1. The Healing Process

2. Stages of Healing Injury Inflammation Stage (Days 1-4)
Fibroblastic Repair Stage (Day weeks)
Maturation and Remodeling Stage (2-3 years)
Note: Phases of healing overlap and have no definitive beginning or end

3. Inflammatory Stage Days 1-4
When a cell is damaged chemicals are released to initiate the inflammatory response

4. Signs of Inflammation Redness (Rubor) Swelling (Tumor)
Tenderness (Dolor)
Increased Temperature (Calor)
Loss of Function (Functio laesa)

5. Inflammatory Stage Cont.
Chemical mediators (Histamine, leukotrienes, and cytokines)
Vascular reaction (vasoconstriction, vasodilation, and exudate creates stasis)
Platelets and leukocytes adhere to the vascular wall
Phagocytosis
Clot formation

6. Fibroblastic Repair Stage
During this stage proliferative and regenerative activity lead to the formation of scar tissue
Extracellular Matrix consists of:
Collagen
Elastin
Ground Substance
Proteoglycons
Glycosamenglycans

7. Maturation Stage
This process is to take the existing scar tissue and or calcium growth and smooth it out so it matches the existing tissue

8. Factors That Impede Healing
Extent of the injury
Microtears- small disruptions in tissue that occur over time (overuse injury)
Macrotears- large disruptions in tissue that occur quickly (acute trauma)

9. Edema and Hemorrhage
Swelling that sits in the injured area retards the healing by
Causing separation of tissue
Inhibits neuromuscular control
Impedes nutrition to the area
This happens even to the smallest injury but too much has the same effects as edema

10. Other Factors Poor vascular supply
Separation of tissue- smooth edges yield smaller scars, jagged edges yield an increase in scar tissue
Muscle spasms
Atrophy
Corticosteroids- Controversial early impedes healing, late stages up for debate

11. Other Factors
Keloids- results because of an increase in collagen production and a decrease in collagen absorption/breakdown
Infection- presence of bacteria in the wound delays healing and increases scarring
Health, Age and Nutrition- increase in age = decrease in elasticity of skin
Nutrition is very important- Vitamin A (collagen synthesis and immune system), Vitamin K (clotting), Vitamin C (immune system), zinc (enzyme production), and amino acids (protein restructuring)