Wound Healing Primer英文文献.pdfVIP

Wound Healing Primer Stephanie R. Goldberg, MDa, Robert F. Diegelmann, PhDb,* KEYWORDS Acute wound Phases of healing Healing mechanisms Guidelines for healing Surgeons often care for patients with conditions of abnormal wound healing, which include conditions of excessive wound healing, such as fibrosis, adhesions, and contractures, as well as conditions of inadequate wound healing, such as chronic non- healing ulcers, recurrent hernias, and wound dehiscences. Despite many recent advances in the field, which have highlighted the importance of adjunct therapies in maximizing the healing potential, such as optimization of nutrition, growth factor therapy, advanced wound dressing materials, and bioengineered skin substitutes, conditions of abnormal wound healing continue to cause significant cost, morbidity, and mortality. To understand how conditions of abnormal wound healing can be cor- rected, it is important to first understand the basic principles of wound healing. PHASES OF WOUND HEALING Wound healing consists of a complex but very orderly array of overlapping phases in which highly specialized cells interact with an extracellular matrix to lay down a new framework for tissue growth and repair.1 There are 4 distinct but overlapping phases of wound healing, which include hemostasis, inflammation, proliferation, and remod- eling (Fig. 1). These phases are influenced by the various cellular interactions and are regulated by the local release of chemical signals such as cytokines, chemokines, growth factors, and inhibitors.2,3 HEMOSTASIS PHASE Immediately after tissue injury, hemostasis occurs to minimize hemorrhage. While the blood vessels constrict, platelets are activated by binding to the exposed collagen in the extracellular matrix. The platelets then release fibronectin, thrombospondin, sphin- gosine 1 phosphate, and von Willebrand factor, which