The Vital Role of the Lymphatic System in Wound HealingJan 04, 2024
The lymphatic system plays an active and integral part in the wound healing process. Superficial intial lymphatics are literally just below the skin surface and if there is a breach of the skin, then not only is the tissue affected but also the venous capillaries and the initial lymphatics.
So, wound healing should not be considered as a process limited only to damaged tissue. There will always be an intensive, local immune response by the lymphatics.
Influx of microorganisms that live on the skin and cellular changes caused by tissue damage when the skin is breached, are recognised by the lymphatics in the area, irrespective of the site of injury. Of course, during surgery microbes living on the skin is reduced by sterilisation procedures prior to surgery. However, the wound is still open to the microorganisms in the air.
Migrating immune cells ingest the antigens, which then migrate via the intial and collecting lymphatics to the closest group of lymph nodes where elimination of antigens takes place.
We already know how important the lymphatic system is in maintaining fluid homeostasis. But, the role of lymphatics is often neglected in it's contribution to cell equilibrium and normal wound healing - and that is to control interstitial fluid microcirculation and the removal of macromalecules and particulate matter from the tissue spaces.
Failure to remove these particles, results in pollution of the tissues from excess proteins, macromouecules and inflammatory debris from the wound.
As soon as the skin is breached, the interstitium, vascular capillaries and lymphatic systems commence release of various cells involved in wound healing.
We know the importance of the lymphatic system in our overall immunity and therefore it plays a vital role in each stage of wound healing.
In the early stage of wound healing immune cells contribute to the commencement, function and completion of early wound healing and all of these cells start their life in a lymphoid organ - namely the bone marrow.
For example, the first responders in phase 1 are cells known as neutrophils and these remove foreign material and bacteria from the wound. They start off life in the bone marrow.
In phase 2, Monocytes are recruited and transform into tissue-activated macrophages at the wound site. Langerhans cells, T cells and dendritic cells all of which originate also in the bone marrow are also activated to combat antigens.
So, not only is the lymphatic system the main supplier of cells in wound healing. But it is predominately responsible for removing inflammatory debris and tissue swelling caused by the inflammatory process.
Regeneration of lymphatics, which occurs after inflammation has concluded, play an important role in wound healing.
This is particulary important after liposuction when so many lymphatics are completely distroyed during the procedure.
If inflammation does not, or cannot complete because of infection, lymphangiogenises cannot commence which further compromises wound healing.
And, while there is stagnant fluid remaining in the tissues, wound healing becomes problematic, causing issues like fibrosis and unsightly scars.
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