WOUND HEALING 2

HEALING BY SECONDARY INTENTION
1. When there's on going tissue damage from infection
  1. Significant tissue loss where edges of wound cannot be brought together
    1. Granulation tissue formed
      1. Scar contraction greater + re epithelisation less
INFLAMMATION
1. separation of necrotic tissue: phagocyte action within exudate
  1. Necessary part of healing: clearing debris and inducing proliferation
    1. Lasts as long debris is in the wound
PROLIFERATION
1. begins as granulation tissue: new capillary buds, phagocytes and fibroblasts
  1. Reaches dermis epithelial cells, proliferates from edges to centre
    1. Formation of granulation tissue is essential in open wound
      1. Epithelial cells migrate across new tissue to form a barrier
MATURATION AND RE-MODELLING
1. Granulation tissue replaced by scar tissue
  1. scar tissue: increase in extracellular collagen, inflame cells dissapear
    1. collagen matures and contracts
GRANULATION TISSUE
1. Commonly seen with fresh healing tissue
  1. Macroscopically appear as red granular areas which bled easily
    1. fragile newly formed capillaries which proliferate and grow
      1. contains chronic inflam cells
SCAR FORMATION/FIBROSIS
1. Forms when there is a large area of tissue damage
  1. cells do not regenerate due to ischemia, suppuration
    1. starts with granulation tissue the inflam material is removed
      1. Only collagen fibres remain
EFFECTS OF SCAR TISSUE
1. ADHESIONS: may limit movement
  1. FIBROSIS: blockage of an end vessel
    1. SHRINKAGE: as fibrous tissue ages, limited movement
FACTORS INFLUENCING HEALING
1. LOCAL: persisting infection, foreign mat, or stimuli
  1. Poor blood supply
    1. Irradiation
    2. Locally applied drugs, corticosteroids
2. SYSTEMIC: age and nutrition
  1. metabolic disease ie diabetes
    1. Malignancies
DENTAL EXTRACTIONS
1. healing by Secondary Intention as there is wide separation
  1. PHASES OF WOUND HEALING
    1. INFLAM PHASE: coagulation provides clot, provides initial tissue for migration of cells
      1. Platelet plug and secret mediators that attract macrophages and fibroblasts
        PROLIFERATION PHASE: fibroblasts +endo cells from remains of perio membrane
        MATURATION REMODELLING: woven bone is remodelled
        formation of cortical and cancellous bone
        reduction of height in alveolar bone. Site healed in 20-30 weeks

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WOUND HEALING 2

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