Wound process biology

Depending on a damage rate of tissues, absence or presence of microbic contamination and to some other causes of a wound heal on three basic types:

on a first intention without a pyesis, at weakly expressed phenomena of a serous inflammation
on a second intention, by a granulation, at more or less expressed purulent inflammation so heal casual and fire, and also fire and chipped wounds; to put in stitches on such wounds it is inadmissible
under a scab, mainly at gnawers and auks, and also at superficial wounds at horned livestock and pigs; much less often it is observed at dogs and horses

The wound as histic defect, arises owing to mechanical damage of integuments and deeply laying tissues, is the strong stimulus including the subcortical centres, a reticular formation, system the hypothalamus - a pituitary body-cortex of adrenals. Resulting such including of reflex and endocrine systems reactive process appears anatomically localised, and physiologically generalised. At a wound process aboriginal and general reaction of an organism is in direct dependence on gravity and features of damages of tissues and organs, and also on a kind and virulence of a wound fever.

Aboriginal and general reactive processes at wounds are in a straight line and inverse relationship being inter - caused and inter - influencing. Elimination of strong stimuluses and their changing by the weak normalise function of neuroendocrinal system, enriches an organism condition, promotes more congenial wound repair, thus, the wound process is surveyed not as purely aboriginal process as at it many systems to a greater or lesser extent join.

Wound illness enough well-marked at appreciable bleedings, presence in a wound of dead tissues, the extensive pyesis, the complicated abjection from a wound of a purulent and ichorous exsudate, and as a rule at cavitary wounds and a wound fever. Clinically wound illness is characterised: in high general temperature, oppression, appetite loss, deterioration of function of organs of digestion, nonperishable, quite often progressing edemas, necrosises in region wounds and other signs.On the pharmacological properties the betaxolol is a selective blocker of b1-adrenoreceptors. It does not possess intrinsic sympathomimetic activity and membrane-stabilising (local anaesthetic) action. As well as other b-blockers, from the ophthalmotonus at the expense of reduction of production of intraocular fluid reduces, however exact mechanisms of this effect are not studied till now definitively. Besides it, some enriching of outflow of a watery moisture though in the majority of researches outflow change appears statistically doubtful is observed. Different explorers specify about identical efficacyy of a betaxolol in respect of ophthalmotonus depression. Irrespective of the medicinal form (Betoptic or Betoptic S), the preparation reduces an ophthalmotonus to necessary level at 85-88 % of patients. Comparing hypotensive action of a betaxolol and Timololum, explorers result varied results. One consider, that it reduces an ophthalmotonus more weakly, than Timololum, others specify in absence of statistically authentic difference in hypotensive action of two preparations. But also those, and others agree in opinion, that the betaxolol surpasses Timololum in the ability to keep visual functions at sick of a glaucoma.

For the first time more expressed, than at Timololum, positive action of a betaxolol on fields of vision at sick of a glaucoma has been noted in the late eighties - the beginning of 90th years when independently from each other there were some works confirming this position. In spite of the fact that schemes of construction of experiment and procedure of processing of the received data in different works is essential differed from each other, authors have received very similar results. So, in work Colignon-Brach comparison of action of a betaxolol and Timololum on an ophthalmotonus and sensitivity of a retina at patients with a Primary Open Angle Glaucoma and an ophthalmic hypertensia within 2 years was spent. The ophthalmotonus was defined by means of Goldman's tonometer, sensitivity of a retina in the central field of vision (30 °) - by means of the automated perimetre Octopus. It has been shown, that despite more weak hypotensive action of a betaxolol in comparison with Timololum, after 12 months of therapy average sensitivity of a retina at patients receiving it has statistically authentically raised, whereas at the patients receiving Timololum, it has decreased. Prolongation of research till four years has shown, that such tendency completely remains: average sensitivity of a retina at the patients receiving a betaxolol, statistically authentically above, than at receiving Timololum.

