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ƕ Repair by scar [organization] Ƌ when there is tissue loss

- healing by proliferation of connective tissue resulting in
fibrosis and scar formation
ƕ At times both occur together
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ƕ Whether regeneration or fibrosis is
dependent upon the regenerative ability of
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ƕ Tissue Type
- Labile
- Stable
- Permanent
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ƕ Whether regeneration or fibrosis is dependent
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ƕ Stem cells pool in labile and
stable population
ƕ Minority population located
epidermis - basal layer adjacent to BM
intestine - bottom of crypts
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ƕ Continuously dividing
ƕ Regenerate from a population
of stem cells after injury
ƕ >1.5% cells in mitoses
ƕ Examples
- Cells in contact with environment-epidermis,
alimentary tract, respiratory tract, urinary tract,
vagina, cervix, uterus
- Lymphoid Cells Ƌ lymph node, spleen
- Haematopoietic Cells
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ƕ Low level of replication
- < 1.5% of normal adult cells are
in mitoses
ƕ Can respond to stimuli
ƕ Examples
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Ƌ Need intact basement
membrane eg. renal tubules
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Ƌ 2. vascular endothelium
Ƌ 3. bone
Ƌ 4. cartilage cells
Ƌ 5. Mesenchymal cells
ƕ Smooth muscle cells
ƕ Fibroblasts
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ƕ Cells donƎt divide

ƕ No regenerative ability
ƕ 0.0% cells are in mitoses
ƕ Examples
Ƌ Neurons
Ƌ Lens epithelium
Ƌ Cardiac myocytes
Ƌ Skeletal muscle cells
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ƕ Loss of labile population eg.
skin abrasion
ƕ Cells at margin proliferate to
cover defect
ƕ Spread as a thin sheet till
defect covered
ƕ When form confluent layer -
contact inhibition
ƕ Epidermis then rebuilt from
base upwards
ƕ Ability of adnexal glands to
regenerate - used in plastic
surgery
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ƕ Two Processes
1.-Granulation tissue formation with
removal of dead tissue by phagocytosis
2.-Contraction of wound
ƕ Cells involved Ƌ organ injured
- mesenchymal cells
- connective tissue stem cells
- fibrocytes
- histiocytes
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- macrophages,
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ƕ Reduce volume of repair tissue

ƕ Begins in 2-3 days and completes by 14th day
ƕ Result of contraction of myofibroblasts in granulation
tissue.
ƕ Retracts as a whole and brings together surrounding
tissue.
ƕ Collagen secreted at same
time forms a local scar
ƕ tho useful can produce defects
Ƌ Stenosis/stricture intestine
Ƌ Permanent contractions
Ƌ burns
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ƕ Process by which specialised tissues repaired by formation of

mature fibrovascular connective tissue
ƕ Granulation tissue Ƌ early
ƕ Dead tissue removed by macrophage
ƕ Granulation tissue contracts Ƌ scar forms which then undergoes
remodelling
eg. -Infarct
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ƕ Example: surgical wound

ƕ Result: healing with like tissue

and little scar formation
(fibrosis)

ƕ Epithelial regeneration
predominates over fibrosis

ƕ 24 hours
- Neutrophils migrate into
fibrin clot
- Basal cells at edges
- Increase mitotic activity
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ƕ 24 Ƌ 48 hours
Epithelial cells migrate and
proliferate
- Deposition of basement
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ƕ Days 3 - 7
- Macrophages replace
neutrophils
- Neovascularization
- Granulation tissue
- More collagen bundles
- Bridging of wound
- Epithelial cells continue
to proliferate
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ƕ Week 2 ( day 14)
Collagen accumulation continues
to increase
- Fibroblast proliferation
- WBC and edema decreases
- Vascular channels regress
- Blanching

ƕ 4 weeks
- scar formed by fibroblasts and
collagen
- Few inflammatory cells
- Tensile strength increases
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ƕ Injury more extensive Ƌtissue
loss excessive
- More inflammation
- More fibrin
- More granulation tissue
- More complex
repair process
- wound contracts
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ƕ Response characterised by
- phagocytosis to remove debris
- granulation tissue to fill defect
- repair specialised tissue loss
- epithelial regeneration to cover gap

ƕ Time scale will depend on volume of defect

ƕ Final cosmetic result will depend on quantum of tissue

loss and scarring
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ƕ Repair process same, slightly
modified
ƕ Haemorrhage Ƌ hematoma Ƌ
facilities repair Ƌ ground for cells
to grow
ƕ Removal of necrotic tissue
ƕ Organisation of hematoma
ƕ Special Ƌ capillaries accompanied
by fibroblasts and osteoblasts Ƌ
lay down irregular woven bone
(callus)
- replaced by lamellar bone -
gradually remodelled according to
direction of mechanical stress.
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ƕ Epithelium regenerates
ƕ Architecture Ƌ cannot
regenerate
- tubular damage Ƌ can
regenerate
- glomerular damage Ƌ
permanent Ƌ loss of
filtration capacity
- interstitial damage -
fibrosis
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ƕ Neurons - permanent cells Ƌ central nervous system

does not repair effectively
ƕ NO FIBROBLAST proliferation in brain damage
ƕ Necrotic tissue Ƌ liquefactive necrosis
ƕ Glial cells - may proliferate in response to injury to
produce a glial scar or gliosis.

ƕ Peripheral nerve damage - shows degeneration distal to

trauma and recovery depends on alignment and
continuity