D R I M RA N A

PATHOLOGICASPECTS OF REPAIR

ABNORMALITIES IN TISSUE REPAIR

• Complications in tissue repair can arise from abnormalitiesin any of the basic components of the process• Deficient scar formation• Excessive formation of the repair components• Formation of contractures

• Inadequate formation of granulation tissue or formation of a scar can lead to two types of complications:• Wound dehiscence• Ulceration

DEHISCENCE ORRUPTURE OF A WOUND

• Abdominal surgery and is due to increased abdominal pressure.• Vomiting, coughing, or ileus can generate

mechanical stress on the abdominal wound.

ULCERATION

• Inadequate vascularization during healing.• For example, lower extremity wounds in

individuals with atherosclerotic peripheral vascular disease typically ulcerate.• Nonhealing wounds also form in areas devoid of

sensation. These neuropathic ulcers are occasionally seen in patients with diabetic peripheral neuropathy

EXCESSIVE FORMATION

Of the components of the repair process can give rise to hypertrophic scars and keloids.Accumulation of excessive amounts of collagen may give rise to a raised scar known as a hypertrophic scarIf the scar tissue grows beyond the boundaries of the original wound and does not regress, it is called a keloid

HYPERETROPHIC SCAR

KELOID FORMATION

• An individual predisposition, more common in African Americans• Hypertrophic scars generally develop after

thermal or traumatic injury that involves the deep layers of the dermis.

EXUBERANT GRANULATION

• Another deviation in wound healing consisting of the formation of excessive amounts of granulation tissue, which protrudes above the level of the surrounding skin and blocks reepithelialization• Excessive granulation must be removed by

cautery or surgical excision to permit restoration of the continuity of the epithelium

• Incisional scars or traumatic injuries may be followed by exuberant proliferation of fibroblasts and other connective tissue elements that may, in fact, recur after excision. • Called desmoids, or aggressive fibromatoses,

these neoplasms lie in the interface between benign and malignant (though low-grade) tumors

CONTRACTION

• In the size of a wound is an important part of the normal healing process.

• Exaggeration of this process gives rise to contracture and results in deformities of the wound and the surrounding tissues.

• Contractures are particularly prone to develop on the

palms, the soles, and the anterior aspect of the thorax.• Contractures are commonly seen after serious burns

and can compromise the movement of joints.