Granulation tissue

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Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. [1] Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size. Examples of granulation tissue can be seen in pyogenic granulomas and pulp polyps. Its histological appearance is characterized by proliferation of fibroblasts and thin-walled, delicate capillaries (angiogenesis), and infiltrated inflammatory cells in a loose extracellular matrix.

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Appearance

Example of granulation tissue from a cut on a finger with "proud flesh". Finger with granulation tissue.jpg
Example of granulation tissue from a cut on a finger with "proud flesh".

During the migratory phase of wound healing, granulation tissue is:

Structure

Granulation tissue is composed of tissue matrix supporting a variety of cell types, most of which can be associated with one of the following functions:[ citation needed ]

An excess of granulation tissue (caro luxurians) is informally referred to as "proud flesh". [3]

Extracellular matrix

Histopathology of granulation tissue at 11 days after injury, showing fibroblasts, hemorrhage and lymphocytes. Histopathology of biopsy site at 11 days, high magnification.jpg
Histopathology of granulation tissue at 11 days after injury, showing fibroblasts, hemorrhage and lymphocytes.

The extracellular matrix of granulation tissue is created and modified by fibroblasts. Initially, it consists of a network of type-III collagen, a weaker form of the structural protein that can be produced rapidly. This is later replaced by the stronger, long-stranded type-I collagen, as evidenced in scar tissue.

Immunity

The main immune cells active in the tissue are macrophages and neutrophils, although other leukocytes are also present. These work to phagocytize old or damaged tissue, and protect the healing tissue from pathogenic infection. This is necessary both to aid the healing process and to protect against invading pathogens, as the wound often does not have an effective skin barrier to act as a first line of defense.

Vascularization

It is necessary for a network of blood vessels to be established as soon as possible to provide the growing tissue with nutrients, to take away cellular wastes, and transport new leukocytes to the area. Fibroblasts, the main cells that deposit granulation tissue, depend on oxygen to proliferate and lay down the new extracellular matrix.

In vascularisation, also called angiogenesis, endothelial cells quickly grow into the tissue from older, intact blood vessels. These branch out in a systematic way, forming anastomoses with other vessels.

Approximate times of the different phases of wound healing, with substantial variation depending on wound size and healing conditions. Granulation tissue formation is seen in green box at days to weeks. Wound healing phases.png
Approximate times of the different phases of wound healing, with substantial variation depending on wound size and healing conditions. Granulation tissue formation is seen in green box at days to weeks.

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<span class="mw-page-title-main">Angiogenesis</span> Blood vessel formation, when new vessels emerge from existing vessels

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<span class="mw-page-title-main">Fibroblast</span> Animal connective tissue cell

A fibroblast is a type of biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework (stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells of connective tissue in animals.

<span class="mw-page-title-main">Fibronectin</span> Protein involved in cell adhesion, cell growth, cell migration and differentiation

Fibronectin is a high-molecular weight glycoprotein of the extracellular matrix that binds to membrane-spanning receptor proteins called integrins. It is approved for marketing as a topical solution in India by Central Drugs Standard Control organization in 2020 under the brand name FIBREGA for chronic wounds. Fibronectin also binds to other extracellular matrix proteins such as collagen, fibrin, and heparan sulfate proteoglycans.

<span class="mw-page-title-main">Extracellular matrix</span> Network of proteins and molecules outside cells that provides structural support for cells

In biology, the extracellular matrix (ECM), is a network consisting of extracellular macromolecules and minerals, such as collagen, enzymes, glycoproteins and hydroxyapatite that provide structural and biochemical support to surrounding cells. Because multicellularity evolved independently in different multicellular lineages, the composition of ECM varies between multicellular structures; however, cell adhesion, cell-to-cell communication and differentiation are common functions of the ECM.

<span class="mw-page-title-main">Connective tissue</span> Type of biological tissue in animals

Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops mostly from the mesenchyme, derived from the mesoderm, the middle embryonic germ layer. Connective tissue is found in between other tissues everywhere in the body, including the nervous system. The three meninges, membranes that envelop the brain and spinal cord, are composed of connective tissue. Most types of connective tissue consists of three main components: elastic and collagen fibers, ground substance, and cells. Blood, and lymph are classed as specialized fluid connective tissues that do not contain fiber. All are immersed in the body water. The cells of connective tissue include fibroblasts, adipocytes, macrophages, mast cells and leucocytes.

<span class="mw-page-title-main">Healing</span> Process of the restoration of health

With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area and replace it with new living tissue. The replacement can happen in two ways: by regeneration in which the necrotic cells are replaced by new cells that form "like" tissue as was originally there; or by repair in which injured tissue is replaced with scar tissue. Most organs will heal using a mixture of both mechanisms.

<span class="mw-page-title-main">Bone healing</span> Healing from bone injury

Bone healing, or fracture healing, is a proliferative physiological process in which the body facilitates the repair of a bone fracture.

<span class="mw-page-title-main">Wound healing</span> Series of events that restore integrity to damaged tissue after an injury

Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue.

Haptotaxis is the directional motility or outgrowth of cells, e.g. in the case of axonal outgrowth, usually up a gradient of cellular adhesion sites or substrate-bound chemoattractants. These gradients are naturally present in the extracellular matrix (ECM) of the body during processes such as angiogenesis or artificially present in biomaterials where gradients are established by altering the concentration of adhesion sites on a polymer substrate.

<span class="mw-page-title-main">Loose connective tissue</span> Type of connective tissue in animals

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<span class="mw-page-title-main">Basement membrane</span> Thin fibrous layer between the cells and the adjacent connective tissue in animals

The basement membrane, also known as base membrane is a thin, pliable sheet-like type of extracellular matrix that provides cell and tissue support and acts as a platform for complex signalling. The basement membrane sits between epithelial tissues including mesothelium and endothelium, and the underlying connective tissue.

A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. Chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. To overcome that stage and jump-start the healing process, a number of factors need to be addressed such as bacterial burden, necrotic tissue, and moisture balance of the whole wound. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role.

<span class="mw-page-title-main">Myofibroblast</span>

A myofibroblast is a cell phenotype that was first described as being in a state between a fibroblast and a smooth muscle cell.

<span class="mw-page-title-main">Stroma (tissue)</span> Part of a tissue or organ with a structural or connective role

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<span class="mw-page-title-main">Desmoplasia</span> Growth of fibrous or connective tissue

In medicine, desmoplasia is the growth of fibrous connective tissue. It is also called a desmoplastic reaction to emphasize that it is secondary to an insult. Desmoplasia may occur around a neoplasm, causing dense fibrosis around the tumor, or scar tissue (adhesions) within the abdomen after abdominal surgery.

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References

  1. "Granulation Tissue Definition". Memidex. Archived from the original on 16 November 2018. Retrieved 25 October 2014.
  2. Bhat, Sriram (2013). Srb's Manual of Surgery, 4e. Jaypee Brother Medical Pub. p. 18. ISBN   9789350259443.
  3. Healing and Repair Archived 2010-09-27 at the Wayback Machine Chapter 9 from an "Introduction to Pathology" on a Tuskegee University website
  4. Reference list is found on image main page.