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What grading systems are used?

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Healing occurs via regeneration or replacement. regeneration is that the tissue is the same as before injury - repaired to the same state.

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primary, secondary, tertiary of delayed primary closure

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Molecular and cellular mechanisms in normal skin repair

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Molecular and cellular mechanisms in normal skin repair

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 Early stages of wound healing include hemostasis and activation of keratinocytes and inflammatory cells. The intermediate stage involves proliferation and migration of keratinocytes, proliferation of fibroblasts, matrix deposition, and angiogenesis. Late-stage healing involves remodeling of ECM, resulting in scar formation and restoration of barrier. 

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complete/durable closure

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Involves a complex interplay between many cellular mechanisms in the skin, primarily keratinocytes, fibroblast, endothelial cells of vessels and recruited immune cells

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keloids extend beyond the margins of the original tissue damage, do not tend to regress spontaneously, and show a genetic predisposition.

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Immune cells migrate to the wound site to orchestrate the healing process

Upregulation of wound-associated genes enabling collective cell migration

Local and blood-born fibroblast proliferate and migrate to form the wound granulation tissue

Deposit new extracellular matrix (ECM)

Keratinocytes around the wound edge change adhesions so that they can migrate to different parts of the wound- can detach from basement membrane.

Normal inflammatory response

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Hypertrophic scars develop after surgery, trauma, particularly burns, or spontaneously in predisposed patients.

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Chronic wound edge keratinocytes express a gene signature reflecting partial proliferative activation

Reduced growth factor signalling

Reduced levels of TGF-B receptors

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Chronic, persistent inflammatory response

A large influx and retention of innate immune cells to chronic wounds is likely to inhibit many repair processes.

Bactericidal and phagocytic activities may be reduced.

Build-up of necrotic debris at the wound edge

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The skin battery and the current of injury – 127207

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microbes need to be brought down to a stable level to be cleared and accepted by healthy tissue.

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microbes need to be brought down to a stable level to be cleared and accepted by healthy tissue.

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is a negative feedback loop mechanism for repair and regeneration of the skin.

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Chronic wounds are defined as barrier defects that have not proceeded through orderly and timely reparation to regain structural and functional integrity.

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Demographically, the number of patients suffering from chronic wounds and impaired healing conditions is reaching epidemic proportions and will become even more burdensome in both human health and economic terms.

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Chronic wounds show hyperproliferative and nonmigratory epidermis, unresolved inflammation, presence of infection, and biofilm formation.

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a majority occur on the lower part of the body'

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a majority occur on the lower part of the body'

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Frequently, hyperpigmentation as a consequence of melanocyte recruitment can occur at the wound site, and persist even after a chronic wound has successfully healed.

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Frequently, hyperpigmentation as a consequence of melanocyte recruitment can occur at the wound site, and persist even after a chronic wound has successfully healed

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1. Chronic wound
2. hypertrophic scar/wound

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1. inflammatory phases
"Inflammatory cells, such as neutrophils, monocytes, and endothelial cells, adhere to a fibrin scaffold that is formed by platelet activation. The neutrophils enable phagocytosis of cellular debris and bacteria, allowing for decontamination of the wound" (Wallace, 2020)
2. Proliferation phase- formation of granulating tissue, re epithelation and vascular - can take up to 7 weeks and is discrete goes un noticed /  happening in the background.
3. Maturation Phase
or re modelling phase.

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Chronic disease conditions affects millions of people worldwide each year. Contributing factors such as poor regulations of healthy tissue response, including factors such as inflammation, angiogenesis, matrix deposition and cell recruitment. Failure of any of these cellular processes are generally linked to an underlying clinical condition such as vascular disease, diabetes or aging. All of these factors are associated to poor healing. Other chronic conditions are venous leg ulcers, 

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Chronic disease conditions affects millions of people worldwide each year. Contributing factors such as poor regulations of healthy tissue response, including factors such as inflammation, angiogenesis, matrix deposition and cell recruitment. Failure of any of these cellular processes are generally linked to an underlying clinical condition such as vascular disease, diabetes or aging. All of these factors are associated to poor healing. Other chronic conditions are venous leg ulcers, 

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Able to follow the natural stages of the wound healing process, without any interference.   

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Able to follow the natural stages of the wound healing process, without any interference.   

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Prolonged inflammation phase turns into chronic condition

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Poor wound healing may be associated with inflammation, angiogenesis, matrix deposition and cell recruitment. 

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Poor wound healing may be associated with inflammation, angiogenesis, matrix deposition and cell recruitment. 

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this can lead to other chronic conditions within the body such as
- vascular disease
- diabetes

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arachadonic acid, complement and coagulation cascades?