Healing

Question 1

What is the definition of healing?

Answer 1

the process of making or becoming sound or healthy again

Question 2

Describe the first phase of healing

Answer 2

• haemostasis
• occurs immediately after wounding
• vascular constriction
• fibrin clot formation; stops bleeding, release pro-inflammatory cytokines and growth factors
• once bleeding is stopped, inflammation can occur

Question 3

Describe the second phase of healing

Answer 3

• inflammation
• 2-5 days
• vasodilation; increases blow flow to injured site
• increased vascular permeability; macrophages, neutrophils, building materials in exudate
• debridement; phagocytosis of cellular debris and foreign matter

Question 4

Describe the third phase of healing

Answer 4

• reconstructive phase
• 2 days to 3 weeks
• filling in; fibroblasts secrete collagen, granulation tissue forms, angiogenesis begins
• iron, vitamin C and oxygen essential in collagen formation
• sealing; epithelialisation, epithelial cells from all sides of wound grow inward, eventually meeting to seal off wound
• prevents further contamination from foreign bodies
• shrinking; contraction, myofibroblasts containing myofibrils contract to anchor wound

Question 5

Describe the fourth phase of healing

Answer 5

• remodelling
• maturation
• 3 weeks to 2 years
• continued contraction
• scar tissue is remodelled and capillaries disappear
• result = avascular scar

Question 6

Regeneration time

Answer 6

• the best outcome
• damages tissue is replaced by original tissue
• complete return to normal structure and function
• often not possible in adults
• resolution: almost the same as regeneration

Question 7

Repair

Answer 7

• damaged tissue is replaced by scar tissue (collagen)

- collagen fills the gap but does not perform same physiological functions as original tissue

Question 8

Healing by first intention

Answer 8

• wound edges are approximated (close enough to unite properly)
• sutures, staples, glue
• wound edges must be sharp, clean, free of microbes
• e.g. surgical incisions
• resolution or repair? Depends on extent of wound

Question 9

Healing by second intention

Answer 9

• large amount of tissue loss
• edges are too far apart, cannot be approximated
• e.g. pressure ulcers, large wounds, burns
• wound is severely contaminated
• takes longer, larger amount of scarring, greater chance of infection
• repair from below
• resolution not possible, so repair

Question 10

Describe exudates

Answer 10

• serous, watery
• hemorrhagic
• fibrinous - sticky, fibrin rich
• purulent - pus

Question 11

What is dysfunctional healing?

Answer 11

• can occur at any stage
• insufficient repair
• excessive repair (keloid)
• infection
• anything that influences inflammation will influence healing

Question 12

What factors can affect healing?

Answer 12

• blood
• smoking
• High blood glucose
• age
• infection
• presence of foreign body
• state of health / nutrition
• moisture
• etc