Refrat DR Am Edited
Refrat DR Am Edited
Refrat DR Am Edited
Arranged by :
Laila Ninda Shofia G99162029
Nikko Rizky Amanda G99162025
Mutiyas Nadia Ulfa G99172120
Periode : 4-8 Mei 2018
Pembimbing :
dr. Amru Sungkar, SpB, SpBP-RE
Wound healing repair or reconstruction
of a defect in an organ or tissue
2. Proliferative phase/granulation
The wound is ‘rebuilt’ with new granulation tissue which is
comprised of collagen and extracellular matrix
3. Remodelling phase
Involves remodelling of collagen from type III to type I
Phases of Normal Wound Healing
Inflammatory phase
• Begins immediately following tissue
injury
• Purpose:
• attainment of hemostasis
• removal of dead and devitalized tissue
• prevention of colonization and invasive
infection by microbial pathogens
Inflammatory phase
Proliferative Phase
• Occuring 4 to 21 days after injury
• Balance between scar formation and
tissue regeneration occurs
Remodelling Phase
• Occuring from 21 days up to 1 year
• The longest part of wound healing
• To maximize the strength and structural
intergrity of the wound
Hypergranulation process
Hypergranulation tissue is an excess of granulation tissue
beyond the amount required to replace the tissue deficit
incurred as a result of skin injury or wounding
Hypergranulation forms in the proliferative phase of healing;
in wounds healing by secondary intention this phase is
characterised by the formation of granulation tissue and
epithelial tissue.
It grows from the base of the wound until it comes level to the
surface of the surrounding skin. When it has, epithelial cells at
the wound margins and from around the base of any remnant
hair follicles in the wound, start to divide and multiply, moving
across the surface of the wound to re-establish skin integrity
(Tortora and Grabowski, 2000).
Granulation tissue type
Healthy granulation tissue presents as a highly vascular,
moist, pinkish/red tissue with an undulating (granular)
surface; it is characterised by a dense network of
capillaries, high numbers of fibroblasts and macrophages
and newly formed collagen fibres (Vuolo, 2009).
Hypergranulation
In some wounds, production of granulation tissue
continues beyond the height of the wound surface
resulting in a raised mass (or peduncle) in excess of the
wound itself. This tissue, known as hypergranulation
tissue, can impede healing in several ways.
Hypergranulation may prevent the migration of
epithelial cells across the wound surface and increase
the risk of infection and may increase the risk of scar
formation by forcing the wound edges further apart
(Dunford, 1999).
Hypergranulation cause
There is relationship between (matrix metalloproteinase) MMP
and hypergranulation. MMPs are a group of proteolytic (protein
degrading) enzymes which play an important role in the
proliferative phase of healing (Stephens and Thomas, 2002).
In particular, collagenese regulates the balance between collagen
synthesis and lysis by facilitating the growth of new connective
tissue and the re-absorption of the extra cellular matrix (ECM),
the temporary filler which physically supports the newly formed
blood vessels and granulation tissue characteristic of the
proliferative phase
1. inflammatory in nature (Type I)
2. those that are related to an occluded wound environment (Type
II)
3. those that are caused by a cellular imbalance of some kind (Type
III).
Abnormal Wound Healing
3. Contractures
Loss or lack of fullness movement of joint space actively or pasively
due to joint limitations, fibrosis of support tissue, muscle and skin
Early Complication
Infection
• Rubor, dolor, kalor
• Purulent product
Bleeding
• Must check min 3x/day
Keloid
• Not reduced in the final phase of wound healing
• Predilection area is skin, thorax especially in front of
sternum, waist, jaw area, neck, face, ears, and
forehead