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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