Talk:Wound healing

message: Sorry I made this page so rediculously long; it's most of the contents of a paper I wrote for a wound healing tutorial for school.  If you want to make new pages ou
== Headline text ==
t of each section or something, that would be cool.  Though I'd say this page still needs little blurbs about each phase and links to the pages in that case.  Also, the proliferation phase is too long in this page and the maturation phase is too short.  You can help by expanding the maturation phase and cutting parts you think are unnecessary from proliferation.  Also, if you want to take the time to turn all the text's references into footnote links so the text is smaller and easier to read, that would be great.  And if you want to find links for all of the references and eliminate ones you think are unnecessary, also great. Matterafact, do whatever you want to it. --Delldot 01:17, 18 October 2005 (UTC)
replies: text: You have nothing to apologise for. I think this is excellent, interesting and very well supported. Things that might improve it would be internal Wikipedia links and illustrations. --Mylesclough 06:33, 20 October 2005 (UTC)
replies: text: I'm trying to change the Harvard refs to footnote style to make it shorter and more readable, but I can't get the numbers to correspond to the numbers in the footnotes; they just go up in order they're put in the article, even if the same thing is cited twice.  Anyone know how to fix this?  If you do, let me know or do it yourself.  Thanks. --Delldot 14:50, 20 October 2005 (UTC)
thread_title: Sorry

message: Why are there links to sites about maggots when this not discussed in the text?  The final link is also inaccesiblem Mike 12:02, 10 October 2006 (UTC)
thread_title: maggots?

message: A great deal of material was blanked in may and I didn't notice till now.  I'm in the process of restoring it and many of the refs that were removed.  I'm also making some changes, and this may take a couple hours.  I'd appreciate it if, as a favor to me, you could wait to make any edits until after I remove the notice.  If that's not possible, let me know and I can add your edits into the version I'm working on.  Thanks much, delldot | talk 04:00, 27 December 2006 (UTC)
replies: text: I'm about half done converting the refs and have removed the in use template.  I'll have to put it up again when I finish replacing the refs.  Thanks everyone!  delldot | talk 06:34, 27 December 2006 (UTC)
replies: text: I've stuck the tag back up so I can finish the other half of converting the refs.  Let me know if anything comes up.  delldot | talk 04:07, 31 December 2006 (UTC)
replies: text: OK, changes done, tag removed.  delldot | talk 05:19, 31 December 2006 (UTC)
thread_title: Major edit in progress

message: I added a little on scarring, and was going to add two recent reviews, but for some reason it won't work, can someone post to the tutorial on adding references, I can't seem to get the right combination of links. The reference are  Eur J Surg. 2002;168(10):523-34.  and Wound Repair Regen. 2005 Jan-Feb;13(1):7-12.
I plan to extend the scarring section slightly and improve the links to pathological scarringGasboy 23:26, 25 January 2007 (UTC)
thread_title: scarring

message: Overall quite good, however I think the section on proliferation could use some work on flow --the tie between collagen/angiogenesis/epithelialization and granular tissue was a bit confusing.  I'm by no means an expert on this and I don't feel comfortable making the changes myself. --Bobak 23:01, 19 February 2007 (UTC)
thread_title:  Suggested refinement: proliferation phase 

message: Impressive discussion. When I worked on the early topical hyperbaric driven tissue regeneration program with Sandia Nat Lab/UCLA/VA, it was noticed that scar tissues did not form. We were able to fill deep ulcers with healthy tissue in just a few weeks. The only other example of this was working with embryonic tissues. You may thus want to go back and review some of the work of Madalene Heng to get this mechanism. Dr. E. McGowan 68.6.94.22 (talk) 09:44, 9 August 2009 (UTC)
thread_title: Note on scar tissue

message: Great article, I have made some minor changes to the introduction and will look at the rest when I can. If you don't like them - just delete! Thanks. (I spend all day 9-5 looking at wounds so might have something useful to say).  —Preceding unsigned comment added by Mark3k (talk • contribs) 23:13, 28 November 2007 (UTC)
thread_title:  Minor changes 