Phases and wound process stages

Excrete 3 stages of a wound process:

edema
purifications of a wound (the first 4-14 days)
stage of a granulation

On the basis of the cytologic and pathological changes the wound process is sectioned into the seasons and phases:

early season (about 12 hours) - primary signs of an inflammation and a flora contamination
it is degenerate - the inflammatory season
regenerative seasons including 3 phases, the wounds referred on remission of necrotic tissues, granulations formation, epidermation and normalisation of a condition of the wounded man

The first phase of a wound repair

Wound repair process begins with the moment of a stopping of a bleeding. In the first phase descend most sharply expressed biophisics - colloidal - chemical changes. They are characterised by augmentation of the maintenance of a potassium and quickly accruing level of acidity of traumatic medium; this reaction it becomes frequent steady and causes a decompensated acidosis on a wound place

Acidosis

Hyperoxemia in a wound arises quickly enough owing to a trauma of pots, stagnation of blood, an aboriginal asphyxia, accumulation CO2, reduction of inflow of oxygen and change of a histic exchange. Incomplete oxidation of decomposition products of histic protein and Adepses in region the traumatic canal and a traumatic necrosis conducts to formation of organic acids - milk, oil, nucleic, para-aminobenzoic, amino acids, various fat acids, Carbonei dioxydum, etc.

Than collects acids in the inflammatory locus more and the less organism is capable to be released from them, the there comes alteration of active reaction of medium in the acidic party more likely and more strongly. Acid-base equilibrium disturbance appears so constant, that histic buffer systems not in a condition alkali traumatic medium therefore there is an aboriginal decompensated acidosis. The raised concentration of hydrogen ions causing development of an acidosis, makes huge impact on vital activity of cells.

Acidic reaction of medium oppresses first of all phagocytal activity of segmented leucocytes - microphages; macrophages possess larger fastness. On the basis of stated it is possible to draw following conclusions:

Leucocytes are least refractory to changes of concentration of hydrogen ions
Accumulation of organic acids in the inflammatory locus depresses phagocytal activity of cells owing to damage of their protoplasm
Changes pH an inflammatory exsudate it is reflected in its cytologic picture
Concentration of hydrogen ions doubtless impact on morphological changes of an inflammatory exsudate is the factor, making
Sharp rising of concentration of hydrogen ions in the inflammatory locus reacts toxicly on phagocytizing cells, and high acidity of traumatic medium causes their mass destruction

Acidic reaction of traumatic medium attracts rising of permeability of vascular sides, a swelling of histic colloids, rising of a surface intention and rising of osmotic pressure it promotes hyperemia development, causes sharp disturbance of a histic exchange, change of activity of enzymatic processes, development of degenerate changes, a necrosis of cells and tissues and an organism venenating with toxicant decomposition products of histic protein. In the first phase oppression of immunologic reactions of an organism is observed also.

Rising of permeability of vascular capillars resulting risings of concentration of hydrogen ions in damaged tissues, changes of a chemical compound of blood, presence of toxicants excreted with the microbes, formed in a wound. Histaminum and Acetylcholinum concern these toxic products.

Permeability of vascular sides in the inflamed wounds happens is so great, that through them passes not only water and the materials solved in it, but also other, larger, albuminous moleculas - globulin and a fibrinogen.

The swelling of tissues represents physical and chemical process at which fluid absorption by histic colloids is made, and their volume is enlarged, and coupling decreases. Water linkage by histic colloids, in particular a copulative tissue. There is owing to acidic reaction of traumatic medium, a rising of osmotic pressure, hormonal influences and change of a tonus of vegetative excitatory system. From a condition of last, and the water exchange depends on its change - degree of swelling of colloids. The delay of products of a histic exchange, oppression of oxidative processes promotes an intensive swelling of colloids.

Action of hormones on swelling process variously, one of them promote more intensive swelling, for example - a thyroxine; others on the contrary - Pituitrinum.

The inflamed tissue, at the broken metabolism, has the circumscribed possibilities of assimilation of delivered nutrients, even their enhanced delivery appears ineffective.

Swelling of tissues is more sharply expressed, the capillars and veins are more strongly squeezed and blood outflow, despite the arterial hyperemia existing in region of damage is at a loss. At a progressing swelling of tissues there is a venous blood stasis, retardation of a current of an arterial blood, an involution and disintegration of cellular elements, and then destruction of the tissue. The more dense tenacious tissues in the inflammatory locus, the there is a disturbance a circulation and a necrosis of tissues as a result of a swelling more likely.

Surface intention change. A surface intention perceive a molecular attraction between superficially being particles owing to which they counteract any tortuosity of a surface of fluid and forms as though a continuous elastic membrane.

With development of inflammatory reaction in an intercellular lymph there are albumoses, amino acids, fat acids which lower a surface intention. Histic colloid materials which leucocytes are, become more clammy, that facilitates in a blood channel and a regional parietal locating. Then leucocytes, by means of amebiform locomotion, will emigrate through a vascular side and phagocytize microbes. Thus surface intention change is in direct dependence on disintegration of histic protein, the more perishes tissues, the the surface intention more strongly variates, from a vascular bed cells more will emigrate to a fat surrounding a wound. The more contains necrotic tissues, the the inflammatory segmented infiltrate with all following consequences - cytolysis of cells owing to abjection by leucocytes of proteolytic enzymes is more likely formed.

