Healing Process

Healing Process

• The final phase of the inflammation process is healing
• Healing includes two major components:
  • Regeneration
    • Replacement of lost cells and tissues with cells of the same type
  • Repair
    • Occurs by primary, secondary, or tertiary intention
      • Primary intention – When wound margins are neatly approximated, as in a surgical incision or a paper cut
      • Secondary intention – From trauma, ulceration, and infection have large amounts of exudate and wide, irregular wound margins with extensive tissue loss
      • Tertiary intention (delayed primary intention) – Contaminated wound is left open and sutured closed after the infection is controlled, and when a primary wound becomes infected, is opened, is allowed to granulate, and is then sutured

Complications of wound healing

• Adhesions 
  • Bands of scar-like tissue that form between two surfaces inside the body and cause them to stick together
• Contractions
  • Excessive fibrous tissue formation due to shortened muscle tissue
• Dehiscence
  • When a surgical incision reopens, either internally or externally, or when a primary healing site bursts open
• Evisceration
  • When wound edges separate to the extent that intestines protrude through wound
• Hypertrophic scars
  • Overabundance of collagen is produced during healing that results in large, raised red and hard scars
• Keloid formation
  • Extra scar tissue grows, forming smooth, hard growths without any tendency to subside
• Hemorrhage
  • Abnormal internal or external blood loss caused by suture failure, clotting abnormalities, dislodged clot, infection, or erosion of a blood vessel by a foreign object (tubing, or drains) or infection process