message: please add a timeline. ex. number of days until this phase... etc etc.Tkjazzer (talk) 01:27, 11 February 2008 (UTC)
replies: text: Ooh, that's an awesome idea.  We could maybe even make an image, that would be very cool.  I'll add this to my embarrassingly vast to do list, but if others want to get to this before the end of the next century... delldot talk 10:47, 12 February 2008 (UTC)
thread_title:  timeline 

message: It would be great if you guys could add a 'wound healing for dummies' section for the non-medical folks.  —Preceding unsigned comment added by 84.45.218.135 (talk) 18:49, 25 April 2008 (UTC)
replies: text: Sounds like a great idea, I can work on getting rid of the too technical language.  If you notice something in particular, definitely bring it up here, or have a go at it yourself!  delldot on a public computer talk 06:49, 8 May 2008 (UTC)
replies: text: Agreed. I followed a disambig page here for Scab and was looking for a 10,000 foot view of what they're made out of, how they form, and why they happen. This article is very jargon-heavy, even in the introductory paragraph. CSZero (talk) 16:10, 2 June 2013 (UTC)
replies: text: You aren't alone.  I hope my new section on this talk page will help get your message acted upon.  — President Lethe (talk) 16:29, 3 March 2014 (UTC)
thread_title:  Less technical section for non-medical readers? 

message: As a general reader coming here for information, I was disappointed there was no information regarding nutrition to support wound healing. Maybe a section would be helpful on what nutrients are essential for wound healing? Like protein, etc. --142.46.14.98 (talk) 17:36, 25 August 2008 (UTC)
thread_title:  Section Addition Idea(s) 

message: Does this link really provide more info?  "BioTherapeutics Education and Research Foundation."  --Abbaroodle (talk) 13:44, 27 July 2009 (UTC)
replies: text: No, so I have removed it. JamesBWatson (talk) 20:08, 27 July 2009 (UTC)
thread_title:  Links? 

