Chapter 6. The Healing Process
Repair
• Processes that replace the ______________ or ______________ cells with healthy ones.
Relationship to Inflammation
• Repair ______________ inflammation
• Begins within a couple of ______________ after injury
– Depends on the size of the ______________
Two Types of Repair
• (1) ____________________ with the same type of cells as were injured
• Occurs in cells that normally have a high rate of turnover
• Most of the damaged cells are replaced by ______________ cells.
– Some replacement with ______________ tissue and thus some
______________ formation
• (2) ____________________ with simpler cells
• ______________ cells
–Results in ______________ formation
• Also known as repair by ______________ tissue
• Can be either ______________ union or ______________ union
• Primary
–
•
Secondary u
–
Four Phases of Repair
• (1)
• (2)
– Lymphatic drainage and exercise
• (3)
• (4)
Cellular
• Same as ______________ ______________ and ______________ that occurs during
inflammation
• ______________scavenger cellular debris.
• Circulatory and lymphatic systems remove ______________ ______________
• The more protein in the area, the bigger the ______________
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Lymphatic Drainage and Exercise
•
• Depends on ______________ ______________ to promote fluid movement
• ______________ squeezes the lymphatic vessels and forces contents toward the
______________ system.
• Massage and intermittent compression pumps promote______________ ______________
Vascular
• ______________ phase during which new vessels are formed
• Transient because ______________ vessels eventually ______________
• New vessels are necessary to deliver ______________ and ______________ to the wound for
repair
• New vessels are formed via ______________ ______________
• ______________ cells of existing vessels at the ______________ of wound begin to
______________
• New cells crawl away but keep contact with the ______________ vessel
• Adjacent ______________ ______________ migrate toward one another, meet, unite,
and create a ______________ ______________
• Arches form a ______________, or a capillary ______________
• Blood then begins to flow through, causing new budding.
– Gives free circulation to the wound area to support ______________
Collagenization
• ______________ and ______________ down collagen in the wound space
• Collagen is the principle solid substance of ______________, ______________, and
______________ ______________
• ______________ manufacture strands of collagen, then extrude it into the wound space.
• Most collagen is laid down within ____–____ days after the injury.
• Wound is not very strong yet due to ______________ ______________
• Collagen will realign ______________ to the lines of force.
• Realignment sometimes takes up to a ______________
– May be longer if patient is ______________
•
•
Requires great amounts of ______________
• Oxygen provides ______________
• Oxygen is the building block of ______________
Healing wounds normally do not have all of the oxygen that they could use.
• ______________ accumulated in the damaged tissue and the tensile strength of skin wounds
linearly related to ______________ availability
• ↑ oxygen =
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Contraction and Restructuring
 Process by which ______________ ______________ becomes smaller and paler
 Contraction occurs ______________
• Capillary arcade ______________
• Collagen is relatively ______________ tissue.
• Doesn’t need much ______________; therefore, doesn’t need much circulation
• Collagen ______________ occurs next
• Collagen fibers ______________ from haphazard to ______________ arrangement.
• Compacts scar
• Fiber reorganization gives the scar greater ______________
• Fibers running ______________ to the lines of force will not help keep the edges of
the wound together.
• Fibers running ______________ to the lines of force ______________ the injured
tissue.
• Active exercise is necessary during final phase of wound healing.
Exercise and Healing
• Stimulates ______________, thus increases ______________ delivery to healing tissue
• Provides ______________ lines that are ______________ as a guide to restructuring
collagen
– Too ______________ will ______________ the healing tissue
– Too ______________ will not provide adequate o ______________ or
______________ for normal healing
Healing Modifiers
*** Goal: To help the healing process. ***
• Immediate care procedures
– The ______________ the hematoma, the quicker the repair
• Close lacerations immediately.
–
•
•
Use suture or Steri-Strips to close the wound gap.
For best results:
– ASAP, but within 4–6 hr after injury
Therapeutic Exercise
• Facilitate or hinder healing?
– Brings more ______________ to the wound sites
– Guides fiber ______________ during restructuring
– ______________ exercise will tear the healing tissue and thus ______________
healing.
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Therapeutic Modalities
• Stimulate healing:
• Promote lymphatic drainage:
• Modulate pain, thus facilitating therapeutic exercise:
Proper Nutrition
• Many vitamins and trace elements are essential to healing.
• No evidence that extra facilitates healing.
• Lack of them, however, will hinder healing.
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