Wound Healing and Repair PDF

WOUND HEALING
By
Sindhu Priya E S
Assistant Professor
YPCRC
Contents
❖Definitions of wound, healing, regeneration
and repair
❖Mechanism or types of healing

❖Healing by first intention
❖Healing by second intention
❖Factors affecting wound healing

Wound
▪A wound is the break in the

integrity of skin or tissues often
associated with the disruption of
the structure and function
Healing is the body response to injury
in an attempt to restore normal
structure
Healing involves and function
2 distinct processes:
REGENERATION REPAIR
Regeneration
▪ Regeneration is by proliferation of
parenchymal cells & results in complete
restoration of original tissue.
▪ The goal of surgical procedures is

regeneration which returns the tissues to their
normal microstructure and function.
Repair
▪Repair is a healing outcome do not return
to their normal architecture and function.
▪It occurs by proliferation of connective
tissue & results in scarring & fibrosis.

Regeneration
Vs
Repair
Regeneration Repair
Types of Wound healing
Wound healing occurs by any one of the two
pathways:
1. Healing by first intention (primary union) –

wounds with opposed edges
2. Healing by second intention (secondary union)

– wound with separated edges.
Incision
wound
Excision
wound
1. Healing by First intention
This is defined as healing of a wound which has the

following characteristics:
i) clean and uninfected

ii) surgically incised
iii) without much loss of cells and tissue
iv) edges of wound are approximated by surgical sutures.
v) wounds with opposed edges
The sequence of events in First
intention
1. Initial haemorrhage
Immediately after injury the space between the incised
wound is filled with blood which then clots and seals
the wound.
2. Acute inflammatory response

This occurs within 24 hours with appearance of
polymorphs but are replaced by macrophages.
3. Epithelial changes
The cells of epidermis from both the cut margins start
proliferating and migrating towards incisional space
resulting in layers of epithelium in 48 hours.
4. Organisation
By 3rd day - fibroblasts invade the wound area
By 5th day - new collagen fibrils start forming
By 4 weeks - a scar is formed.
5. Suture tracks
Suturing seals the incised wound by hemmorhage,
acute inflammation and epithelial changes.
Healing by first intention
2. Healing by second
intention
This is defined as healing of a wound having the
following characteristics:
i) open with a large tissue defect

ii) having extensive loss of cells and tissues
iii) the wound is not approximated by surgical
sutures but is left open.
The sequence of events in second intention
1. Initial haemorrhage
As a result of injury, the wound space is filled with
blood and fibrin clot which dries.
2. Inflammatory phase
There is an initial acute inflammatory response
followed by appearance of macrophages as in primary
intention.
3) Epithelial changes
The cells of epidermis, epithelial spurs from both the
cut margins start proliferating and migrating towards
incisional space resulting in layers of epithelium in 48
hours separating dead tissue called scab.
4) Granulation tissue
This forms the main bulk and is formed by proliferation
of fibroblasts and newly formed one is red, deep,
granular and very fragile.
5) Wound contraction
Once the active matured granulation tissue is formed

the wound contraction starts.
6) Presence of infections
Bacterial contamination of wound delays wound

healing due to release of bacterial toxins.
Healing by Second intention
Differences between primary and
secondary union wounds
Link for wound healing mechanism video:

https://www.youtube.com/watch?v=6qU-0ETo5_s
Factors affecting wound healing
Local factors Systemic factors
▪ Infection ▪ Age
▪ Poor blood supply
▪ Nutrition
▪ Foreign bodies
▪ Systemic infection
▪ Movement
▪ Glucocorticoids
▪ Ionizing radiation
▪ UV radiation ▪ Uncontrolled diabetes
▪ Type, size and location of ▪ Haematologic

injury abnormalities
Complications of wound healing
▪ Infection delays wound healing

▪ Implantation cyst formation: epidermal cyst formation
▪ Pigmentation: Haemosiderin accumulation in scars
▪ Deficient scar formation: inadequate granulation tissue
formation
▪ Hypertrophied scars or keloid formation
▪ Excessive wound contraction
▪ Neoplasia or carcinoma development in some cases
Thank you

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WOUND HEALING

❖Mechanism or types of healing

❖Healing by second intention

❖Factors affecting wound healing

▪A wound is the break in the

▪ The goal of surgical procedures is

▪Repair is a healing outcome do not return

to their normal architecture and function.

▪It occurs by proliferation of connective

tissue & results in scarring & fibrosis.

1. Healing by first intention (primary union) –

2. Healing by second intention (secondary union)

This is defined as healing of a wound which has the

i) clean and uninfected

2. Acute inflammatory response

i) open with a large tissue defect

Once the active matured granulation tissue is formed

Bacterial contamination of wound delays wound

Link for wound healing mechanism video:

▪ Type, size and location of ▪ Haematologic

▪ Infection delays wound healing

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