message: Wound healing is a complex but orderly phenomenon involving a number of processes:
i)	coagulation
ii)	induction of an acute inflammatory  process by the initial injury
iii)	regeneration of parenchymal cells
iv)	migration and proliferation of both parenchymal and connective tissue cells
v)	synthesis of ECM proteins
vi)	remodeling of connective tissue and parenchymal components
vii)	collagenization and acquisition of wound strength
Coagulation: 
Coagulation is the process by which prothrombin is converted into the proteolytic enzyme thrombin, which in turn cleaves the fibrinogen molecule to form insoluble fibrin in order to stabilize and add to the platelet plug.  Coagulation consists of a series of zymogen activation stages in which circulating proenzymes are converted in sequence to activated proteases.  The traditional concept of the clotting system evolved from test tube analysis and follows two pathways:  the intrinsic pathway involves components normally present in blood, and the extrinsic pathway is initiated by the tissue lipoprotein.  The clotting system and inflammation are intimately connected processes.
Injury causes hemorrhage from damaged vessels and lymphatics.  Vasoconstriction occurs almost immediately as a result of release of catecholamines.  Various other vasoactive compounds, such as bradykinin, serotonin and histamine are released from tissue mast cells.  They initiate the process of diapedesis, a passage of intravascular cells through vessel walls and into the extravascular space of the wound.  Platelets derived from the hemorrhage form a haemostatic clot.
The platelets release clotting factors to produce fibrin, which is haemostatic and which forms a mesh for the further migration of inflammatory cells and fibroblasts.  Fibrin is produced from fibrinogen, which is formed by the action of thrombin in the presence of thromboplastin.  If the fibrin mesh is eliminated, the wounds ultimate strength is diminished.  Fibrin serves as the frame work on which fibroblasts and endothelial cells to  develop along.
Platelets are also extremely important because they are the first cells to produce several essential cytokines, which modulate most of the subsequent wound healing events.  These cytokines include PDGF, EGF, TGF-β.
Acute Inflammatory Process:
Acute inflammation is the immediate and early response to an injurious agent.  It is complex reaction the vascularized connective tissue.  There are three major components: i) alterations in vascular caliber that lead to an increase in blood flow, ii) structural changes in the microvasculature that  permit the plasma proteins and leukocytes to leave the circulation and iii) emigration of the leukocytes from the microcirculation and their accumulation in the focus of injury.
Inflammation is a vascular and cellular response that serves to clean dead tissue and foreign bodies from the wound.  During this phase, the microcirculatory response is promoted with aggregation of blood cells, kinins, and products favouring haemostasis, and isolation and neutralization of tissue irritants.  With this, cleaning of the damaged tissue allows tissue repair.  This phase lasts from three to ten days.  Macrophages move into the inflammatory environment and are important constituents of granulation tissue, responsible for clearing extracellular debris, fibrin, and other foreign material at the site of repair.
Regeneration of parenchymal cells:
Regeneration denotes replacement of injured cells by cells of the same type, sometimes leaving no residual trace of the previous injury.  With injury, cell replication is stimulated which is controlled by a complex interplay of growth factors, growth factor receptors, transduction mechanisms and transcription factors.  The entry and progression of cells through the cell cycle are controlled by changes in the levels and activities of cyclins.  
Fibrosis:
Tissue destruction of both parenchymal and stromal tissue cannot be repaired solely by regeneration.  Repairing tissue damage then occurs by replacement of nonregenerated parenchymal cells by connective tissue.  This involves:
i)	formation of new blood vessels
ii)	migration and proliferation of fibroblasts
iii)	deposition of extracellular matrix (ECM)
iv)	maturation and organization of the fibrous tissue
Formation of fibrous tissue occurs by formation of granulation tissue which consists of new small blood vessels and proliferation of fibroblasts. 
Formation of new blood vessels first involves degradation of the basement membrane of parent vessels, to allow formation of a capillary sprout and subsequent cell migration.  This is followed by migration of endothelial cells toward the angiogenic stimulus, vascular endothelial growth factor (VEGF) and fibroblast growth factors (bFGF).  There is proliferation of endothelial cells behind the leading front of migrating cells.  Maturation of endothelial cells then occurs which includes inhibition of growth and remodeling into capillary tubes which is controlled by the angiopoietins and their receptors.  Recruitment of periendothelial cells to provide support for the endothelial tubes is the final step in maturation.
Migration of fibroblasts to the site of injury and their subsequent proliferation are triggered by multiple growth factors, including TGF-β, PDGF, EGF, FGF, and the so called fibrogenic cytokines, interleukin-1 and TNF-α.  These growth factors are derived from platelets and a variety of inflammatory cells as well as activated endothelium.  These inflammatory cells also elaborate TGF-β, PDGF, and bFGF and therefore promote fibroblast migration and proliferation.  If the appropriate chemotactic stimuli are present, mast cells, eosinophils, and lymphocytes may be increased in number.  Each of these can contribute directly or indirectly to fibroblast migration and proliferation.  Of the growth factors involved in inflammatory fibrosis, TGF-β appears to be the most important because of the multitude of effects that favor fibrous tissue deposition.
As repair progresses, the number of proliferating endothelial and fibroblast cells decreases.  Fibroblasts progressively become more synthetic and deposit increased amounts of ECM.  Fibrillar collagens (collagens I, II, III) form a major portion of the connective tissue in repair sites and are important for the development of strength in healing wounds.  Collagen synthesis by fibroblasts develops as early as days 3 to 5 and continues for several weeks depending on the size of the wound.  Ultimately, the granulation tissue scaffolding is converted into a scar composed of spindle-shaped fibroblasts, dense collagen, fragments of elastic tissue and other ECM components.  As the scar matures, vascular regression continues, eventually transforming the richly vascularized granulation tissue into a pale, avascular scar.
Tissue remodeling:
The replacement of granulation tissue with a scar involves transitions in the composition of the ECM.  This change in ECM composition is brought about by changing balances of synthesis and degradation.  Degradation of collagen and other ECM proteins is achieved by a family of matrix metalloproteinases, which are dependent on zinc ions for their activity.  Metalloproteinases consist of interstitial collagenases(cleave the fibrillar collagen), gelatinases(cleaves type IV collagen), stromelysins (acts on a variety of ECM proteins including proteoglycans, fibronectin, laminin and amorphous collagens) and membrane bound matrix metalloproteinases.  Matrix metalloproteinases are inhibited by a family of specific tissue inhibitors of metalloproteinases which are produced by most mesenchymal cells.
Different tissues will have varying modifications to their remodeling process, e.g. bone will have deposition of calcium hydroxyapatite.
Wound strength:
For skin, when sutures are removed, usually at the end of the first week, wound strength is approximately 10% of the strength of unwounded skin, but it increases rapidly over the next 4 weeks.  At three months, the tensile strength of the wound is about 70 to 80% of unwounded skin.
Local and systemic factors that influence wound healing:
Systemic factors which influence wound healing include:
i)	Nutrition has profound effects on wound healing.  Protein deficiency, for example, and particularly vitamin C deficiency inhibit collagen synthesis and retard wound healing.
ii)	Metabolic status can change wound healing.  As exemplified by diabetes mellitus which can slow wound healing.
iii)	Circulatory status  as inadequate blood supply and impaired venous drainage impair wound healing
iv)	Hormones such as glucocorticoids have anti-inflammatory effects that influence various components of inflammation and fibroplasia and also inhibit collagen synthesis
Local factors which influence healing include the following:
i)	Infection is the single most important cause of delay in healing
ii)	Mechanical factors such as early motion of wounds also delay healing
iii)	Foreign bodies such as sutures and debris constitutes impediments to healing
iv)	Size, location and type of wound also influence wound healing.  Wounds to the face and other well vascularized areas heal more quickly than poorly vascularized wounds
Pathological aspects of wound healing:
Inadequate formation of granulation tissue or assembly of a scar can lead to wound dehiscence or ulceration.  Dehiscence or rupture of a wound is most common after abdominal surgery and is due to increased abdominal pressure.  This mechanical stress on the abdominal wound can be generated by vomiting, coughing or ileus.  Wounds can ulcerate because of inadequate vascularization during healing.  For example, lower extremity wounds in individuals with atherosclerotic, peripheral vascular disease typically ulcerate. Non healing wounds also form in areas devoid of sensation, neuropathic ulcers, as seen in diabetic peripheral neuropathy.
Excessive formation of the components of the repair process can also complicate wound healing.  Aberrations of growth may occur even in what may begin initially as normal wound healing.  The accumulation of excessive amounts of collagen may give rise to a raised tumorous scar, either a keloid or hypertrophic scar.  Keloid scars are more common in blacks.   Exuberant granulation tissue may interfere with epithelialization and should be removed.  
Contraction in the size of a wound is an important part of the normal healing process.  An exaggeration of this process is called a contracture and results in deformities of the wound and the surrounding tissues.  Contractures are particularly prone to develop on the palms, soles and the anterior aspect of the thorax.  These are commonly seen after serious burns and may compromise joint movement.  —Preceding unsigned comment added by 65.183.8.194 (talk) 19:09, 9 March 2010 (UTC)
thread_title:  Pathology 

