4.2. Physiology of Healing: Types of Healing

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Physiology of Wound Healing: Types of Wound Healing

Wound healing is a complex and dynamic process that involves a series of cellular and biochemical events to restore the structural and functional integrity of tissue after injury. This process can be divided into three main phases: inflammation, proliferation and remodeling.

Inflammatory Phase

The inflammatory phase begins immediately after the injury and lasts for about three days. During this phase, vasoconstriction occurs to limit blood loss, followed by vasodilation to allow cells and factors necessary for healing to reach the site of injury. Cells involved in this phase include platelets, leukocytes and macrophages. Platelets form a clot to stabilize the wound, while white blood cells and macrophages clear debris and microorganisms from the wound site.

Proliferative Phase

The proliferative phase begins around the third day after the injury and can last up to three weeks. During this phase, the formation of new blood vessels (angiogenesis), the production of a new extracellular matrix and the formation of granulation tissue occur. The key cells involved in this phase are the fibroblasts, which produce collagen and other extracellular matrix proteins. Granulation tissue is a scar tissue rich in blood vessels and fibroblasts, which provides a substrate for the migration of epithelial cells over the wound surface.

Remodeling Phase

The remodeling phase begins about three weeks after the injury and can last for over a year. During this phase, collagen and other extracellular matrix components are reorganized and remodeled to increase wound strength. The granulation tissue is replaced by more mature and less vascularized scar tissue.

Types of Healing

There are three main types of healing: first intention healing, second intention healing, and third intention healing.

Healing by First Intention

Healing by first intention, also known as primary healing, occurs when the wound edges are brought together (as in a suture) and the wound heals without significant granulation tissue formation or overt scarring. This type of healing is faster and results in minimal scarring.

Second Intention Healing

Second intention healing occurs when the wound edges cannot be brought together and the wound must heal by granulation, contraction, and epithelialization. This type of healing is slower and results in a more noticeable scar. It is common in large, deep, or infected wounds.

Healing by Third Intention

Healing by third intention, also known as secondary healing, occurs when the wound is initially left open and closed at a later time, usually by suturing. This type of healing is used when there is a high risk of infection or when it is necessary to remove necrotic tissue before wound closure. Third intention healing results in a more noticeable scar than first intention healing, but less noticeable than second intention healing.

Understanding the physiology of healing and the different types of healing is critical to effective wound management and promoting optimal healing.

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204.3. Physiology of Healing: Primary and Secondary Healing