Soft tissue and wound repair process

1. Bleeding Phase (4-6hrs)

   – Bleeding occurs directly after the injury/trauma occurs. The amount of bleeding is dependent on the area of injury (if it is an area that is highly vascular or not e.g. muscle injuries will have more bleeding than ligament injuries). Bleeding typically stops approximately 4 to 6 hours after the time of injury.

2. Inflammatory Phase (6hrs to 3 days)

   – Two major responses occur during this phase: a vascular response and cellular response. The vascular response stimulates vasodilation and vasopermeability. The cellular response involves the emigration of phagocytes, monocytes (which become macrophages), lymphocytes, esoinophils and basophils this combined with a chemical response ensures that tissue debridement, fibrin mesh and clot reside are removed. This is absolutely vital in order for correct healing to occur, however the oedema that occurs during this phase can actually restrict blood flow, and create pain.

3. Proliferation (24hrs to weeks)

   – This phase is where the generation of repair material occurs. Cytokine based drives from the inflammatory phase stimulate the release of fibroblasts and endothelial cells. These proliferate and increase activity levels to produce collagen and angiogenesis. At the same time myofibroblasts and contracting the wound and enhancing repair and tissue strength.

4. Remodelling ( Week 1 to months)

   – orientation of the collagen fibres occurs, reabsorption of predominately Type 111 Collagen, replacing it with Type 1 Collagen fibres.

References

Watson, T 2016 Soft Tissue Repair and Healing Review http://www.electrotherapy.org/assets/Downloads/tissue%20repair%202016.pdf