message: This article should cross-reference WP articles on Wound dressing and wound care, development and current status of moist bandaging technique as facilitating and speeding healing process while protecting from infection.  —Preceding unsigned comment added by Ocdnctx (talk • contribs) 15:03, 15 May 2011 (UTC)
thread_title:  This article should cross-reference WP articles on Wound dressing and wound care.  

message: According to a British pharmacy company, skin wounds heal more effectively if they are not allowed to dry out and form a hard scab. Is this true, and if it is, what studies have shown evidence for it? Can someone add a section on it to the article, and also anything about the effectiveness of hydrocolloid plasters making wounds heal better? Wsmss (talk) 10:23, 30 April 2012 (UTC)
replies: text: 98.209.166.26 - Studies have shown repeatedly that protective dressings help wounds heal more quickly, more thoroughly, and with reduced infection rates. Published studies can be found on the PubMed site. (Some search results will link to full, free articles while most provide an abstract summary only. If you want to see a whole, though protected, article, contact the research librarian at your public library who may be able to order it for you, or contact the medical librarian at your local hospital.) For example, this particular study (abstract only) found that humble over-the-counter supplies increase the healing effectiveness in wounds that even we amateurs can utilize: http://www.ncbi.nlm.nih.gov/pubmed/25059458  (Note that "picking" can easily lead to infection and increased scarring.) Thank you, Wordreader (talk) 08:13, 3 December 2014 (UTC)
thread_title:  Moist wound healing 

