Healing by second intention



This is the process by which open wound which is caused by considerable loss of tissue, or necrosis or wound infection, heals. The processes are as follows

 Healing can be performed by the following seven processes

  1. Creation of wound by infection, loss of tissue or necrosis

  2. Early: Filling of wound site by blood and fibrin clot and debris. Acute inflammation then commences at the junction of dead tissue.

  3. A few days: Scab is formed from the blood clot which dries A layer of epitheliocytes  forms at the junction of the living tissue with debris while capillary loops bring into the underlying living tissue macrophages, fibroblasts and polymorphonucelar leucocytes. Scar tissue formed contracts.

  4. A week later: Scab is shed while capillary loops form granulations  which include fibroblasts and macrophages.The combination of capillary loops and their contained cells form the granulation tissue. Loose connective tissue is formed by fibroblasts that have invaded the tissue.

  5. 2 weeks and beyond; epithelial covering of wound is complete and fibrogenesis continues with scar tissue forming beneath epithelial tissue.

  6. Months: Full thickness of the epithelium is restored with thicker collagenous scar beneath. This scar is contracted as a result of myofibroblasts in the forming granulation tissue. Remodelling of scar tissue then proceeds for months to come. Scar tissue may however become exuberant, hypertrophic or keloidal.


Monocyte  macrophages  fibroblast 


Skin explanatory video                     


Fibroblast secretion of collagen   



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