Indian Journal of Plastic Surgery
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Year : 2012  |  Volume : 45  |  Issue : 2  |  Page : 220--228

Cellular events and biomarkers of wound healing


1 Discipline of Plastic Surgery, Universiti Teknologi MARA, Jalan Selayang Prima 1, Batu Caves, Selangor, Malaysia
2 Centre for Pathology Diagnostic and Research Laboratories (CPDRL) and Institute of Medical Molecular Biotechnology, Universiti Teknologi MARA, Jalan Selayang Prima 1, Batu Caves, Selangor, Malaysia
3 Department of Surgery, Melaka Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia
4 Department of Surgery, Faculty of Medicine, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, JKR 1235 Bukit Azah, Johor Bahru, Malaysia

Correspondence Address:
Suneet Sood
Department of Surgery, Faculty of Medicine, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, JKR 1235 Bukit Azah, Johor Bahru
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0358.101282

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Researchers have identified several of the cellular events associated with wound healing. Platelets, neutrophils, macrophages, and fibroblasts primarily contribute to the process. They release cytokines including interleukins (ILs) and TNF-α, and growth factors, of which platelet-derived growth factor (PDGF) is perhaps the most important. The cytokines and growth factors manipulate the inflammatory phase of healing. Cytokines are chemotactic for white cells and fibroblasts, while the growth factors initiate fibroblast and keratinocyte proliferation. Inflammation is followed by the proliferation of fibroblasts, which lay down the extracellular matrix. Simultaneously, various white cells and other connective tissue cells release both the matrix metalloproteinases (MMPs) and the tissue inhibitors of these metalloproteinases (TIMPs). MMPs remove damaged structural proteins such as collagen, while the fibroblasts lay down fresh extracellular matrix proteins. Fluid collected from acute, healing wounds contains growth factors, and stimulates fibroblast proliferation, but fluid collected from chronic, nonhealing wounds does not. Fibroblasts from chronic wounds do not respond to chronic wound fluid, probably because the fibroblasts of these wounds have lost the receptors that respond to cytokines and growth factors. Nonhealing wounds contain high levels of IL1, IL6, and MMPs, and an abnormally high MMP/TIMP ratio. Clinical examination of wounds inconsistently predicts which wounds will heal when procedures like secondary closure are planned. Surgeons therefore hope that these chemicals can be used as biomarkers of wounds which have impaired ability to heal. There is also evidence that the application of growth factors like PDGF will help the healing of chronic, nonhealing wounds.






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