Organization & Repair

Oleh :
Drg Maharani L.A,Sp PM

Tissue replaced extensive tissue damaged as a
result of inflammation.
How is occurs determine by :
1. the extend of tissue damage (supporting
stroma/ connec-tive tissue framework
2. nature of the tissue damaged (Stable, labile or
permanent)
3. General condition of the patient health

Regeneration is the process which occurs when
tissue replaced by similar tissue
Capability of entering the cell cycle and capable
of self replication and that the supporting
stroma of the tissue is preserved

Repair process whereby damaged tissue is
replaced by collagenous scar tissue indicates that
the damaged tissue is incapable of self replication
(exp. Permanent cell outside the cell cycle) or the
connective tissue frame-work is damaged
irreversible

GRANULATION TISSUE the main contributor
to healing process.
There is a dynamic process new capillaries into
area of tissue necrosis and demolition of
inflammatory exudate by macropaghes in the
early stages of healing the vascular predominant
and the relative proportion of vasc tissue to
fibroblastic tissue producing collagen decrease
Over period ( day, week or month) eventually
only collagen remains

HEALING OF SKIN WOUNDS

Wound healing includes epithelial regeneration
and repair of connective tissue with development
of scar tissue

Exp :
Skin wound by edges sutured incision healing
to primary union
Large tissue defect wound edges widely
separated healing by secondary union.

Healing by First Intention / Primary Union (per
primam)

After incision there is some death cells with
haemorrhagic into incised area

In the first 1-2 day / 24-48 hr lead to blood clot
formation and the generation of fibrin release
fibrinectin
Dehydration the clot on the surface of wound
After 2-3 days demolition by PMN and M
Epithelial regeneration occur in sequence of cell
migration follow by proliferation and
remodelling there is proliferation of
epithelial cells from the edge of the wound

24-36 days increased of mitotic cells the cells
migrate and release factors such as collagenase and
plasminogen activator allowed into damaged area

Cells also produce their own new basement
membran and proliferation continue for several days,
during which the thickness of the epithelium is
restored to normal
Repair develop initialy by neovascularization
(angiogenesis) local degradation of parent
capillary basement membrane and changes in
ECM (extra cellular matrix), mediated by
factors such as collagenase and stromelysin by
epithelial cells.

This process modified by metalloproteinases and
Tissue Inhibitor Metaloproteinase (TIMPs)

In the early stages lack of new blood vessels in
basement membrane then limphatis vessels
infiltrate the damaged tissues
Fibroblas as the second major component of
granulation tissue migrate into damaged area
increased synthetic activity to produce ECM
(including the materials such as
glycoaminoglicans, proteoglicans, fibrinectin
and collagens)
In 3-4 days there is significan collagen depo
sition (type III) and with remodelling by colla-
genases from macrophages and fibroblasts
the type I become predominant

Healing by Second Intention/secondary union (per
secundam)

This is the slower process than primary union
Characteristic by a more intense inflammatory
reaction with greater granulation tissue production
and potentially forming scar
Particularly wound contraction will arises as a
result of myofibroblastic contraction of contrac-
tile filaments shortening of collagen fibres
Cause clinical problems of obstruction in
healing the scar tissue formed
Epiderma migration continues but may be
there is loosed of skin adnexal structure

Factors which may influence wound healing

LOCAL:
1. Blood supply arterial desease tend to heal less well
then norma vasculature
2. Infection delay wound healing there is need for
wound debridement for complete wound healing
that may occur by the infiltration of PMN and M
3. Early movement cause delay in bone fracture
healing
4. Foreign material may prevent healing
5. Ionizing radiation tissues which have recently
been irradiated had less well

SYSTEMIC :

1. Metabolic factors deficient in protein par-
ticularly do not heal as quickly as normal
Exp.
* Vit. C its important in the cross linking of
collagen fibres and zinc is co-factor in DNA-
RNA polymerases
* Diabetics generally do not heal as well as
non diabetics patients because more easily to
infection
2. Corticostiroids these drugs impair the
healing response
3. Cytotoxic drugs these drugs interferewith
macromolecule synthesis that inhibitory effects
on proliferating cells

Complication of wound healing

Wound dehisence/ weak scar in the early stage
of the healing that the tensile strength of the
newly formed collagen is weak posssibi- lity
of the wound breaking down
Hypertrophic scar/ keloid Extention pro-
duction of scar tissue tend in racial or fami-
lial factors

Contracture/cicatrization when myofibro-
blasts are a major component of granulation
tissue possibility of severe deformity
(burning wound and peptic ulcer)

Neoplasia increased proliferating tissues
may lead to the development of neoplasia at
the site healing

Organization & Repair

Uploaded by

Copyright:

Available Formats

Organization & Repair

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Organization & Repair

Uploaded by

Copyright:

Available Formats

Oleh :

Drg Maharani L.A,Sp PM

You might also like