General concept of wound healing, revisited
Wound healing is a transition of processes which is also recognized as one of the most complex processes in humanÂ physiology. Complex series of reactions and interactions among cells and mediators take place in the healing processÂ of wound involving cellular and molecular events. The inflammatory phase is naturally intended to remove devitalizedÂ tissue and prevent invasive infection. The proliferative phase is characterized by the formation of granulation tissueÂ within the wound bed, composed of new capillary network, fibroblast, and macrophages in a loose arrangement ofÂ supporting structure. This second phase lasts from day 8 to 21 after the injury is also the phase for epithelialisation.Â The natural period of proliferative phase is a reflection for us in treating wound to reach the goal which ultimatelyÂ defines as closed wound. The final maturation phase is also characterized by the balancing between deposition ofÂ collagen and its degradation. There are at least three prerequisites which are ideal local conditions for the nature ofÂ wound to go on a normal process of healing i.e. 1) all tissue involved in the wound and surrounding should be vital,Â 2) no foreign bodies in the wound, and 3) free from excessive contamination/infection. The author formulated a stepÂ ladder of thinking in regards of healing intentions covering all acute and chronic wounds. Regarding the â€œhierarchyâ€Â of healing intention, the fi rst and ideal choice to heal wounds is by primary intention followed by tertiary intentionÂ and lastly the secondary intention. (Med J Indones 2009;18:206-14)
Key words: inflammatory mediator, epithelialisation, growth factor, wound healing
Copyright (c) 2009 Theddeus O.H. Prasetyono
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