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The biology of wound healing

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Abstract

Wound healing is a normal physiological function that restores the continuity of tissues after injury. It is a complex process characterized by macroscopic and biochemical events. Considerable advances in molecular technology have enhanced our understanding. Through a knowledge of the processes involved, the clinician should be able to appreciate the role they can play in wound healing and understand current and future treatment options that may modulate the healing process. Particular emphasis is given here to cytokine messaging because this is the key that unlocks the mystery to understanding wound healing. This chapter considers the following: Phases of wound healing; Contraction; Maturation; and Wound strength.

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Figures

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1.1 Cellular content and matrix accumulation within a wound during the phases of wound healing. Note the overlap of these events during the phases of wound healing (axis not to scale).
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1.4 Haemostasis. Blood and lymph from damaged vessels and lymphatics fill the wound immediately after injury. The platelets, in combination with the red blood cells, fluid and fibrin, form a plug in the wound. (Modified with permission from )
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1.6 Inflammation. Leucocytes migrate into the wound soon after injury. Tissue damage releases mediators that are potent chemoattractants for neutrophils. (Modified with permission from )
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1.9 Repair. Angiogenesis and fibroplasia result in the formation of the mature extracellular matrix. Epithelialization also occurs. The macrophage, derived from the wound monocyte, is integral to stimulation of the process. The myofibroblast is essential to wound contraction and ECM modulation. (Modified with permission from )
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1.10 Repair. Complex interactions within the ECM allow movement of cells into the wound and the formation of new structures. Ligands within the ECM bind integrin receptors on the fibroblasts to facilitate cell migration through a path cleaved by proteases (MMPs).
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1.13 Maturation. Remodelling of the ECM reduces the cellular, collagen and vascular content of the matrix. Collagen reorientation and cross-linking increases wound strength. (Modified with permission from )
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1.15 Changes in wound strength during wound healing. Axes not to scale. (Modified with permission from )

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