1. injury tissue and cells abrasion tissue loss restore
repair

2. Chapter Ⅱ
Injury Repair

3. Tissue response to injury
Tissue response to injury. Repair after injury can occur by regeneration, which restores normal tissue, or by healing, which leads to scar formation and fibrosis.

4. Repair: Definition: Forms: regeneration
After injury caused by the body that lost part of the cells and tissues, the body formed to carry out the repair defect restore process.
Forms: regeneration
           fibrous repair

5. During repair, the injured tissue is replaced
by regeneration of native parenchymal cells
completely restore
(completely regeneration)
by filling of the defect with fibroblast scar tissue
fibrous scar restore
(incompletely regeneration)

6. Injury rehabilitation teaching contents
Section 1 Regeneration
Section 2 Fibrous Repair
Section 3 Wound Healing

7. Section 1: Regeneration
three aspects :
(1)the regenerative capacity of involved cells (their ability to divide ),
(2) the number of surviving viable cells
(3) the presence of a connective tissue framework that will provide a base for restoration of normal tissue structure.

8. one cell divided two cells
physiological --- normal
pathological --- abnormal

9. physiological regeneration
Epidermal update
Digestive tract epithelium
Cyclical endometrial shedding
Blood cell update

10. pathological regeneration
Complete regeneration: After tissue injury, neighboring
cells, tissue repair, and maintain
the existing organizational struc-
ture and functions.
Incomplete regeneration: Organize defect filled by granu-
lation tissue scar.

11. CELL CYCLE AND CELL REGENERATION OF DIFFERENT TYPES OF POTENTIAL
Successive phases of a cell through its cycle of replication are define with reference to DNA synthesis and cellular division.

12. Cell cycle M G2 G0 G1 S

13. Normal cell proliferation and cell cycle

14. cellular division

15. regeneration capacity
Youngest↑, elderly ↓
Low Biology↑, higher organisms↓
Organize naive↑, well-differentiated
organizations ↓
Easy to damage, regular updates↑,
the contrary ↓

16. 2.Regeneration capacity of cells: ⅰ. labile cells ⅱ. stable cells
divided into three groups
ⅰ. labile cells
ⅱ. stable cells
ⅲ . permanent cells:

18. labile cells:
proliferate continuously in post-natal life, they have a short life-span and a rapid ‘turnover’ time

19. Epidermal cells
Respiratory and digestive tract epithelium
Male and female gonadal cells lining organs
Lymphatic and hematopoietic cells
Mesothelial cells
strong
regenerative
capacity

20. regeneration of glandular epithelia
Gland and its basement membrane damage, epithelial hyperplasia, the formation of simple glands, to repair.

21. stable cells:
divide very infrequently under normal conditions, but are stimulated to divide rapidly when such cells are lost.
Gland organs( Liver,Endocrine gland )
Bone
Fibrous tissue
Renal tubules

22. Renal tubule
stable cells
Fibrous tissue
Gland organs

23. Stable cells (proximal tubule)

24. Liver cell regeneration
Liver injury, with more dual-nuclei of liver cells, which are regenerating liver cells

25. permanent cells:
normally divide only during fetal life and they cannot be replaced when lose.
nerve cell
skeletal muscle cells
cardiac muscle cells

26. skeletal muscle cells
cardiac muscle cells
nerve cell

27. Abilities of Regeneration
Potential of regeneration Frameworks Sequelae
Labile cells remained complete regeneration
Labile cells destroyed fibrous repair
Stable cells remained complete regeneration
Stable cells destroyed fibrous repair
Permanent cells remained fibrous repair
Permanent cells destroyed fibrous repair

28. The Processes of Regeneration of Various Tissues
Epithelium
covering epithelium
glandular epithelium
connective tissue
bone and cartilage
blood vessel
muscle (heart, skeletal, smooth)
neuron (axon, myelin sheath)

29. ⅠEpithelial Tissue Regeneration
1. Lining epithelial regeneration
Squamous epithelial defect by fate, or at the bottom of a basement Splinter Cell hyperplasia - single layer - stratified
Mucosal epithelial damage by the neighboring basement Splinter Cell Hyperplasia - Cubic - columnar

30. 2. Glandular epithelium regeneration
Basement membrane integrity, and residual glandular Splinter Cell proliferation, restore the original structure and function.
Basement membrane completely destroyed, it is difficult to regeneration.