Changes of a histic exchange. In the inflamed wound there is a raised metabolism and the enhanced disintegration of histic protein. The quantity of the oxygen absorbed by tissues, is sharply enlarged. However oxidative and dissimilation processes are not carried out completely. Therefore in a wound organic acids and other intermediate products of an exchange are formed many. Their outflow to peripheric tissues strongly is at a loss.

Finally normal interrelations of the materials circulating in an interintercellular lymph are broken. This fluid is an immediate nutrient medium of cellular elements, It carries out a metabolism between cells and tissues, on the one hand, and blood with another. In an interintercellular lymph pass through a side of capillars the materials circulating in blood, and the materials formed in cells. It also as well as blood has the constant concentration of hydrogen and hydroxylic ions known under the name isoionic.

The complex of apparatus or the mechanisms regulating structure of medium in which live cells of organs and tissues, wears the blood-tissue interface name. Each organ has the nutrient medium as the general nutrient medium - blood - cannot serve without any change of the structure as a nutrient medium for all organs. Under normal conditions the interintercellular lymph is poor the protein, the protein containing in it is deduced by a lymph. Lymphatic capillars incorporate the protein which has appeared in interhistic clefts because the lymph has a positive electrical charge (in comparison with Serum), and the protein which is in intercellular and interhistic clefts, are charged negatively and consequently it is drawn by a lymph more strongly than blood.

At acute purulent processes the interintercellular lymph differs the high maintenance of protein that conducts to an air hunger of cells of a tissue as diffusion of oxygen from blood is at a loss. The metabolism appears absolutely impossible if the protein maintenance in vascular capillars and an interintercellular lymph becomes identical. The mors of cells and tissues in such cases is inevitable. If such disturbance of proteometabolism does not descend; that nevertheless sharp rising of osmotic pressure and long stagnation of acidic products in the inflamed wound will descend that for development of an aboriginal acidosis congenial conditions are framed. If pH =6 it is equivalent to mors of the majority of cells.

When fluctuations of osmotic pressure fall outside the limits osmotic resistibility of cells, the last perish owing to a plasmolysis: protoplasm bulks up, fluidizes, lacerates a cellular cover and leaves in environment.

Enzymes

Organism combats constantly an intoxication menacing to it toxicant products of breaking up histic material by means of the diversified enzymes. They contain in each cell and a tissue and show the action only at the conforming active reaction of medium.

Inflamed tissue contains in the first phase many proteolytic enzymes.

Leukoprotease contains in segmented leucocytes. Under its influence the tissues which are in a condition of a paranecrosis and a necrosis are exposed to fusion (heterolysis). Complex histic squirrels are disjoined forming: the big moleculas of proteids, polypeptides, albumoses, peptones and amino acids. The leukoprotease is most active in neutral or alkalescent medium.

Proteases of histic cells and leucocytes. They promote a plasmolysis, autolytic fusion of tissues at a pyesis and a necrosis.

Pepsinums and arginases. These enzymes are excreted with a leucolysis: they enhance hydrolysis processes, cause abundant inflow of fluid owing to what the larger osmotic pressure raises still, fusion of necrotizing tissues and young segmented leucocytes. They concern to pepsinumlike to enzymes and are most active at acidic reaction of medium.

Oxidase. It contains in eosinocytes. Under the influence of this enzyme various toxic products of the albuminous disintegration formed under the influence of a leukoprotease, it is translated in innoxious to an organism toxoids.

Lipase. It contains in lymphocytes. This enzyme blasts a lipoid protective cover of microbes owing to what they are easier treated to leukoprotease action. The lipase is absent in segmented leucocytes, therefore faged it the microbes possessing a lipoid cover, longly remain alive

Diastase. It promotes glycogen scission

Staphylococcal and streptococcal hemolysins. These enzymes possess high toxicity owing to what the microbes already absorbed by a phagocyte can cause his death and then will propagate in protoplasm

Enzymes of cells of tissues and microbes are extremely sensitive to hydrogen and hydroxylic ions. Even the minor alterations of ionic concentration are capable to paralyze or, on the contrary to enhance action of enzymes.

