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Cutaneous wound healing

LO. Describe cutaneous wound healing.Compare and contrast healing by 1st intention and 2nd intention.Describe the local and systemic factors that influence cutaneous wound healing.Explain complications of cutaneous wound healing.. . We discuss wound healing in the skin to illustrate general princ

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Cutaneous wound healing

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    1. Cutaneous wound healing

    2. LO Describe cutaneous wound healing. Compare and contrast healing by 1st intention and 2nd intention. Describe the local and systemic factors that influence cutaneous wound healing. Explain complications of cutaneous wound healing.

    3. We discuss wound healing in the skin to illustrate general principles of repair that apply to most tissues

    5. Phases of cutaneous wound healing Haemostasis Inflammation- early - late Granulation tissue formation and re-epithelialization Wound contraction, ECM deposition, and remodeling

    12. What are Growth Factors? How do they contribute to normal ST?

    13. Growth Factors Ligands which bind enzyme linked receptors Signal diverse cellular responses including: Proliferation Differentiation Growth Survival Angiogenesis Can signal to multiple cell types or be specific

    14. Important growth factors are EGF- epidermal growth factor and transforming growth factor-a (TGF-a) Mitogenic Widely distributed Produced by keratinocytes, macrophages and inflammatory cells It binds to EGFR with intrinsic tyrosine kinase activity

    15. Hepatocyte growth factor (HGF) Also called scatter factor Produced by fibroblast, endothelial cells liver parenchymal cells It has mitogenic effect on most epithelia Promotes cell scattering and migration in embryonic development

    16. Vascular endothelial growth factor (VEGF) Potent inducer of blood vessel formation vasculogenesis angiogenesis- in tumors -chronic inflammation -healing of wounds

    17. Platelet derived growth factor (PDGF) Stored in platelets alpha granules Released on platelet activation Produced by variety of other cells, macrophages, endothelial cells, smooth muscle cells and many tumor cells Causes migration and proliferation of fibroblasts, smooth muscle cells and monocytes

    18. Fibroblasts growth factor (FGF) Made by variety of cells Released FGFs associate with haparan sulphate in the ECM Functions are angiogenesis wound repair development- skeletal muscle -lung maturation Hematopoiesis

    19. TGF-ß and related growth factors Produced by variety of different cell types, platelets, endothelial cells, lymphocytes and macrophages Have multiple effects Is a growth inhibitor for most epithelial cells and leukocytes loss of TGF-ß receptors occur in tumors It is a potent fibrogenic agent It is strong anti-inflammatory

    32. Healing by first intention: wounds with clean opposing edges (surgical incision, should form a narrow scar due to small amount of granulation tissue required to fill the gap)

    33. Healing by second intention: wounds with separated edges (trauma that requires abundance of granulation tissue for wound closure) Granulation tissue consists of newly formed blood vessels, macrophages, fibroblasts and loose ECM framework As collagen accumulation increases, the granulation tissue scaffolding is converted into a mature scar composed of mature spindle-shaped fibroblasts, dense collagen and elastic fibers. The mature scar does not contain vessels

    34. Healing by First & Second Intention Healing by first intention – edges close together or wound edges brought together by sutures ? loss of parenchymal (structural) tissue ? amount of scar tissue healing occurs faster less chance of infection

    35. Healing by second intention - wound not closed / unable to be closed examples: decubitus ulcers (bed sores), burns significant loss of parenchymal tissue ? amount of scar tissue healing occurs slower greater chance of infection

    37. Factors influencing wound healing Systemic and Local

    38. Systemic factors Nutrition : protein deficiency vitamin c deficiency Metabolic status: Diabetes mellitus Circulatory status: atherosclerosis Hormones: corticosteroids

    39. Local factors Infections: Mechanical factors Foreign bodies Size, location and type of wound

    40. Complications in cutaneous wound healing

    41. Three general categories Deficient scar formation Excessive formation of the repair components Formation of contractures

    42. 1:Deficient scar formation Rupture of wound-common after abdominal surgery ulceration

    43. 2: Excessive formation of the repair components Hypertrophic scar Keloid Exuberant granulation Desmoids or aggressive fibromatosis

    44. 3: Formation of contractures Seen after serious burns Compromise movements of joints

    50. Complications of wound healing Infection; Implantation cyst; Pigmentation Deficient scar formation; Hypertrophied scar; Incisional hernia; Excessive contraction; Neoplasia;

    53. Thanks

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