Information about cause, treatment, and prevention

Normal Wound Healing

There are three phases in normal wound healing: inflammatory, repair, and remodeling.

To understand how keloids form, it’s important to know how normal wound healing takes place. Wound healing is complex, involving multiple processes that take place both simultaneously and in phases. One good way to grasp the overall concepts of wound healing is to think of it as a reconstruction project after an emergency. There are three phases in normal wound healing: inflammatory, repair, and remodeling, and the following explains these phases in terms of a reconstruction project:1-2,5

Inflammation Phase. Think of the inflammation phase as the body’s initial response to an emergency that causes damage and destruction. The wound occurs and the body sets off the alarms for emergency response crews to gather in all the necessary helpers to create the initial set up to begin repair and prevent further damage. Immune system cells are like the clean-up crew in this initial phase—getting rid of potentially harmful debris. This preparation takes 2-3 days to complete and move into the repair phase.

Repair Phase. In the repair phase the emergency response crews call in the construction crews and tradesmen to start generating all the components necessary to begin rebuilding. Extra construction provided by the body encourages the builders to produce these components. Reconstruction starts with the necessary material to build the foundation, scaffolding, and molds to form the reconstructed tissue. Tradesmen help put in new plumbing. The initial set up is taken down as the foundational scaffolding is constructed. Managers order in the right kinds and numbers of specialty workers to handle communications between all the construction crews and ease the transition from one phase to the next. At this time it is also determined which types of special equipment operators will be needed in the final phase. Setting up all this foundational and structural work takes 3-6 weeks.

Remodeling Phase. The remodeling phase is like putting the final finishing touches on a major reconstruction job. As the plumbing is being installed, signals go out to some of the repair phase construction crews and emergency operatives that special incentives are no longer necessary and production of certain structural components slows down.The managers start re-organizing the materials and workers, sending out clean-up crews to break down the scaffolding and forms as the final cement is put in place and calling in the special equipment operators to tie up loose ends.

The management of the construction materials and crews is all intricately coordinated, just as in any major project. As you can see, healing a wound is as complex as a major demolition, cleanup, and reconstruction project. If not regulated properly, sometimes things can go wrong in one phase that can result in a messy, unattractive final project—in other words, a keloid.

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Cytokines, commonly known as inflammatory proteins.
For example, proteins called growth factors and immune cells.
The fibrous clot.
For example, continued loss of blood.
For example, lymphocytes and macrophages.
Fibroblasts (collagen-producing cells), keratinocytes, and endothelial cells.
Mostly collagen III and proteoglycans with
small amounts of other collagens, elastin, and hyaluronic acid.
The extracellular matrix.
The endothelial cells.
Blood vessels and other membrane structures.
Regulatory proteins.
By prompting DNA to produce.
For example, signaling and inhibitor proteins.
Modified fibroblasts called myofibroblasts.
Blood vessels.
Fibroblasts and endothelial cells.
Inflammatory proteins.
In the form of proteins called growth factors.
Collagen and proteoglycan molecules.
MMP-enzymes (matrix metalloproteinases).
Type I collagen.
Modified fibroblasts called myofibroblasts.