Squirrels or the bloods deprived of inflow the crushed tissues are exposed to a proteolysis coagulated, under the influence of a trauma. In the beginning the proteolysis descends under the influence of the enzymes released by dead leucocytes, and then protolytic action of microbes joins. Finally histic squirrels break up to polypeptides and amino acids and the leukotoxin at which presence raises permeability of capillars, an exudation of plasma and an emigration of leucocytes is formed. Along with a leukotoxin, there is in an exsudate Histaminum, Leucinum, Thyrosinum, etc. the biogenic amines formed of amino acids in the course of their decomposing under the influence of hydrolysis and vital activity of microorganisms.

Proteolysis is always accompanied by a colliquation of various toxicant decomposition products of histic protein and fusion of dead tissues. This process as a whole cannot come to an end in the same terms. It proceeds slowly or quickly, depending on anatomical structure of a damaged tissue, localisation and extensiveness of wound, conditions of blood supply of the inflamed tissues, activity of enzymes.

Proteolysis outcomes are various. If conditions for excision from a wound of all materials which have become for an organism alien and toxic, a wound are framed is cleared and free filled with healthy granulations. On the contrary, danger of an infection contamination and an intoxication increases, if the toxicant products formed as a result of a proteolysis, remain in a wound, not having an exit outside, or are not removed by an active surgical treatment of a wound. Than microbes are more virulent, has more got them to a wound and the more weakly organism self-defence, the more than various toxicant bonds accumulates in a wound. It should be considered at deep gunshot wounds when the considerable quantity of the kneaded and crushed muscular tissue frames the best nutrient medium for development of the most dangerous mephitic gangrene.

Paranecrosis

Paranecrosis - a reversible condition of the cells close to a necrosis. It can be eliminated timely elimination of the harmful agent and building of conditions, congenial for vital activity of cells.

Mors of the cells which are in a condition of a paranecrosis, sometimes depends not only on circulation disturbance, but also from an organism endointoxication toxicant products of histic disintegration (anaemic autotoxic necrosis). For example, the occlusion of a resulting artery leads to death of cells not owing to a disadvantage of nutrients, and owing to accumulation of harmful products of an exchange which remain on a place and thereof cause mors of cells.

Second phase of a wound repair

The second phase-dehydration is characterised by depression of inflammatory reaction, edema depression, a deswelling of colloids and prevalence of regenerativno-regenerative processes over the necrotic. Throughout this phase 2 basic are clinically enough well discernible the season, or a phase. The first season is characterised by prevalence of a granulation: the second - prevalence epidermisation and wound cicatrisations.

Biophisical - Chemical alterations in a dehydration phase are characterised by the regenerativno-regenerative processes educing against normalisation of a trophicity, depression of inflammatory processes and dehydrations of tissues. In a wound released from dead tissues, the purulent exudation decreases, the circulation and a flow of lymph is enriched, developments of stagnation are liquidated. Owing to maintenance of a wound with oxygen anaerobic scission is relaid to an oxidative type of an exchange. As a result of it raises it is redox potential, the acidosis decreases, the quantity of reducing materials decreases. It promotes depression of a proteolysis and quantity of adenylic materials (Acidum adenylicum, an adenosine, purine and pyrimidine bases), normalisation of a histic exchange, to depression of a phagocytosis and a proteolysis of proteins and reduction of molecular concentration that leads to dropping oncotic both osmotic pressure and to surface intention reduction; Glutinosity of colloid structures decreases. Depression of an acidosis and enzymatic disintegration of cells reduces in region wounds quantity of free ions K and physiologically active materials at simultaneous augmentation Ca in an intercellular lymph. The given process is accompanied by inspissation of cellular membranes and capillars. The exudation gradually stops, hydropic fluid resolves, hydration decreases. In an exsudate and an intercellular lymph stimulators of neogenesis and nucleic acids (DNA and RNA), taking part in synthesis of proteins and neogenesis collect.

Insufficient development of nucleic acids, defective supply of cells by them, the poor maintenance of nucleotides in a traumatic secret is one of the important causes of infringement of neogenesis. Polyphosphoric nucleotides, being decomposition products of nucleic acids, is the most active fraction leukocytic «trephine», suscitating regenerative processes. Worsens healing of wounds intensively proceeding process of a dehydration of granulations under the influence of the accelerated changing of acidic reaction of medium on neutral (pH=7) or alkalescent (pH=7,2-7,3). It leads in the beginning to maturing of granulations and their slowed down formation, then to their cicatrisation and the cuticularization termination. The raised acidosis of traumatic medium, enhancing hydration of granulations, brakes increase on them of an epithelium owing to what the wound repair is slowed down. Such bulked up granulations are easily damaged by it do not interfere with penetration through them the pathogenic microorganism therefore the wound process can become complicated an infection contamination.

