General Pathology — Wound Healing and Cellular Injury

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Content Collagen accumulation reaches approximately its maximum around day 80; tensile strength continues to increase for months as collagen is remodelled and reorganised. Epidermal ingrowth from a wound margin is limited to approximately 1 cm. Infection is the most important local cause of delayed wound healing. Vitamin C is required for conversion of proline to hydroxyproline during collagen synthesis; deficiency therefore impairs wound healing. Secondary-intention healing requires more granulation tissue and contraction and produces a slower-healing, larger irregular scar than primary union. Hyperplasia increases cell number whereas hypertrophy increases cell size; permanent cells have little or no regenerative hyperplastic capacity. Dysplasia shows disordered maturation, loss of polarity, pleomorphism, increased nuclear:cytoplasmic ratio and increased mitotic activity. The characteristic nuclear sequence in necrosis is pyknosis → karyorrhexis → karyolysis. Necrosis characteristically provokes inflammation, whereas apoptosis produces controlled cell fragmentation without the same inflammatory response.

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