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NORMAL WOUND HEALING, fibroblasts require VIT C for producing collagen,…

- - - - PROLIFERATIVE
        
        REMODELLING
        
        MAXIMUM TENSILE STRENGTH OF WOUND AT 12 WEEKS POST INJURY
        
        AT 12 WEEKS 80% OF UNINJURED SKIN STRENGTH
        
        maturation of collagen leading to increased tensile strength
        
        type 1 collagen is aligned along the line of skin tension
        
        type 1 replaces type 3 , until ratio of 4:1 achieved
        
        decreased VASCULARITY of wound
        
        FIBROBLAST AND MYO FIBROBLAST ACTIVITY
        
        WOUND CONTRACTION
        
        CORTICAL STRUCTURE AND MEDULLARY CAVITY ARE RESTORED IN REMODELLING PHASE
        
        3RD DAY TO 3WEEKS
        
        new blood vessels as capillary loops ANGIONEOGENESIS
        
        RE EPITHELIALISATION of wound surface
        
        IN BONE PERIOSTEAL AND ENDO OSTEAL PROLIFERATION PRODUCE CALLUS
        
        CALLUS IS IMMATURE BONE LAID BY OSTEOBLAST AND MINERALIZED BY HYDROXYAPPATITE
        
        If fracture ends are accurately opposed and rigidly fixed then callus formation is minimal and PRIMARY healing occurs , If gap exists them SECONDARY healing with malunion non unionor delayed union happens
      - macrophages clear cells
        
        remove devitalized tissue
        
        remove micro organism
        
        regulate FIBROBLAST activity during PROLIFERATIVE phase
        
        FIBROBLASTS form COLLAGEN and ground substance ( GLYCOSAMINOGLYCANS AND PROTEOGLYCANS )
        
        EARLY PART OF PROROLIFERATIVE PHASE WOUND TISSUE IS GRANULATION TISSUE
        
        LATER PART OF PROLIFERATIVE PHASE
        
        Increase collagen deposition , initially type 3 that is randomly arranged
        
        wound contraction ie reduced area of wound
    - - vasoconstriction , thrombus formation
        
        platelet adhere to endothelium
        
        release ADH
        
        THROMBUS FORMATION
        
        release of transforming growth factor beta, platelet derived growth factor and platelet factor 4
        
        these are cytokines ,
        
        ATTRACT POLYMORPHONUCLEAR LYMPHOCYTES
        
        release amines like HISTAMINE , SEROTONIN and release PROSTAGLANDINS
        
        These are vasoactive
        
        increase vascular permeability
        
        aid cellular infiltration
    - - rubor , tumor, calor, dolor