Test 2- Wound Healing Flashcards Preview

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Flashcards in Test 2- Wound Healing Deck (39):


injured tissue



replacement of injured tissue


Healing begins...

Healing begins immediately after a wound develops



• Immediate

Vasospasm  leads to relaxation

Platelets aggregate to exposed

collagen and a network of fibrin forms

-  Reduces blood loss

-  Binds edges of the wound


-  Initiate angiogenesis (PDGF,

TGFβ)- growth factors are released, which are important for the proliferative phase


Phases of wound healing

  1. Hemostasis
  2. Inflammation-"clean up"
  3. Proliferation- 1 week in
  4. Maturation- weeks in ;



24-96 hours

Cardinal signs of inflammation seen

Some ECM components are chemotactic

Degradation–leukocytes“clean up” cell debris from the injury

Leukocytes secrete chemotactic

and growth factors leads to proliferation


If excessive, can reduce healing




up” cell debris from the injury

Leukocytes secrete chemotactic

and growth factorsproliferation


If excessive, can reduce healing



3-7 days, lasting up to 3-4 weeks

Regeneration of tissue:

-  Endothelium (angiogenesis)

-  Epithelium (epithelialization)

-  Connective tissue (fibrosis)


Granulation tissue forms

Stem cells in a quiescent stage are

influenced by cytokines / growth factors

---Limited by proliferative potential of cell

types involved

Fibroblasts proliferate to fortify the

woundcollagen deposition

Decreases with age and disease



Begins 3-4 weeks after injury, after proliferation, can last years

Remodeling of granulation tissue, maturation of fibrosis, and wound contraction

Required for return of tensile strength

Re-establishment of cell interactions

Vascular regression


Wound Healing by Primary Intention

Wounds with opposed edges


Wound healing by Secondary Infection

Gaping wounds

Septic wounds

Foreign bodies

Wound with delayed healing process


Primary vs secondary infection

- both have the same phases of wound healing

 THE DIFFERENCE IS, the extent to which it has to be healed.

Primary can be healed in about 3-5 days.

Before secondary intention can occur, you have to have healthy granulation tissue, so it will take longer.

Scar will be much bigger in secondary intention and the tensile strength of the wound will be decreased.


Note large amounts of granulation tissue and wound contraction in the healing by

secondary intention



Must remove junk before healing can occur

Things in the center of a wound:

–  Dead cells

–  Leukocytes

–  Cytokines

–  Serum/clotting proteins

–  ECMsubstances

How leukocytes do it:

–  Phagocytosisandlysosomaldegradation

–  Degranulationandreleaseofdigestive enzymes

–  Matrix metalloproteinases–very important for degrading the ECM

Must remove junk before healing can occur

Things in the center of a wound:

–  Dead cells

–  Leukocytes

–  Cytokines

–  Serum/clotting proteins

–  ECMsubstances

How leukocytes do it:

–  Phagocytosisandlysosomaldegradation

–  Degranulationandreleaseofdigestive enzymes

–  Matrixmetalloproteinases–very important for degrading the ECM


Phase of Wound Healing



A tissues ability to return to normal depends on

A tissues ability to return to normal depends on:

Retention of ECM structural framework

Regenerative capacity of cells


Regenerative capacity of cells

Regenerative capacity of cells

Labile/Continuously dividing cells

–  Proliferate throughout life, replacing those cells that are destroyed

–  Ex: epithelial cells of liver, kidney, lung, pancreas, skin, mucous membranes

Quiescent/Stable cells

–  Low level of replication; undergo rapid division in response to stimuli

–  Capable of reconstituting the tissue of origin

–  Ex: smooth muscle, fibrocytes, vascular endothelial cells, chondrocytes, osteocytes

Permanent cell/Non-dividing cells

–  Have left the cell cycle & cannot undergo mitotic division in postnatal life

–  Ex: Neurons, cardiac & skeletal muscle


Regeneration of Epithelium (Epithelialization)

Proliferate immediately at denuded surfaces

Must disassemble connections to the basement membrane and junctional complexes with neighboring cells

Must express surface receptors that bind ECM

Intact basement membrane greatly facilitates!

Regulated by contact inhibition


Kidney from a calf with renal tubular necrosis and regeneration due to oak bud toxicosis


Role of the extracellular matrix (ECM) in regeneration and repair.

Role of the extracellular matrix (ECM) in regeneration and repair.

