- After initial wounding, the blood vessels in the wound bed contract and a clot is formed.

- Characterized by production of polymorphonuclear neutrophils

- Begin to enter the wound site within six hours of clot stabilization

- The main role of PMNs is wound decontamination by phagocytosis by phagocytosis of bacteria

- Presence of macrophages

- Reaches peak concentration by approximately third or fourth day

- They remain in wound until healing is completed

- The wound is „rebuilt‟ with new granulation tissue

- Granulation tissue

- fragile structure composed of an extracellular matrix of fibrin, fibronectin, glycosaminoglycans, proliferating endothelial cells, new capillaries, and fibroblasts mixed with inflammatory macrophages and lymphocytes.

- Healthy granulation tissue is granular and uneven in texture; it does not bleed easily and is pink/red in color.

- Dark granulation tissue can be indicative of poor perfusion, ischaemia and / or infection.

- Fibroblasts migrate into the wound site on the 3rd

day after injury and achieve their peak numbers

by approximately 7th day.

- As the number of macrophages declines and

fibroblasts population increases, the wound

transforms from granulomatous tissue to

- granulation tissue.

- Fibroblasts produce type Ill collagen initially and

as the wound matures type I collagen is formed.

- Formation of new blood vessels at the site of injury takes place by proliferation of endothelial cells from the margins of severed blood vessels.

- The newly formed blood vessels are more leaky accounting for the more edematous appearance of new granulation tissue.

- Begins 5 to 7 days after injury.

- There is conversion of granulation tissue to fibrous connective tissue and decrease parallelism of collagen to the plane of the wound.

- Maturation of the epithelial layer quickly follows formation of the epithelial seal.

Scar strength is: in 1 Week

Scar strength is: in 3 Week

Scar strength is: in 12 Week

- Osteoclasts act as an organizational unit to debride necrotic bone from the wound margin similarly as macrophages remove tissue debris from the clot.

- New bone formation is apparent about 6 days after surgery.

- Bone formation is categorized into two types

- Begins 10 to 12 days after root end resection.

- The exact sequence leading to the formation of new cementum remains unidentified.

- Cementum covers the resected root end approximately 28 days.

- Begins 10 to 12 days after root end resection.

- The exact sequence leading to the formation of new cementum remains unidentified.

- Cementum covers the resected root end approximately 28 days.

The following are local factors except:

Bone formaton is categorized into two types and this type

- Woven bone formation

- Osteoblasts produce matrix vesicles through exocytosis of their plasma membrane.

- It begins with the deposition and growth of hydroxyapatite crystals in the pore regions.

- The crystals amalgamate to form spherulites whose union results in mineralization.

Bone formaton is categorized into two types and this type

- Lamellar bone formation

- Osteoblasts secrete an organic matrix composed of longitudinally arranged collagen matrix fibrils.

- Mineralization occurs by mineral deposition directly along the collagen fibrils.

- The osseous defect is filled with bone tissue by 16 weeks after surgery.

partial or total separation of the edges of the wounds

 in short reopening of the wound

 can be accidental or intentional

 ex: when surgical sutures get infected the physician may need to surgically reopen the wound. It can also happen accidentally when the wound has not fully healed and reopened due to excessive movement or pressure near or on the site of the wound

- these are open sores caused by poor blood circulation

- poor blood circulation can cause the wound not to heal properly making minors wounds that would normally heal quickly to not heal or heal longer which can lead the wound to develop into ulcers

 ex: patients with diabetes have high glucose levels that damage the blood vessels and result in the poor blood circulation in the body and this causes wounds not to heal or heal longer than expected because the nutrients needed for the wound to heal is not delivered.

- thicked raised scar

- contained within the site of injury

- occurs commonly in taut skin areas following skin trauma, burns or surgical incisions

- often regress completely with time

- also known as overgranulation or proud flesh

- wounds cannot heal with hypergranulation because it limits the ability of epithelial cells to migrate across the wound bed

- it appears light red or dark pink, smooth, bumpy tissue form and it is moist, soft to touch and may bleed easily

- occurs when granulation tissue during the proliferative phase grows beyond the wound surface due to excessive moisture, friction and/or pressure

- Also known as aggressive fibromatosis

- a rare type of fibrous tumor with low-grade malignancy and high potential of recurrence

- caused by trauma, hormonal factors (estrogen) or may have a genetic associations (familial adenomatous polyposis & garner's syndrome

- can occur anywhere in the body

- It is formed when connective tissue cells develop changes in its DNA. These changes cause the ct cell to multiply rapidly, creating a mass of cell (tumor).

- develops when normally stretchy (elastic) tissues are replaced by non-stretchy (inelastic) fiber-like tissue.

- fixed tightening of muscles, tendons, ligaments, or skin

- injury to and around a joint causes inflammation, which can lead to different structures sticking to each other, resulting in stiffness and limited motion