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12 Cards in this Set

  • Front
  • Back
Healing by first intention
events within within 24 hrs. 4 events
neutrophils appear at margins of incision, moving toward fibrin clot
- epidermis at cut edges thickens as a result of mitotic activity of basal cells
- spurs of epithelial cells from edges migrate and grow along cut margins of dermis depositing basement membrane
- fusion of epithelial cells at midline beneath the scab surface
Healing by first intention
events by day 3. 4 events
- neutrophils largely replace by macrophages
- granulation tissue progressively invades incision space
- collagen fibers are present in the margin of the incision
- epithelial cell proliferation continues, thickening epidermal covering layer
healing by first intention events by day 5
5 events.
- incisional space is filled with granulation tissue
- neovasculization is maximal
- collagen fibrils become more abundant and begin to bridge the incision
- epidermis recovers to normal thickness
- differentiation of surface cells yields a mature epidermal architecture with surface keratinization
healing by first intention events in second week. 2 events
- continued accumulation of collagen and proliferation of fibroblasts
- leukocytic infiltrate, edema, and increased vascularity largely disappear
heaing by first intention events by end of first month. 4 events
- scar comprises a cellular connective tissue devoid of inflammatory infiltrate
- covering of intact epidermis
- line of incision is lost
- tensile strength of would increases thereafter, but it may take months for the
wounded area to obtain its maximal strength
healing by secondary intention differences from healing by primary intention
1) large tissue defects initially have more fibrin and more necrotic debris and exudates that must be removed; hence, the inflammatory reaction is more intense
2) much larger amounts of granulation tissue are formed.
3) wound contraction - myofibroblasts contribute to contraction
growth factors and cytokines which stimulate collagen synthesis in wound healing (3, 2)
- growth factors: PDGF, FGF, TGF-beta
- cytokines: IL-1 and IL-4
cell division growth factors (4)
angiogenesis growth factors
matrix modification growth factors
TGF beta, CTGF
types of fibrosis in wound healing
 excessive accumulation of extracellular matrix
 keloid: benign overgrowth beyond the wound margin
 hypertrophic scar: disfiguring, but within the wound margin
four chronic wound types
 decubitus ulcer (pressure sore)
- infarction of the skin over bony processes
 arterial ulcer
- insufficiency of blood supply
 venous (stasis) ulcer
- failure of valves to prevent lymphadema
 diabetic ulcer
- complication of hyperglycemia, atherosclerosis, impaired microcirculation, and hypoproliferation