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Topic: Current Concepts in Wound Healing

Current concepts in the physiology of adult

wound healing

Friji Meethale Thiruvoth, Devi Prasad Mohapatra, Dinesh Kumar Sivakumar,
Ravi Kumar Chittoria, Vijayaraghavan Nandhagopal

Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
Address for correspondence: Dr. Friji Meethale Thiruvoth, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical
Education and Research, Puducherry 605006, India. E‑mail: frijimt@gmail.com

ABSTRACT

Wound healing requires a complex interaction and coordination of different cells and molecules. Any
alteration in these highly coordinated events can lead to either delayed or excessive healing. This
review provides an overview of adult wound healing physiology. A review of the literature focused
on wound healing physiology and current advances in wound healing was conducted using the online
MEDLINE/PubMed database. The aim of this review was to inspire further investigation into wound
healing physiology that will ultimately translate into improved patient care.

Key words:
Cytokine, growth factor, inflammation, wound healing

INTRODUCTION collagen remodeling begins, along with vascular maturity
and regression; this process typically lasts 6‑24 months
Wound healing without complications is critical to the from the time of injury [Figure 1].
[1]
survival, as it restores the integrity of the skin and protects The wound healing cascade may be arrested in
the individual from infection and dehydration. Adult wound any of these phases, leading to the formation of a
healing involves a well‑orchestrated series of events leading chronic nonhealing wound. Many mediators including
to the repair of injured tissues, resulting in scar formation. inflammatory cells, growth factors, proteases such as
Healing of acute wounds, triggered by tissue injury, matrix metalloproteinases (MMPs) and cellular and
consists of overlapping and highly coordinated phases of extracellular elements play important roles in the process
hemostasis, inflammation, proliferation and remodeling. of wound healing. Alterations in one or more of these
When a breach of the skin’s integrity occurs, hemostasis components may lead to the impaired healing. Wound
[2]
is initiated by platelets through fibrin clot formation. healing can also be negatively influenced by many
Platelets also release various mediators of wound healing exogenous factors, including concurrent diseases, such as
to attract macrophages and fibroblasts to the site of diabetes, renal failure, malnutrition, smoking, radiation
[1]
tissue injury. The inflammatory phase begins with the exposure, infection and an immunocompromised state.
arrival of neutrophils followed later by macrophages and In the presence of these factors, wounds can fail to heal
[3]
lymphocytes at the wound site. The proliferative phase is adequately, resulting in chronic wound formation. The
characterized by new blood vessel formation (angiogenesis), wound healing process can occasionally go into overdrive,
synthesis of extracellular matrix (ECM) components and
re‑epithelialization. Following the proliferative phase, This is an open access article distributed under the terms of the Creative Commons
[2]
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix,
Access this article online tweak, and build upon the work non-commercially, as long as the author is credited
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Website: For reprints contact: reprints@medknow.com
www.parjournal.net
How to cite this article: Thiruvoth FM, Mohapatra DP, Sivakumar DK,
Chittoria RK, Nandhagopal V. Current concepts in the physiology of
DOI: adult wound healing. Plast Aesthet Res 2015;2:250-6.
10.4103/2347-9264.158851
Received: 12-01-2015; Accepted: 27-02-2015

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