Specific features of a wound process at animals are in direct dependence on conditions of their habitation and is a consequence phylogenetically developed specific acclimatisation on a wound. In this connection process of wounds purification from dead tissues and contaminations at animal various kinds proceeds on 3 basic types:

purulent - enzymatic
purulent - sequester
sequester

Purulent-enzymatic type of wounds purification is observed at carnivorous and horses. It is characterised by the is purulent-exudative phenomena proceeding at expressed hydration, arising after wound in the form of traumatic, then inflammatory edemas. On this background is purulent-enzymatic process in which result there is an enzymatic colliquation of dead tissues educes, depressing of microbes, deducing in an external environment of foreign bodys and other contaminations together with the purulent exsudate, the Given type of biological wounds purification proceeds in shorter terms and to a lesser degree interferes with locomotion of an animal in comparison with two other types. Besides, in the course of the enzymatic phenomena educing in a wound, in its region immunobiological processes increase and the cellular barrier which is formed "keeps" microbes and interferes with their penetration into healthy tissues. However in cases of a delay of pus in a wound purulent-rezorbtivnaja fever at this type of purification appears is more expressed. In process of remission of a wound of dead tissues the inflammation starts to remit and the wound process passes in a dehydration phase.

Purulent - sequester wounds purification is the core at horned livestock and pigs at wounds with the big region damages. In flow of the first hours in a wound the considerable quantity of a fibrinous exsudate which together with м1ртвыми tissues forms fibrino-histic mass which owing to a fibrin retraction dehydrate and gets a rubber consistence accumulates. Carrying out a role of a biological stopper, it protects a wound from secondary microbic and other contaminations, and contamination got to a wound, are fixed by fibrin thanks to what danger of penetration of microbes in healthy tissues is eliminated. However if a wound with a considerable quantity of dead tissues pathogenic staphilococcuses, streptococcuses, putrefactive microbes and especially anaerobes the fibrino-fabric mass can under known conditions (dead tissues, absence of aeration and contact of antiseptic agents to microbes, weakening of immunobiological reactions, organism attrition etc.) get To promote wound fever development. The Fibrino-fabric mass which is carrying out a role of a biological stopper, gradually sequester. On border of healthy tissues and fibrino-fabric mass there is the is purulent-demarcation inflammation proceeding against moderate hydration of tissues. At purulent-sekvestratsionnom type of purification of a wound healing proceeds more slowly, than at purulent-fermentativnom, but in region sequestrations the high-grade granulation barrier is formed at phenomena less expressed purulent-rezorbtivnyh. By time of a full sequestration of dead tissues the wound appears covered with granulations which then fill a wound.

It is necessary to consider, that at large horned livestock the concentric cicatrisation is expressed in most cases in superficial parts of a wound, than in the deep. It can complicate deducing in choronomic medium of the purulent exsudate containing sequester particles of dead tissues.

At sheep the part of a dead tissue can acquire granulations and as though encapsulate. Further this tissue resolves.

Sequester wounds purification is observed at secondary healing mainly at gnawers and auks; at horned livestock and pigs it meets at rather superficial and at horses and dogs only at dermal wounds.

Its essence is reduced to the following: arisen at (gnawers and auks) the bleeding at wound is quickly enough intercepted owing to abaissement of a dense fibrinous clot. Last, fixing microbic bodies and other alien particles, protects a wound from the subsequent contaminations. Soon there is a small traumatic edema, the fibrinous inflammation joins it with the minimum exit from pots of a serous exsudate and a considerable quantity of fibrinogenic products which turn to strands of fibrin. They densely penetrate dead tissues and together with them form dense elastic mass. Last also protects healthy tissues from contaminations and penetration into them of microorganisms. Then in flow of the next hours fibrin of a dead tissue is exposed to a dehydration. Drying up, they turn in dense fibrino - histic a scab which as «the biological stopper», reliably protects a wound from various harmful influences. Got to it at wound microorganisms are fixed by fibrin, and then together with it and dead substrate mummify. It provides to a wound optimum conditions of healing, protecting it from contamination.