Liver regeneration with restoration of normal tissue after injury requires an intact  cellular matrix.

If the matrix is damaged the injury is repaired by fibrous tissue deposition and scar formation.


Growth factors

Needed for cellular

– Proliferation
– Differentiation

EGF – bind receptors on epithelial cells thenactivates MAPK then induces G0 phase cell cycle


Stem Cells

Stem Cells – important source for epithelial regeneration


Embryonic – pluripotent; isolated from blastocysts

Tissue stem cells- most in WOUND HEALING

– Not pluripotent; restricted lineage- specific differentiation capacity- depends on what tissue it is in

– Bone marrow(bone marrow, umbilical cord) – hematopoietic and mesenchymal cells- greater capacity-

– Skeletal muscle “satellite cells”


Regeneration: Endothelium (Angiogenesis)

Formation of new blood vessels from existing ones

• PDGF,FGF,VEGF-Abind GF-R’s on endothelial cells induce vascular formation by...

– Endothelial proliferation
– Recruitment of pericytes
– Deposition of ECM proteins


Regeneration of Connective Tissue

Fibroplasia – migration & proliferation of fibroblasts

Fibrosis – scar formation by connective tissue remodeling

Factors that favor fibrosis:

–  Severe and prolonged tissue injury

–  Loss of tissue framework (basement membranes)

–  Large amounts of exudate/inflammation

–  Lack of renewable cell populations


Fibrous connective tissue

–  Dense accumulation of fibroblasts and collagen

–  With time, the collagen becomes more densely packed

–  Persists for years (life)


Consequences of fibrosis

-  Loss of functional parenchymal tissue

-  Alteration of physical properties of tissue


Granulation Tissue

• Distinctive arrangement of connective tissue fibers, fibroblasts, and blood vessels

Fibroblasts and connective tissue grow parallel to wound surface

– Blood vessels arranged perpendicular to fibrosis

Fragile capillaries – bleeds easily

Granular surface

Can be excessive, a type of hypertrophic scar termed proud flesh


Granulation Tissue


When good granulation tissue goes bad...

“Proud flesh”
(aka exuberant granulation tissue)


Wound contraction

A normal part of the maturation phase of wound healing

But can be bad when connective tissue contracts and place tension on surrounding tissues

May immobilize or deform the tissue (ex: burns)

Mediated by myofibroblasts

–  Form within wounds in response to


–  Increase with time and severity


Conditions with Impaired Wound Healing

Tension on a tissue

Prolonged inflammation

–  Local infection, foreign material

–  Abundant necrotic tissue

Disorders in collagen synthesis

–  Protein malnutrition

–  Hyperadrenocorticism – antagonistic effect of steroids

–  Inherited defects – osteogenesis imperfecta, Ehlers-Danlos syndrome

–  Scurvy(vitaminCdeficiency)

Poor blood supply

– Diabetes mellitus – impaired angiogenesis

• Impaired ability of cellular regeneration

–  Chemotherapy

–  Old age

–  Denervatedtissue


What phase of wound healing is this, if there is necrosis and neutrophils?

early inflammation stages


What stage of wound healing is this?



You can see the hypertrophic epithelial cells toward the center of the picture.


Angiogenesis process

  1.  proteolysis of ECM
  2. Migration and chemotaxis
  3. proliferation
  4. lumen formation, maturation, and inhibition of growth
  5. increased permeability through gaps and transcytosis



A , Bone marrow. EPCs are mobilized from the bone marrow and may migrate to a site of injury. The homing mechanisms have not yet been defined. At these sites, EPCs differentiate and form a mature network by linking with existing vessels.
B, Preexisting vessels (capillary growth). In angiogenesis from preexisting vessels, endothelial cells from these vessels become motile and proliferate to form capillary sprouts. Regardless of the initiating mechanism, vessel maturation (stabilization) involves the recruitment of pericytes and smooth muscle cells to from the periendothelial layer


What is this?

Fibrous connective tissue


Synthesis of ECM

–  Collagen, elastin, fibronectin, laminin

–  Growth factors induces fibroblasts to synthesize collagen

–  Collagen = triple helices with lots of cross-linkage providing tensile strength



Produced by platelets & leukocytes

Is important for fibroblast migration & proliferation, and collagen/ECM protein synthesis


Consequences of fibrosis


liver- nodular surface


fibriotic liver stained with Thrichrome stain


What is this?

Granulation tissue- VERY GOOD