The Healing Process

Stages of Healing Injury Inflammation Stage (Days 1-4) Fibroblastic Repair Stage (Day 4 - 6 weeks) Maturation and Remodeling Stage (2-3 years) Note: Phases of healing overlap and have no definitive beginning or end

Inflammatory Stage Days 1-4 When a cell is damaged chemicals are released to initiate the inflammatory response

Signs of Inflammation Redness (Rubor) Swelling (Tumor) Tenderness (Dolor) Increased Temperature (Calor) Loss of Function (Functio laesa)

Inflammatory Stage Cont. Chemical mediators (Histamine, leukotrienes, and cytokines) Vascular reaction (vasoconstriction, vasodilation, and exudate creates stasis) Platelets and leukocytes adhere to the vascular wall Phagocytosis Clot formation

Fibroblastic Repair Stage During this stage proliferative and regenerative activity lead to the formation of scar tissue Extracellular Matrix consists of: Collagen Elastin Ground Substance Proteoglycons Glycosamenglycans

Maturation Stage This process is to take the existing scar tissue and or calcium growth and smooth it out so it matches the existing tissue

Factors That Impede Healing Extent of the injury Microtears- small disruptions in tissue that occur over time (overuse injury) Macrotears- large disruptions in tissue that occur quickly (acute trauma)

Edema and Hemorrhage Swelling that sits in the injured area retards the healing by Causing separation of tissue Inhibits neuromuscular control Impedes nutrition to the area This happens even to the smallest injury but too much has the same effects as edema

Other Factors Poor vascular supply Separation of tissue- smooth edges yield smaller scars, jagged edges yield an increase in scar tissue Muscle spasms Atrophy Corticosteroids- Controversial early impedes healing, late stages up for debate

Other Factors Keloids- results because of an increase in collagen production and a decrease in collagen absorption/breakdown Infection- presence of bacteria in the wound delays healing and increases scarring Health, Age and Nutrition- increase in age = decrease in elasticity of skin Nutrition is very important- Vitamin A (collagen synthesis and immune system), Vitamin K (clotting), Vitamin C (immune system), zinc (enzyme production), and amino acids (protein restructuring)