Wound Healing

Last modified: May 30, 2021
Estimated reading time: 5 min

DNB ENT Theory Question June 2014, June 2013Dec 2011, June 2015Dec 2016 – Briefly  discuss  the  mechanism  of  wound healing. What  are  the intrinsic and extrinsic factors which can effect wound healing? Briefly discuss the best practices that a surgeon should practice to improve healing outcome.

Phases of wound healing:

  1. Coagulation phase,
  2. Inflammatory phase
  3. Fibroplasias proliferative phase and Remodeling phase

Phases of Healing

Coagulation

-damaged vessels and lymphatic trigger a cascade of events:

-vasoconstriction; mast cell release of vasoactive compounds: bradykinin, serotonin, histamine; diapedesis of cells into wound; hemostatic clot of platelets

-platelets release clotting factors to produce fibrin; also produce several essential cytokines which modulate the subsequent wound healing events

 

Inflammation

-migration of leukocytes into the wound

-24h:  predominantly PMNs, then by macrophages.

 

Fibroplasia

-fibrous protein collagen is synthesized

-cross-linking of collagen provides strength and integrity

-increased synthesis within 10h of injury

-synthesis peaks after 5-7 days and then declines gradually

 

Remodelling

-acute and chronic inflammatory cells diminish gradually, angiogenesis ceases, and fibroplasias ends

-equilibrium between collagen synthesis and collagen degradation is gradually restored. 

Scott mentions – “Inflammation, Proliferation and Remodelling”

Mechanisms involved

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