Professional Documents
Culture Documents
TISSUE REPAIR,
AND FIBROSIS
DR . RI BKA TH EO DO RA
DR . REYH AN FARANDI
DR . G OESTI YUDI STIR A
DR . NUR NAT H ANI A
DRG . DI NA NOVI ANTI
Wound Healing
• Wound : a break in the epithelial integrity of the skin + disruption of the
structure & function of underlying normal tissue
• Healed Wound :
◦ Connective tissues have been repaired + re-epithelialized
◦ Returned to its normal anatomical structure and function
• Type :
1. Acute wounds :
- Occur within the past 3-4 w
2. Chronic wounds :
- Persist trough 4-6 w
- Chronic wounds = non healing wounds, recalcitrant, delayed healing
Wound Assessment
Paper-made ruler, transparent
gridlines
healing:
Inflammatory Phase
(day 1-3)
Purpose: attain homeostasis, remove devitalized
tissue and prevent invasive infection
1. Attainment of homeostasis
• Fibrillar collagen and tissue factor act to
activate the clotting cascade prevent
hemorrhage
• Platelets degranulates and releases .. Fibrin
polymerization into a gelatin
2. Removal of devitalized tissue & prevent infection
• Recruitment of inflammatory cells
(neutrophils) attracted by TGF-β &
lipopolysaccharide followed by monocytes
macrophages phagocytosis
• Lymphocyte enters at day 5-7
Proliferative Phase: day
4-21
Purpose: to achieve wound closure by granulation,
angiogenesis, and epithelization
1. Tissue proliferation
• Macrophages as a conductor of cell interaction
and mediators VEGF, FGF, TGF-α& β
• Fibroblast FGF-2 regeneration of
endothelial cells
• Endothelial cells IGF proliferation of
keratinocytes and fibroblast
• Keratinocytes TGF-α& β 1,2,3
keratinocytosis (centripetal)
WOUND HEALING
Permanent
◦ nonproliferative in postnatal life
◦ neurons, cardiomyocytes, skeletal
Stable
◦ regeneration as response to injury
◦ parenchyma – liver, pancreas, renal tubules
◦ mesenchymal cells, endothelium
Continously
◦ continuous regeneration from stem cells (self-renewal)
◦ hematopoietic cells in bone marrow
◦ surface epithelia – skin, oral cavity, vagina, cervix
◦ duct epithelia – salivary glands, pancreas, biliary tract
◦ mucosas – GIT, uterus, fallopian tubes, urinary bladder
Tissue Types
Occur in two ways :
Scar Formation
Substitution of cellular matrix a patch
to re-establish continuity physically and
physiologically
(replacement by connective tissue (fibrosis))
and
Tissue Regeneration
Re-creation of pre-existing tissue
(by parenchymal cells of the same type)
Abnormal response to
injury & abnormal
wound healing
Inadequate regeneration Excessive regeneration
• CNS injuries following traumatic injury or • Hyperkeratosis in cutaneous psoriasis,
tumor ablation granuloma formation in healing wounds
• Induce neural regeneration implanted • Loss of growth control & possible
neural stem/progenitor cells transformation to overt cancer
• Bone nonunions & corneal ulcers
Excessive scar formation
Inadequate scar formation • Skin : hypertrophic scarring or keloid
• Diabetic foot ulcers , sacral decubiti, formation.
venous statis ulcers • Pulmonary : fibrosis or cirrhosis.
• Abnormality in restoring cutaneous
integrity and collagen cross-linking
• Vit C deficiency
Keloid vs Hypertrophic
Scar
The ideal scar should be
• Similar to a fine line scar
• Pigmentation related to the
neighboring healthy tissue,
• Without any irregularities in
texture or contractures
distorting the adjacent skin
Fibrosis
• Fibrois the formation of excess fibrous connective tissue in an organ or
tissue.
• If injury is severe. regeneration can't happen. So, fibrosis (tissue scar)
replaces the injured tissue.
• Four components to this process :
1. New vessel formation
2. Fibroblast proliferation
3. Synthesis of collagen (scar formation)
4. Remodelling scar