message: Apparent consensus for this merge on Wikipedia_talk:WikiProject_Medicine#Scarless wound healing. Lesion (talk) 11:15, 4 October 2013 (UTC)
replies: text: And here is a diff-link to that discussion to enable quick access to it once it is archived. Flyer22 (talk) 11:44, 4 October 2013 (UTC)
thread_title:  Merge from [[Scarless wound healing]] 

message: After a clot has formed and inflamation decreases, there is growth of new skin under the clot.  After new skin has formed, the fibers that hold the clot to the wound break or weaken so that the clot falls off or can be easily pulled off without damaging the new skin.  Sometimes new skin does not form under the clot and any attempt to pull off the clot months after the injury, results in new injury.  These normal and abnormal processes are not adequately described in this article.  Perhaps there are healing substances under the clot that cause new skin to grow, but if these substances are not all present, no new skin forms or new dermal cells form, but fail to complete an epidermis. Greensburger (talk) 21:55, 25 January 2014 (UTC)
thread_title:  New skin under the clot 

message: I was looking here for information on scabs and I agree with the comment above that at least scabs should be defined on first appearance in text, please.
2.217.209.130 (talk) 17:05, 20 April 2014 (UTC)
replies: text: I think scabs need their own article, this is one of the densest most complex articles I have seen outside of mathematical topics and that's saying something. 90.250.1.152 (talk) 16:25, 17 June 2023 (UTC)
thread_title:  yes, please clarify formation of scabs 

message: I don't mind the process of coining new words for new things, I grimace when I read "terms of art" that remind me of the slang of the criminal underground, but this is ridiculous! At least invent a Latin or Greek word I can look up. 
Besides the article is mostly BS. 67.206.163.192 (talk) 00:51, 12 March 2014 (UTC)
replies: text: I don't know how hard you looked before you felt it necessary to declare the page bullshit, but primary intention is where the skin heals with the margins of the wound in apposition. No new area of tissue is required to close the defect. Secondary intention usually occurs with more extensive wounds, or ones which are not sutured closed and tend to gape open. An area of new scar tissue forms. Lesion (talk) 02:14, 12 March 2014 (UTC)
replies: text: Somewhere along the way, 67.206.163.192, you may have heard another term for "primary intention": "first intention", if that helps, as in "healing by first intention". Thank you, 24.47.173.120 (talk) 22:26, 2 December 2014 (UTC)

text: Sorry - I posted too soon. That's me - Wordreader (talk) 22:30, 2 December 2014 (UTC)
thread_title:  Wth is Primary intention? 

message: Influence of Short-term, Repeated Fasting on the Skin Wound Healing of Female Mice - Sridc (talk) 17:01, 7 November 2019 (UTC)
thread_title:  Fasting & wound healing 

message: It appears that a (nonetheless, interesting) landscape photo has been inserted into this group of images. Drlegendre (talk) 06:02, 11 May 2022 (UTC)
thread_title:  Vandalism of image captioned "Deep wound on shin with stitches healing over five weeks"? 

message: It starts off by stating exactly what wound healing is so it catches the audiences attention right away. It states what the article is going to be about and gets right to the point. Content is up to date. Article does a very good job of explaining all the different stages. The article is unbiased and keeps the information very neutral. States a lot of facts and information. Sources are reliable and back up what the article is saying. The sources are up to date. The sources also give a lot of good and reliable information. The organization is okay. I think it could use some work. I feel like a lot of information is just thrown on a page and it's hard to find things. Spelling looked good and I did not find any errors. The images are great. It helps you understand the information you are reading. It shows the different kinds of wounds and the stages a wound goes through to heal. The conversations going on were talking about specific things going on in the article. Whether it was something the reader didn't like or how the liked a specific thing or wanted clarification on a specific something. It is part of a wiki project. It is part of the physiology project. I really like this article. It has really good information and pictures. It gives a lot of information and goes into specifics about everything. I think the information could be a little bit more organized. I think it is well-developed.  Bnesheim3 (talk) 05:20, 21 February 2023 (UTC)
thread_title:  Article  

message: For the time lapse series of pictures titled “Deep wound on shin with stitches healing over five weeks” in this article, one of the pictures is a landscape that has nothing to do with the subject matter. 2603:8001:6E00:B2B5:F55F:3852:CBD5:9A0E (talk) 02:11, 30 May 2023 (UTC)
thread_title:  Picture Problem