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Step 1-
Hemostasis
and
Inflammation Kicks off the acute chronic inflammatory
response
Macrophages arrive As injury clears up,
PMNs arrive to clear up debris & macrophages start off
necrotic tissue. the repair process
Step 2: Cell proliferation
• May take upto 10 days
• You now have a clean wound- need to lay connective tissue to close
that wouldn.
• Cells that proliferate are
• Epithelial Cells- cover the wound
• Endothelial cells- angiogenesis
• Fibroblasts- lay down connective tissue and collagen fibers that form scar
• Have formation of Granulation Tissue
• Combination of new blood vessels, loose connective tissue, proliferating
fibroblasts and scatered chronic inflammatory cells
Begins 2-3 weeks after injury
and can continue for months
to years
Step 3-
Remodeling The connective tissue that has
been deposited by fibroblasts
is reorganized to produce the
stable fibrous scar .
2nd intention (secondary
1st intention (primary union)
union)
• epithelial regeneration with • larger wounds that heal by a
minimal scarring combination of
• Ex: seen in well-apposed regeneration and scarring
surgical incisions • involves more extensive
scarring and wound
contraction.
FGFs
• proliferation of endothelial cells.
• promote the migration of macrophages and fibroblasts to the damaged area, and stimulate epithelial cell
migration to cover epidermal wounds
MMPs
• Degrade the ECM to permit remodeling and extension of the vascular tube
Molecules in Angiogenesis
Activation of Fibroblasts and Deposition of
Connective Tissue
• Deposition of CT in two steps:
• (1) migration and proliferation of fibroblasts into the site of injury
• (2) deposition of ECM proteins produced by these cells
• Diabetic ulcers
• affect the lower extremities, particularly the feet.
• Tissue necrosis and failure to heal are the result of small vessel disease
causing ischemia, neuropathy, systemic metabolic abnormalities, and
secondary infections.
• Histologically, these lesions are characterized by epithelial ulceration and
extensive granulation tissue in the underlying dermis
Excessive formation of the components of the
repair process can give rise to hypertrophic
scars and keloids