31. E.g.: liver regeneration
After partial hepatectomy through the liver Splinter Cell proliferation, restore the original size of the short term.
Liver cell necrosis, the integrity of hepatic lobule wallstent - restore normal structure
Extensive liver cell necrosis, hepatic lobule wallstent collapse, nodular regenerative liver cells, collagen and fibrous tissue hyperplasia.

32. Nodular regeneration of liver cells

33. Ⅱ Fibrous Tissue Regeneration
Static fibrocytes or mesenchymal cell
division hyperplasia
Fibrocytes Fibroblasts

35. Bone Tissue Regeneration
Ⅲ Cartilage Tissue and
Bone Tissue Regeneration
Cartilage regeneration - the proliferation of perichondrium
Chondroblastoma - the formation of cartilage matrix
Bone tissue regeneration ability

36. Ⅳ Vascular Regeneration
Regeneration of capillaries
(in the manner Budding)
Endothelial cell swelling split hyperplasia solid cell cord→New capillary network →small arteries and small vein

37. Steps in the process of angiogenesis

38. Angiogenesis by mobilization of endothelial precursor cells (EPCs) from the bone marrow and from pre-existing vessels (capillary growth). EPCs are mobilized from the bone marrow and may migrate to a site of injury or tumor growth (upper panel). The homing mechanisms have not yet been defined. At these sites, EPCs differentiate and form a mature network by linking with existing vessels. In angiogenesis from pre-existing vessels, endothelial cells from these vessels become motile and proliferate to form capillary sprouts (lower panel). Regardless of the initiating mechanism, vessel maturation (stabilization) involves the recruitment of pericytes and smooth muscle cells to form the periendothelial layer.

39. Capillary regeneration

40. Repair great vessels
required surgical anastomosis, splinter cell endothelial hyperplasia, connected, restore the original structure.

41. Ⅴ Muscle Tissue Regeneration
Striated muscle, sarcolemma integrity, muscle fiber has not been completely broken, muscle cell division, resulting in sarcoplasmic, myofibrillar differentiation, restore normal structure.

42. Smooth muscle from undifferentiated mesenchymal
cell differentiation from bowel or anastomosis of
vascular surgery, the fibrous tissue connecting.
Myocardial regeneration capacity extremely weak, scar repair after injury.

43. Ⅵ Regeneration of Nerve Tissue
Brain and spinal cord non-renewable capacity, after damage by glial cell proliferation - glial scar

44. Peripheral nerve injury, such as nerve cells are still alive, the two ends of less than 2.5 cm, at both ends of nerve sheath cells form a ribbon connecting ends. The two ends is greater than 2.5 centimeters or the loss of distal amputation, the regenerated nerve axons should not enter the nerve sheath, with the proliferation of fibrous connective tissue mixed, curled into a Mission - traumatic neuroma.

45. Peripheral nerve regeneration

46. Section 2: fibrous repair
GRANULATION TISSUE
MORPHOLOGY AND ROLE
Do not confuse with GRANULOMA

47. composition and morphology
Ⅰ granulation tissue
composition and morphology
DEFINITION
      Granulation tissue from the new thin-walled capillaries and proliferation of fibroblast cells and accompanied by inflammatory cell infiltration. The naked eye, the performance of bright red, granular, soft and moist, the shape of fresh granulation.

48. New capillary
Red cells
Base membrane
Capillary endothelial cells

49. fibroblast collagen Fibrin cell
Fibroblast are stimulated to divide and to secrete collagen
fibroblast
collagen
Fibrin cell

50. A fresh granulation tissue: Note the fibroblasts, new capillaries
and a few inflammatory cells.

51. Granulation tissue

52. Granulation tissue

53. Inflammatory cells in a fresh granulation tissue

54. Ⅱ Function of granulation tissue:
1. anti-infection and protect wound surface
2. fill wound and other tissue defect
3. organization and encapsulation of necrosis, thrombus, inflammatory exudate and other foreign matter.

55. Outcome Mesenchymal gradually absorb moisture to reduce
Inflammatory cells to reduce and gradually disappear

56. Part of capillary lumen occlusion, a
decrease in the number; in accordance with
the normal functions required, a small
number of capillary wall thickening, alteration of small arteries and small veins

57. Fibroblasts produce more collagen fibers, while the number of fibroblasts decreased slender nucleus and deeply stained change into fibrocytes

58. SCAR TISSUE MORPHOLOGY AND ROLE
Scar organization refers to the converted sophisticated granulation tissue formation of connective tissue fibers.

