Wound healing is a physiological process involving tissue repair in response to injury. It involves a complex interaction of various cell types, cytokines Cytokines Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. Adaptive Immune Response, and inflammatory mediators. The overall process protects underlying structures from further damage. Wound healing stages include hemostasis Hemostasis Hemostasis refers to the innate, stepwise body processes that occur following vessel injury, resulting in clot formation and cessation of bleeding. Hemostasis occurs in 2 phases, namely, primary and secondary. Primary hemostasis involves forming a plug that stops the bleeding temporarily. Secondary hemostasis involves the activation of the coagulation cascade. Hemostasis, inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation, granulation, and remodeling. Certain conditions such as diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, peripheral vascular disease, and malnutrition Malnutrition Malnutrition is a clinical state caused by an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute severe malnutrition are marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema). Malnutrition in children in resource-limited countries can limit Limit A value (e.g., pressure or time) that should not be exceeded and which is specified by the operator to protect the lung Invasive Mechanical Ventilation the body’s ability to heal itself, thus resulting in complications.
Last updated: Mar 31, 2022
There are 3 main stages of wound healing:
Timeline of wound healing
Image: “Timeline of Wound Healing” by Wikimedia Commons. License: Public Domain FilesDay 1 |
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Exudative phase Exudative Phase Hypertensive Retinopathy (immediately after injury): hemostasis Hemostasis Hemostasis refers to the innate, stepwise body processes that occur following vessel injury, resulting in clot formation and cessation of bleeding. Hemostasis occurs in 2 phases, namely, primary and secondary. Primary hemostasis involves forming a plug that stops the bleeding temporarily. Secondary hemostasis involves the activation of the coagulation cascade. Hemostasis and inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation
Image by Lecturio.Exudative phase Exudative Phase Hypertensive Retinopathy (day 1–4): inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation and resorption
Image by Lecturio.Proliferative phase Proliferative phase Menstrual Cycle (day 2–16): granulation
Image by Lecturio.Reparative phase (day 5–25): epithelization
Image by Lecturio.Wound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy a day after falling off a bike onto concrete: day 1
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 2
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 3
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 4
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 5
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 6
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 7
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 8
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 9
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 10
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 11
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesWound on palm of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy after falling off a bike onto concrete: day 12
Image: “Wound on palm of hand” by Arria Belli – Own Work. License: Public Domain FilesKeloid found on the foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy of a patient
Image: “Preoperative appearance of a patient” by Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Seoul; Deokjeok Health Care Center, Incheon. License: CC BY 2.0Diabetic foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy syndrome
Image: by Intermedichbo from Wikimedia Commons. License: CC BY-SA 4.0Example of a patient with Ehlers-Danlos syndrome Ehlers-Danlos syndrome Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue disorders that are characterized by hyperextensible skin, hypermobile joints, and fragility of the skin and connective tissue. Ehlers-Danlos Syndrome
Image: by Division of Ophthalmology and Visual Sciences, Queen Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. License: CC BY 2.0Two examples of hypertrophic scars on the dorsum of the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy
Image: “Treatment of Hypertrophic Scar Scar Dermatologic Examination in Human with Autologous Transplantation of Cultured Keratinocytes Keratinocytes Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. Skin: Structure and Functions and Fibroblasts Fibroblasts Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. Sarcoidosis along with Fibrin Fibrin A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. Rapidly Progressive Glomerulonephritis Glue” by Department of Stem Cells and Developmental Biology at Cell Science Research Research Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. Conflict of Interest Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran. License: CC BY 2.5, edited by Lecturio.DIABETIC ulcer on the great toe
Image: “Diabetisches Fußsyndrom” by Papa1234. License: Public Domain