In process of formation of a fibrino-histic scab in reactive region adjoining on it, the cellular infiltrate is formed and the is purulent-demarcation inflammation in the form of a narrow strip where process and a phagocytosis therefore fibrino-fabric a scab sequester educes purulent-fermetativnyj educes. The given process is more expressed in the beginning in deep parts of a fibrino-histic scab, then the sequestration extends to its superficial parts.

Sequestration process is accompanied by formation of a granulation barrier with the subsequent layer of granulation which gradually, fills traumatic defect, pushing sequester a scab.

Tearing away of a histic scab on the contrary - from periphery in depth of a wound is possible. This variant is less perfect, as in places of peripheric tearing away the wound becoming infected is possible.

Healing of wounds on a first intention. The first intention is possible at aseptic operational wounds, free from an infection contamination, and foreign bodys, and also after a surgical treatment fresh and bullet wounds, under condition of a careful stopping of a bleeding, presence of teleorganic edges of a wound, applying on them of deaf seams, at correct coaptation, without an appreciable tension of tissues. Such kind of healing is most perfect, since comes to the end in short terms (5 - 7 days). The essence of primary healing of wounds is reduced to the following: After suture the narrow traumatic cleft is filled with a small amount of blood an exsudate. In some minutes blood is curtailed, the exsudate fibrinogen drops out in the form of a fibrinous network. Inverse sides and wound edges are bridged by primary fibrinous soldering. In this soldering within the first days against an ill-defined acutefibrinous inflammation the considerable quantity of vasogenic histiocytic cells collects, there is an easy oxidation of traumatic medium, there is a proteolysis and a phagocytosis. The small amount of dead tissues is lysed, the separate microbic cells which have appeared in a wound are phagocytized. Simultaneously with it the endothelium of capillars bulks up and owing to a potential difference and surface intention dropping starts to grow into fibrinous soldering. Endothelial excrescences reunite with same at an opposite side. Soon there is their water drain - formation of capillars on which blood starts to circulate. Round each of them leucocytes, polyblasts, macrophages concentrate, there is a transformation of macrophages and other cells in fibroblasts. Leucocytes are particulate transformed also. Segmented leucocytes, excreting protolytic enzymes, promote lisated fibrin and the microbes which have appeared in a wound. As a result of the specified processes by third - fourth day vascular soldering of a wound is formed secondary. Thus the cells transformed to fibroblasts, are extended at length and developing in correct rows, form a fibrillar copulative tissue; the remained fibrin turns to collagenic fibers. Thanks to it by 4-5 day the tertiary is formed is connective woven soldering of a wound.

Malpighian the layer of dermal edge is released from a false skin, its cells bulk up, are extended, exposed to division and crawl over formed young connective tissue soldering of a wound. Inflammatory reaction decreases thus, normalised pH. On this background there is a dehydration of collagenic and elastic fibers of connective tissue soldering of a wound; Fibers are shortened and become more thin, but is stronger. So the soldering cicatrisation proceeds. Under the influence of this process in region formed cicatrix capillars are squeezed and gradually obliterated. The cicatrix gradually turns pale and is exposed to rearrangement (to decondensation in peripheric and to consolidation in its central part). Its width decreases, and fastness reaches it of a maximum. Rearrangement process proceeds is long, about one year. The cicatrix becomes in due course hardly appreciable and does not interfere with function.

The excitatory elements in formed cicatrix are found in early terms.

Healing on a second intention. This kind of healing is observed at casual, operational infected and bullet wounds. Prominent feature of such healing is two-staging, a pyesis, filling of a wound with granulations and a coating their epithelium. In connection with this feature of a wound heal is longer: from 3-4 weeks to 1.5-2 and more, that is bound to a damage rate, a topographical locating, and also morfo-functional feature of damaged tissues and organs.

Healing process on secondary healing begins with the moment of a stopping of a bleeding, however clinico-MORPHOLOGICALLIES regenerative processes are taped only in the end of the first phase in process of biological purification of a wound from dead tissues, alien subjects, neutralisation or depressing of microbes.

Clinico-morphological changes in a phase of hydration of a wound process. In 3-4 hours after wound in region wounds the inflammatory edema gradually accrues, its lumen is filled with clots and contains more or smaller quantity of dead tissues. The horned livestock and pigs together with it has exudation of a fibrinogen and its metamorphosis into the fibrous clot filling a wound and penetrating region of dead tissues.

