what are the 4 phases to the healing process?
Hemostasis, Inflammation, Proliferation, and maturation
the healing process begins
immediatley following the injury, while each of the stages of healing may vary in lenght the process applies to all trauma or injury to vascularized tissue regardless of the degree of injury.
immediately upon trauma and injury to the blood vessels
Goal of hemostasis
to stop bleeding and limit contamination from the enviornment via clot formation
what happens in hemostasis?
SNS relases epinephrine and norepinephrine to cause vasoconstriction for the first 5-15 min, chemicals relased by the damaged cells attract platelets to the area, thrombin is produced to convert fibrinogen to fibrin, fibrin is what forms the meshwork to hold the platelet plug together, thrombin also stimulates vascular permeability and facilitates extravascular migration of inflammatory cells
Inflammation phase occurs
day 1-6 (24 hrs)
Goal of Inflammation phase is
to lacate areas of trauma/diseased and destroy, decrease ilolates damaged cells
cardinal signs of inflammation heat
cabor= increases vascularity
cardinal sign of inflammation redness
cardinal sign of inflammation swelling
tumor=blockage of lympatic draninage
cardinal sign of inflammation pain
dolar= physical pressured/or chemical irritaiton of pain sensitive structures
cardinal sign of inflammation loss of function
functio ????? pain and swelling
casuses of inflammation
soft tissue trauma, fx, sutures autoimmuned diseases, bacterial/virial agents, thermal agents chemical agents
Inflammatiion vascular response
immediate constriciton of damaged vessels to minimize blood loss, dilation of nerby umdamaged vessels and increased capillary permeability causing imflammatiion, blood vessel walls become attracted to on another and "stick", this and vasoconstriciton increase the viscosity of the blood, which eventually leads to clotting, pressure changes cause edema by increasing fluid flowing into intersitial spaces
first fluid formed, few cells and little protein
more viscous and cloudy, high content of lipids and cellular debris (blisters)
increased leukocytes in exudates, may also include bacteria if infection is present
Hemostatic response to inflammation
controls the blood loss following injury, platelets are the first cells to respond: aid with relasing fibrin to begin clotting, fibrin and fibronectin form a "web" to limit bleeding and fluid drainage:helps confine the imflammatory process and provides strenght to the damaged tissues
cellular response to inflammation
erythrocytes provide oxygen to the area and leukocytes clear the site of debris and microorgamisms
Inflammation immune response
cellular and humoral factors are both involved, complement system is activated, main occurrences during theis stage are indreased vascular permeability, phagocytosis and chemotactic stimuli for leukocytes,without inflammation, healing cannot occur, however, the inflammatory response can cause further damage in certain autimmune diseases (RA, lupus) if it is prolonged and causes scar tissue
what does PRICE stand for ?
protection, rest, ice, compression, elevation
Proliferation phase -increas skin tissues occurs
during days 3-20
proliferation phase goal is
wound is covered and strengthened
Proliferation phase Epithelialization
provides protective covering to the area of injury to prevent loss of fluid and decrease risk of infection, uninjured epithelial cells from bothe side of the injury reproduce and work toward one another when th two sides connec, the initial covering og the wound is formed
Proliferation phase collagen production fibroblast
grow and make collagen within the connective tissue, make procollagen and form a perpendicular web to add strenght to the wound area
proliferation phase collagen production branulation tissue
composed of capillaries, fibroblast and myofibroblasts, increases to provide a more permament stucture
Proliferation phase wound contraction
pulls the edges of the injury toghether and minimizes the size of the wound, myofibroblasts are the cells primarily responsible durings this stage as they contain contractile properties, if this process does not occur in a contolled manner contractures can result esp across joints
Proliferation phase Neovascularization
brings mew blood supply to area via formation of mew blood vessels, mew vessels are susceptible to injury because of their thin walls
Proliferation phase what can we do in PT?
AROM to stimulte collagen production and increase circulation to aide debris removal, must be careful not to stretch too aggressively as immature collagen fibers can tear easily and slow healing process.
Maturation phase occurs
beginning on day 9 and can last up to a year ofter the injury
maturation phase goal is
return atea to preinjury functioning state
Strength of new tissue formed in comparison to normal tissue
one week 3% , at three weeks, 20%, at three months, 80%
maturation phase collagen production (synthesis) vs. destruction (lysis)
collagen crosslinks add tensil strength to area, owygen dependency, synthesis is oxygen dependent, lysis is not, use of pressure garments decreases oxygen levels an helps aid in lysis of collagen and decreases collagen synthesis, synthesis > lysis, Hypertrophic or keloid scar develops (raised and may be outside original borders of scar)
Maturatrion phase what can we do in PT?
contine to exercise patient, as tension applied to the collagen detemines its orientation and ultimate strength> PROM , just because pain is gone dosent imply healing is done.