After occur damage of tissue that caused by surgical action
or accidental vulnus, will be always accompanied by changes in molecular and
cellular that is the body's reaction to repair damage of tissue.
In principle, the overall process of sanatio vulnera include
the formation of fibrous tissue ( fibroplasia ) and regeneration of the
epithelium.
Phase treatment of vulnus include :1. Inflammatory phase.
Inflammation is a response of vascular and cellular on damage of tissue to overcome the contamination of microorganisms, neutralize irritants and improve elimination of necrotic tissue. Hemoragi which occurred after the formation of the wound will flow into the wound, then the blood will be frozen and dried so that occur the formation of crustae that have task protects the surface vulnus.
Immediately after the formation of the wound will be followed by process of acute inflammatory characterized by increase permeability of capillary and within 12 hours will accumulate exudate in the vulnus which containing erythrocytes, leukocytes core polymorphs, fibrin and macrophages. In the first 24 hours will occur increase polymorphs cells then further will be destroyed within 48 hours. Further, between 24 to 72 hours followed by the process of phagocytosis by activity of macrophages so that debris of cellular will be eliminated.
Elimination of necrotic tissue very necessary to promote healing of
vulnus. Vasoconstriction of blood vessels locally is the initial response to
tissue damage that occurs from 5 to 10 minutes. Then, occur vasodilatation 30
to 60 minutes after tissue trauma, endothelial of blood vessel that
experiencing of damage will be coated by leukocytes ( especially if occur on
the small blood vessels ). Activity fibroblastik in the form of secretion of
collagen and polysaccharides proteins that form granulation tissue that there
are on the edge of vulnus in 24 hours after formed vulnus and the number of
fibroblasts and the maximum mitotic activity occurred after 72 hours. Fiber of
collagen in the vulnus will be experiencing of hyalinisasi and looked swollen,
so that causing oedema and respone of pain in the wound.
Histamine, serotonin
and kinin released from mast cells with task on the walls of capillary blood
vessels that resulted in a decrease affinity of endothel cells from blood
vessels, so that mast cells can exit the blood vessel lumen. The role of
prostaglandin E occurs at the beginning of the inflammatory process and at the
ending with prostaglandins F and prostaglandin A, which the role of at the end
inflammatory reaction when simultaneously will be occurred early repair of
tissue damage.
2. Proliferation phase.
In minor injuries will occur reaction of acute inflammatory during 3 - 5 days after the formation of the wound. Fibrin and fibronektin are two factors that stimulate occur the fibroplasia. Fibronektin is glycoprotein with high molecular weight that stimulates the formation of fibrin and collagen. Activator of plasminogen from cells endothel of blood vessels that damage will be stimulate fibrinolysis. Excessive fibrin may inhibit migration of fibroblasts and cells epithelial. The formation of collagen by fibroblasts will be eliminated fibrin from the wound surface. Activity of collagenase in the development of cells epithelial required for regulation of collagen. Fibroblastic phase is over 2 - 4 weeks or depending on the width of the wound. The end of this phase is marked by the formation of capillary, fibroblasts and collagen .
3. Recovery tissue phase.
Collagen contributes to the healing process during a few weeks after the healing process. Fiber collagen that mature will be resorbsi and fiber collagen that new will be formed to strengthen the wound. On the healing that perfectly cell formation must be balanced with the absorption of cells. The formation of cells with new branching and the formation of collagen with the process of hydrolysis, degradation and absorption. The end of this phase is marked by the formation of collagen is less than at the start of the healing process. Shrinkage of the edge surface of the wound resulted in injury to shrink, however, this shrinkage is not due to proliferation of epithelial or maturation of scar.
In general, process of healing vulnus in the tissue with each other is same, however there are some differences of principles that must be observed. Here is the process of healing wounds in body tissue :
1. Bone.
In the bone there are process of maturation and deferensiasi different beside phase of inflammation and collagen. In cellular that have task for healing of bone include osteoblasts, osteoclasts, condroblas and condroklas.
2. Cartilage.
These tissue often be found on the surface of the joints, where the nutritional needs be derived from synovial fluid. Therefore vulnus occurred in the joints area should be covered with bandages to prevent contact with air which in turn resulted in drying up the tissue.
3. Tendon.
Tendons are reviewed from locations of anatomis contained in the synovial membrane and some are located outside. For process of healing tendon is the role of facia cells around the tendon and tenoblas. Tendons are sutured and not located in the synovial membrane will experience healing with the proliferation of fascia cells and tenoblas around the tendon it. Cells of the fascia will be migration into the gap of tendon that ruptur in 2 - 3 days first, then after 7 days in tenoblas will be migration and has 14 days will be close the gap of tendon. Healing of tendons that be located in the synovial membrane come from cellular activity of membranes and around the tissue. At 7 weeks have been formed tendons cells that mature.
4. Musculus.
Healing of musculus happened through forming tissue of fibrosa without process of regenerasi , so that is though sewed will not generate strength at vulnus.
5. Facia.
Tissue of facia have the character of inelastic hence will generate tension at vulnus, so that required by supporter stitching until scar tissue become strength. This situation result happened time elongation at process of healing .
6. Mucosa.
Tissue of mucosa there are at inner organ system ( gastrointestinal tractus, respiratorius tractus, urogenitalia tractus ). Action healing of vulnus at tissue of mucosa have to be labour so that layer of mucosa do not too much losing because this matter will inhibit closing of vulnus. To give strength of vulnus shall stitching layer of submucosa must be done with good and for layer of serosa have to be sewed inversi.
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