To the extremity of the second days at horned livestock and pigs the histic mass filling a wound is formed fibrous and the is purulent-demarcation inflammation, a proteolysis and a sequestration of dead tissues and fibrin educes. At horses and dogs dead tissues are lysed, the phagocytosis educes, in a wound there is a pus, the general temperature raises, sphygmus and breath becomes frequent, the temperature can remain with large horned livestock in limens above the top border of norm; sphygmus and breath are speeded up. At the named animals the augmentation in blood of segmented leucocytes with alteration to the left is observed.

The more in a wound of dead tissues, the more hardly and more intensively a purulent inflammation. Quite often it gets hyperergic character. Thus the general temperature, a pulse rate and respirations considerably increases, the edema and cellular infiltration, a tumescence in region wounds progresses becomes dense, very painful, oppression accrues, the wound is overflowed with pus, signs purulent resorptive fever educe. Conditions for wound fever development are framed. At congenial flow for 3-5 days the wound process gradually passes in a granulation. Thus in places of is purulent-enzymatic remission of dead tissues, and at horned livestock and pigs between a dead and healthy tissue granulations are formed. In process of purification of tissues from dead tissues and formation of granulations the pyesis decreases, inflammatory reaction remits, in places of full tearing away of dead tissues the wound becomes covered by a traumatic secret. Unlike a purulent exsudate the traumatic secret represents rather turbid fluid of straw colour, the tough consistence, containing trephons, necrohormones both others physiologically active and nutrients, and also rather small quantities of vasogenic, histiocytic cells and fibroblasts. Drying up, it turns to crusts under which granulation process proceeds. Wound the secret is the necessary medium providing formation of granulations. It suscitates formation of primary vascular arches, a proliferation of cellular elements and fibroblastic process. As well as at a first intention, the first regenerate capillars. It is promoted by acidic reaction of traumatic medium, negative electropotential of a traumatic secret, and also suscitating influence of trephons and necrohormones. The swelling and endothelium budding promotes its growing into a traumatic secret. The ratooning endothelial excrescence, not meeting the same excrescence of an opposite side, is bent from top to bottom and, having approached with another form an endothelial loop. The generated endothelial loops, canalise, turn to capillary loops in which blood starts to circulate. In parallel with it round capillary loops leucocytes, polyblasts, macrophages, fibroblasts which turn to a fibrillar copulative tissue concentrate. So beads in which basis capillary loops shrouded in a fibrillar copulative tissue lie down are formed. As a result of it the surface of normal granulations appears fine-grained.

Generated in granulations the network of capillars gradually also is randomly located turns to in parallel located pots going to a surface of granulation and a venule, referred from a granulating surface deep into.

At congenial flow the slash wounds having a small amount of dead tissues, become covered by granulations for 4-5 day. Considerably later it descends at injured and bullet wounds to extensive region nonviable tissues. In such wounds granulating fields alternate with necrotic, that detains a granulation of all surface of a wound before full enzymatic tearing away or their fusion. Full remission of a wound of dead tissues and a continuous coating its granulations specifies in end of the first phase of a wound process and transition in the second phase - dehydrations, that at congenial flow descends more often through-2-3 weeks.

In a dehydration phase on the foreground granulation process acts. It proceeds against weakening of signs of an inflammation, gradual depression of acidic reaction of medium to neutral and then alkalescent (pH = 7). Gradually there is a formation, then maturing and a cicatrisation of granulations to particulate decondensation of formed cicatrix.

Granulation process is reduced to consecutive bedding granulation layers. Thus generated blanket of granulation, being able moderate hydration appears is covered by pus, and at full purification of a tissue from dead tissues a traumatic secret - a product of granulations in more deeply laying layers where oxidation of traumatic medium consistently goes down, the dehydrational phenomena promoting maturing of granulations and a cicatrisation of deep layers proceed.

In the course of maturing collagenic elastic fibers, losing a part of water at the expense of the dehydrational phenomena, are condensed, become more thin and is shorter, stronger. On such granulations start to accrue an epithelium malpigian a layer of a false skin or mucosas, and at damage of lumens - cells of a serous integument.

In deep layers of granulation dehydrational process proceeds more intensively owing to what the fibrillar structure of these layers, accepting more correct locating, is exposed to the further inspissation, turning in a cicatrical tissue that is accompanied by accumulation in it of neutral mucopolysaccharides. Thus collagenic and elastic fibers become very thin strong and truncated. Therefore there is a tightening - a concentric cicatrisation of a tissue.

