Chapter3RepairtoInjury.docVIP

PAGE  PAGE 41 Chapter 3 Repair to Injury AIMS 1. To grasp pathologic characteristic and function of granulation tissue. 2. To be familiar with the types of wound healing and their characteristics. CONTENTS Gross specimen Tissue sectionGranulation tissueGranulation tissueWound healing of the skinScar of the skinHealing of fractureHealing of fracture KEY POINTS OF SPECIMEN OBSERVATION 1. Granulation tissue Basic pathologic changes (1) Gross morphology ◆ It is wet, reddish, soft and granular in gross appearance, looks like fresh granulation. (2) Histopathology ◆ Numerous newly formed small blood vessels, their endothelial cells are swollen; ◆ Lots of Fibroblasts between the small blood vessels; ◆ It shows a loose edematous ECM containing inflammatory cells. Specimen observation Tissue section: (Figs.3-01a,b,c,d) The tissue is taken from the base of an ulcer. ①There are inflammatory exudates and necrotic substance in the superficial layer, under which is granulation tissue, in the most inferior layer is scar tissue; ②The granulation tissue consists of many newly formed small blood vessels embedded in edematous and a loose ECM containing fibroblasts and inflammatory cells; ③The vessels are arranged as a series of loops arching into the superficial. The fibroblasts are spindle or irregular, with plentiful cytoplasm and oval light stained nuclei. Question: What are the main functions in the granulation tissue? How will the granulation tissue develop? 2. Wound healing of the skin Basic pathologic changes (1) First intention healing ◆ A regular, small scar is formed in the incision of the skin. Microscopically, the epidermis is thin under which small quantities of collagen fibers deposit. (2) Second intention healing ◆ A big, irregular scar is formed in the incision of the skin. Microscopically, hyaline degenerated collagen accumulates. Specimen observation Case abstract: A 30 year-old female received a caesarean operation one year ago, the operati