Komarcević A, Pejakov L, Komarcević M
Klinika za decju hirurgiju, Institut za zdravstvenu zastitu dece i omladine, 21000 Novi Sad, Hajduk Veljkova 10.
Med Pregl. 2000 Sep-Oct;53(9-10):479-83.
A great deal of progress has been made in the last few decades in understanding the cellular and biochemical interplay that comprises the normal wound healing response. This response is a complex process involving intricate interactions among a variety of different cell types, structural proteins, growth factors and proteinases.
Acute wounds maturate through phases of coagulation, inflammation, matrix synthesis and deposition, angiogenesis, fibroplasia, epithelialization, contraction and remodelling, but three classic phases of wound healing are inflammation, fibroplasia and maturation.
Two main forms of fibroproliferative disorders are hypertrophic scars and keloids. These disorders are characterized by an overabundance of wound collagen through overproduction of collagen or impaired degradation of collagen. Hypertrophic scars are raised, pruritic and edematous lesions that do not exceed the margins of the original wound (in contrast to keloids). Histologically, these lesions are indistinguishable and are characterized by thick, hyalinized collagen bundles arranged in nodules. The degree of hypertrophic scarring is believed to be related to the duration of time during which the wound is allowed to remain in inflammatory phase of healing. Wound closure tension may also play a role by altering the intracellular cytoskeletion of fibroblasts and increased secretion of TGF-beta and cytokines.
Healing of chronic cutaneous wounds is still a great problem of modern society--huge costs, impaired quality of life. In the last few decades a great progress was made in understanding the cellular and biochemical interplay.
在过去几十年里，我们对构成正常伤口愈合反应的细胞和生化相互作用的理解取得了巨大进展。这种反应是一个复杂的过程，涉及多种不同细胞类型、结构蛋白、生长因子和蛋白酶之间的复杂相互作用。
急性伤口通过凝血、炎症、基质合成与沉积、血管生成、纤维增生、上皮形成、收缩和重塑等阶段成熟，但伤口愈合的三个经典阶段是炎症、纤维增生和成熟。
纤维增生性疾病的两种主要形式是增生性瘢痕和瘢痕疙瘩。这些疾病的特征是通过胶原蛋白过度产生或胶原蛋白降解受损而导致伤口胶原蛋白过多。增生性瘢痕是隆起、瘙痒和水肿性病变，不超过原始伤口的边缘（与瘢痕疙瘩相反）。从组织学上看，这些病变无法区分，其特征是厚的、玻璃样变的胶原束排列成结节状。增生性瘢痕的程度被认为与伤口处于愈合炎症阶段的持续时间有关。伤口闭合张力也可能通过改变成纤维细胞的细胞内细胞骨架以及增加转化生长因子-β和细胞因子的分泌而发挥作用。
慢性皮肤伤口的愈合仍然是现代社会的一个重大问题——成本巨大，生活质量受损。在过去几十年里，我们在理解细胞和生化相互作用方面取得了巨大进展。