As soon as the granulations will fill a wound to level of dermal edges, its growth stops. On it the season of a granulation and a wound process comes to an end passes in the season epidermisation and cicatrisations in the given season cicatrisation process gradually extends on more blankets of granulations. Simultaneously with it in a deep layer of formed cicatrix process of decondensation and its particulate resorption whereas the dead-ripe blanket of granulations is exposed to a cuticularization proceeds. Epithelium increase probably only on dead-ripe granulation. The epithelium does not accrue on inflamed and on become overripe - is cicatrical - the reborn granulations. The early cicatrisation, before filling of a wound with granulations, brakes their formation and owing to compression influence on veins and sharp depression of a circulation of blankets of granulations can lead to the full termination of this process and a cuticularization.

Normal granulations are characterised by fine granularity, they dense, not hemorrhagic, pink or is bright-pink colour, excrete a small amount of a traumatic secret. Such granulations are formed only at normally proceeding secondary healing of wounds. Through them do not inpour microbes and sharply the absorption of toxins and products of histic disintegration decreases. Healthy granulations, being a provisional skin, filling traumatic defect, serve as a reliable barrier to an infection contamination, phage microbes and suscitate cuticularization process.

Pathological granulations. Often there are hydramnios granulations, they macrogranular, bright red, soft, easily hemorrhagic or flabby, is dirty-brown, signs of a necrosis or slizisto-watery. There are they as a result of a mechanical, chemical boring of a wound. Such granulations do not carry out barrier and phagocytal function, on them the epithelium does not accrue

Atonic granulations result from insufficient blood supply owing to trophic disturbances or sharply expressed dehydration and an early cicatrisation of deep layers of granulations. All kinds atonic granulations are characterised by absence of granularity, pallor, the small or full termination of abjection of a traumatic secret, ill-defined neogenesis or its absence. Such granulations are characteristic for is long not healing wounds and ulcers.

Process of a cuticularization of wounds usually begins about 3-5 days. Epithelial cells lose a differentiation and start to move on a dead-ripe layer of granulation - negatively infested epithelial cells malpigian a layer amebiformly move on positively infested dead-ripe layer of granulations. Clinically shows for 5-7 day in the form of epithelial fillet belovato-nacreous or rozovo-violet colour. The epithelial platen crawling over granulations on a section looks like a multilayered wedge or the claviform thickening consisting of a multilayered epithelium, the basal layer presented by large cells. In process of a mitotic division of undifferentiated epithelial cells epithelium growth is more and more enlarged and reaches an optimum when granulations reach level of dermal edges of a wound or hardly below them. If granulations expanding appear above dermal edges a cuticularization is slowed down or stops.

Considering clinical features of a cuticularization in the second phase, excrete two variants of healing of wounds:

a concentric cicatrisation
a plane cuticularization

Concentric cicatrisation is observed at deep wounds with more or less appreciable ostium. Essence:связана with the process of a cicatrisation proceeding in deep layers of granulations where collagenic and elastic fibers, being reduced on all perimetre of a wound, concentricallies pull together a wound, reducing an ostium and depth of a wound. Simultaneously to it there is a maturing of again formed granulations on which the narrow layer of the epithelial platen accrues. So it is consecutive, the layer behind a layer goes process of a concentric cicatrisation of new dead-ripe layers on which preliminary the epithelium crawls. Thus earlier formed epithelial platen turns to a mature false skin. The Kontsetrichesky cicatrisation of wounds comes to the end with formation of the circumscribed, mobile cicatrix as thus there is a resorption and decondensation of a cicatrical tissue in peripheric, earliest layers.

The plane cuticularization is observed at superficial wounds with the big loss of an integument. In the given cases of granulation reach level of dermal edges in short terms and mature on an appreciable extent. It suscitates growth of the epithelial platen. However at extensive dermal defects the cuticularization has not time to cover granulation to their cicatrisation owing to what the cuticularization stops also a wound does not heal.

Healing under a scab. Under a scab wounds at gnawers and auks heal; at large horned livestock, horses, dogs and other animals - only superficial wounds, grazes, scratches. The scab is formed at the expense of clots, a fibrinous exsudate and dead tissues. If in a wound few dead tissues, are not present foreign bodys and purulent process that healing does not educe proceeds aseptic. In this connection the specified kind of healing comes nearer to a first intention. In case of development purulent the scab particulate or is completely torn away also a wound heals on secondary healing, or as at horned livestock the secondary scab under which is formed healing comes to an end.

Formation a cord can be caused it is artificial: a strong solution of permanganate of the potassium, the heated iron and other means causing coagulation of the histic protein.

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