59. 1. Beneficial
  To fill the connecting trauma, so that to maintain the integrity of tissues or organs.
  Scar tissue containing a large number of collagen fibers, tissues or organs can maintain robustness.

60. 2. Adversely
Contraction of scar tissue, joint contracture or restricted activity, narrow pipe.
Cicatricial adhesion, organ sclerosis.
Scar over hyperplasia, the formation of keloids.

61. Connective tissue hyalinization
Integration of collagen fibers was flaky, translucent, uniform red staining consistent material, fiber cells decreased.

62. Scar contracture in a boy after scald

63. keloid

64. Section Ⅲ Wound Healing
body subjected to external force------skin and other tissue emerged from break or defect------healing of repair process------include a variety of organizations regeneration、hyperplasia of granulation tissue, scar formation of the complex combination------demonstrated a variety of process synergy.

65. ⅠBasic Process of Wound Healing
SKIN WOUND HEALING
ⅠBasic Process of Wound Healing
1.wound early change
2.wound contraction
3.granulation tissue proliferation and scar formation
4.skin and other tissue regeneration

67. Ⅱ Type of Wound Healing
The process of healing of a skin wound depends on the size of the defect.
healing by first intention
healing by second intention

68. healing by first intention
Less tissue defect, wound edge neatly, no infections, or aseptic surgical wound; creators face closely together,
Fewer blood clots, mild inflammatory response, regeneration and repair of early, less granulation tissue;

69. Shorter healing time, less scarring;
24-48 hours of epidermal regeneration, 2-3 days the formation of granulation ,5-6 days to form collagen fibers, 2-3 weeks to heal.

70. healing by second intention
large tissue defect, wound edge irregular, duo opened，with infection; wound surface is not tight together
many necrotic tissue or with infections, severe inflammatory reaction, after control infection began the regeneration; many granulation tissue

71. a long time to heal and form scar many
if the organization of early degeneration and necrosis ,after the removal of necrotic tissue regeneration start

72. Steps in wound healing by first intention (left) and second intention (right). Note large amounts of granulation tissue and wound contraction in healing by second intention.

73. healing by first intention

78. healing by second intention

79. HEALING OF BONE FRACTURE
Basic process
  1. Hematoma formation
     Fracture vascular bleeding stump to fill the two fracture hematoma
  2. Fibro-osseous callus formation
     Granulation tissue plane of fracture hematoma
                                                      Fibrous callus

80. 3. Bone bony callus formation
     Fibrous callus Osteoblastoma bone matrix secretion of bone-like tissue calcium deposition in bone tissue

81. 4. Osteotylus alterations or plasticity
     By the mechanical requirements of woven bone osteoblasts, Osteoblastoma trabecular bone matrix secreted resume cortical thickening and bone marrow cavity

82. Healing of bone fracture
Hematoma formation
Bone-bony callus formation
Osteotylus alterations or plasticity
Fibro-osseous callus formation

83. THE IMPACT OF WOUND HEALING FACTORS
Systemic factors
  Age
  Nutrition

84. Local factors
  Infection, foreign body
  Local blood circulation
  Innervation
  Ionizing radiation

85. Factors that affect fracture healing
Fracture ends of the timely and correct reset
Stump fracture timely, reliable fixed
Early systemic and local functional exercise,
To maintain a good blood supply to the local

86. If fixed, reset improperly, will have an impact on fracture healing, resulting in malformation.
Healing bone deformity (general)

87. brief summary
Regeneration and
capacity of cells
Granulation tissue

88. Thank you
for
your attention!

89. Repair responses after injury and inflammation
Repair responses after injury and inflammation. Repair after acute injury has several outcomes, including normal tissue restitution and healing with scar formation. Healing in chronic injury involves scar formation and fibrosis (see text).

90. Development of fibrosis in chronic inflammation
Development of fibrosis in chronic inflammation. The persistent stimulus of chronic inflammation activates macrophages and lymphocytes, leading to the production of growth factors and cytokines, which increase the synthesis of collagen. Deposition of collagen is enhanced by decreased activity of metalloproteinases.