the proteases activity is (SLPI)
being countered by circulating
proteases inhibitor.
Resolved inflammation
relatively acellular scar. Less erythematous, less itch flatter scar
NECROTIC BACTERIAL
EXUDATE
TISSUE LOAD
WOUND HEALING
• Alcoholism
• Uremia
• Jaundice
• Obesity: increase cell-cell distance decreased O2 perfusion. Difficulties in keeping his/her personal
hygiene of body fold & distant part
• Smoking: vasoconstriction agents: nicotine, hydrogen cyanide, CO2 increase platelet aggregation,
decrease collagen deposition
Stable
◦ regeneration as response to injury
◦ parenchyma – liver, pancreas, renal tubules
◦ mesenchymal cells, endothelium
Continously
◦ continuous regeneration from stem cells (self-renewal)
◦ hematopoietic cells in bone marrow
◦ surface epithelia – skin, oral cavity, vagina, cervix
◦ duct epithelia – salivary glands, pancreas, biliary tract
◦ mucosas – GIT, uterus, fallopian tubes, urinary bladder
Tissue Types
Occur in two ways :
Scar Formation
Substitution of cellular matrix a patch
to re-establish continuity physically and
physiologically
(replacement by connective tissue (fibrosis))
and
Tissue Regeneration
Re-creation of pre-existing tissue
(by parenchymal cells of the same type)
Abnormal response to injury &
abnormal wound healing
Inadequate regeneration Excessive regeneration
• CNS injuries following traumatic injury or • Hyperkeratosis in cutaneous psoriasis,
tumor ablation granuloma formation in healing wounds
• Induce neural regeneration implanted • Loss of growth control & possible
neural stem/progenitor cells transformation to overt cancer
• Bone nonunions & corneal ulcers
Excessive scar formation
Inadequate scar formation • Skin : hypertrophic scarring or keloid
• Diabetic foot ulcers , sacral decubiti, formation.
venous statis ulcers • Pulmonary : fibrosis or cirrhosis.
• Abnormality in restoring cutaneous
integrity and collagen cross-linking
• Vit C deficiency
Keloid vs Hypertrophic Scar
The ideal scar should be