Friday, October 26, 2012

Remodeling Phase

Remodeling Phase
               The remodeling phase is an essential component of tissue repair and is often overlooked in terms of its importance. It is neither swift nor highly reactive, but does result in an organized and functional scar which is capable of behaving in a similar way to the parent tissue (that which it is repairing). The remodeling phase has been widely quoted as starting at around the same time as the peak of the proliferative phase (2-3 weeks post injury), but more recent evidence would support the proposal that the remodeling phase actually starts rather earlier than this, and it would be reasonable to consider the start point at around 1-2 weeks.
               The final outcome of these combined events is that the damaged tissue will be repaired with a scar which is not “like for like” replacement of the original, but does provide a functional, long-term “mend” which is capable of enabling quality recovery from injury. For most patients, this is a process that will occur without the need for drugs, therapy or other intervention. It is designed to happen, and for those patients in whom problems are realized, or in whom that magnitude of the damage is sufficient, some ‘help” may be required to facilitate the process. It would be difficult to argue that therapy is “essential” in some sense. The body has an intricately complex and balanced mechanism through which these events are controlled. It is possible however, that in cases of inhibited response, delayed reactions or repeated trauma, therapeutic intervention is of value.
               It would also be difficult to argue that there was any need to change the process of tissue repair. If there is an efficient (usually) system through which tissue repair is initiated and controlled, why would there be any reason to change it? The more logical approach would be to facilitate or promote the normality of tissue repair, and thereby enhance the sequence of events that take the tissues from their injured to their “normal” state. 

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