Wound healing

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Wound healing


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USMLE® Step 1 questions

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High Yield Notes

6 pages


Wound healing

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USMLE® Step 1 style questions USMLE

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During the wound healing process, a mediator was found to inhibit the inflammation which allows for regeneration and repair to take place. Which of the following is the most likely mediator that has this function?  

External References

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wound healing and p. 209


wound healing p. 209

Endothelial cells

in wound healing p. 209

Epidermal growth factor (EGF)

in wound healing p. 209

Fibroblast growth factor (FGF)

in wound healing p. 209


in wound healing p. 209

Wound healing p. 209


wound healing p. 209


in wound healing p. 209

Macrophages p. 415

in wound healing p. 209

Neutrophils p. 414

wound healing p. 209

Platelet-derived growth factor (PDGF)

in wound healing p. 209

TGF- β

in wound healing p. 209


in wound healing p. 209

Wound healing

phases of p. 209

scar/keloid formation p. 213


Wound healing, is the process where the body repairs damaged tissue after any traumatic injuries--anything from a paper cut to a stab wound.

Acute wounds heal up quickly over days to weeks, whereas chronic wounds like bed sores, foot ulcers, or infections, can persist for months.

Now, some tissues regenerate more easily than others, and the regenerative capacity of tissue is classified as labile, stable, and permanent.

Labile tissues like skin, connective tissue, and small and large intestine heal extremely well, because they contain stem cells, which are undifferentiated cells that can divide and renew the cells that have died.

Stable tissue, like the liver, recover from injury by having mature differentiated cells divide or regenerate via hyperplasia.

Permanent tissues like skeletal muscle, cartilage, neurons, and cardiac tissue have a weak regenerative capacity, because they lack these stem cells and cannot replicate via hyperplasia.

Typically, injured permanent tissues are replaced by scar tissue or fibrosis--ultimately resulting in loss of function of the tissue.

Now when it comes to the skin - which is often the most visible tissue that’s damaged, wound healing occurs by primary, secondary, and tertiary intention.

Healing by primary intention is when the wound edges come together--like what happens when two wound margins are stitched or sutured together.

When this happens, stem cells in the epidermis, or uppermost layer of skin are brought close together and can regenerate the damaged tissue near the surface of skin--leaving a minimal scar.

Healing by secondary intention occurs when the wound edges are too far from one another--this can be consequence of significant tissue loss or if there’s an object embedded in the wound that prevents the edges from coming together.

Examples of healing by secondary intention include tooth extraction sockets or severe burn injuries.

Since the stem cells in these wounds do not approximate, the wound is replaced primarily by connective tissue that grows from the base of the wound upwards.

Healing by tertiary intention, or delayed closure, is when a wound is cleaned and purposefully left open due to a high likelihood of being contaminated by bacteria--like during a dog bite injury.


Wound healing is the process of repairing damaged tissue after an injury. Different tissues have different regenerative capacities: labile tissue, like skin and intestine, heal well, while permanent tissue, like cartilage and skeletal muscle, have limited regenerative capacity and may result in scarring. Wound healing can occur by primary, secondary, or tertiary intention depending on how the wound edges approximate. The steps of wound healing are hemostasis, inflammation, epithelialization, fibroplasia, and maturation. Hemostasis involves the formation of a blood clot to prevent further blood loss, followed by inflammation where immune cells clear debris and microbes. Epithelialization involves the regeneration of the epidermal layer, while fibroplasia strengthens the wound with the production of collagen and ground substance. Maturation involves further strengthening of the wound through collagen crosslinking and wound remodeling.


  1. "Medical Physiology" Elsevier (2016)
  2. "Physiology" Elsevier (2017)
  3. "Human Anatomy & Physiology" Pearson (2018)
  4. "Principles of Anatomy and Physiology" Wiley (2014)
  5. "Potential prognostic factors for delayed healing of common, non‐traumatic skin ulcers: A scoping review" International Wound Journal (2019)
  6. "Antibiotics and antiseptics for surgical wounds healing by secondary intention" Cochrane Database of Systematic Reviews (2016)

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