Stages of wound healing

Wound healing

Last Updated January 23rd, 2023

If the wound does not improve in 4 weeks or the healing is not complete in 8 weeks, it is considered a chronic non-healing wound.
If your wound dressing is not waterproof, avoid submerging it or getting it wet in water.
A small amount of serous fluid drainage from the wound site is normal. It indicates that the wound is healing. However, if there is excess serous drainage, it may indicate the bacterial presence in the wound site.

Overview

Any cut or opening in the skin can be termed a wound. Wounds can result from a fall, accident, or trauma. A cut in the skin generated from a surgical or medical procedure is also classified as a wound. In general, wounds can be classified into five types which include cuts, burns, scrapes, puncture wounds, and pressure sores. The surface of the wound can be smooth or jagged depending on the circumstances. Deep wounds can also affect the muscles, blood vessels, ligaments, tendons, and bones that lie below the skin. Minor wounds can get healed easily while major wounds need special care to prevent the chances of an infection. While most of us do not pay much attention to the healing of minor wounds, the body has a natural mechanism to deal with wounds and it is a complex one.

The primary function of the human skin is to protect against mechanical impacts and pressure, variations in temperature, micro-organisms, and various other external situations. The two main layers of the skin are the epidermis and the dermis and generally the wounds which affect these two layers are healed quickly. A deeper wound can be serious and demand more attention and proper medical care. The healing of wounds is an organized process and involves four major steps which are hemostasis, inflammation, proliferation, and maturation. Some wounds are chronic and they either do not heal or heal slowly or heal but tend to recur. Such wounds can result from various conditions like trauma, burns, skin cancers, severe infection, or underlying medical situations such as diabetes. These types of wounds need special attention and care along with longer periods for healing.

Classification of wounds

There is no standard method of wound classification but they are often categorized based on the management and final healing. The various factors that affect their classification are aetiology, location, type of injury or symptoms, and wound depth and tissue loss. In general, wounds can be classified into three types.

  • Superficial which involves only the loss of the epidermis
  • Partial-thickness wounds involve the loss of the epidermis and the dermis.
  • Full-thickness wounds involve the dermis, subcutaneous fat, and sometimes even the bone.

In terms of how they have been caused, open wounds can be classified into the following main categories. Depending on the nature of the wound, the type of treatment required will vary.

Abrasion

An abrasion occurs when the skin gets rubbed or scrapes against a rough or hard surface. The outer surface of the skin is peeled away but there is no major bleeding as the blood vessels are not damaged. Even then, such a wound needs to be cleaned to avoid an infection.

Laceration

A laceration is a deep cut or tearing of the skin that is generally caused by a sharp object or an edge. Accidents with knives, tools, and machinery are the most frequent causes of lacerations. In the case of deep lacerations that penetrate through the layers of skin, bleeding can be extensive. These wounds need more care to stop the bleeding.

Puncture

A puncture is a small hole on the skin that is caused by a long, sharp object. An injury from a nail, needle, or bullet injury can be classified as a puncture wound. While such a wound may not bleed much, it can be deep enough to damage internal layers and organs. Even for a small puncture wound, a tetanus shot is needed to prevent any chances of an infection.

Avulsion

An avulsion is a serious kind of wound that happens when there is a partial or complete tearing away of the skin and the underlying tissue. Avulsions usually occur during violent accidents that put heavy stress on the body and also result from explosions and gunshots. They can cause a rapid loss of blood and can be life-threatening at times.

The stages of wound healing

The process of wound healing is another wonderful example of how the various mechanisms of our body work together to promote repair and regeneration. The process involves four different stages that are interlinked and are often termed as the “cascade of healing”. The process is complex and fragile and any break in the stages can lead to the formation of chronic wounds. The process is also dependent on various factors like moisture, infection, age, nutritional status, and the overall health of the patient. When the right healing environment is established, healing can be fast and effective. The four stages of wound healing are discussed in detail below.

The haemostasis phase

Haemostasis is the first phase of healing and its main objective is to stop the bleeding. When any blood leaks out of the body, the first step that comes into play is the process of clotting. This is a kind of a dam that forms as the platelets in the blood stick together to seal the opening of the torn blood vessels. The platelets work together with a protein called collagen and the whole process is controlled by an enzyme called thrombin. The threads of a compound called fibrin are formed which starts to adhere within the first sixty seconds of a wound formation. As the fibrin forms a mesh, blood gets transformed from liquid form to a gel form through the pro-coagulants and the release of another enzyme called prothrombin. This is termed the process of coagulation and it reinforces the mesh structure of the fibrin. Finally, a clot or a thrombus is formed that keeps the blood cells trapped in the wound area. While the thrombus plays an important role in sealing the wound and reducing blood discharge, it can cause serious problems in case it detaches and goes through the circulatory system. Such an element in the blood vessel can cause a stroke, pulmonary embolism, or a heart attack.

The defensive or the inflammatory phase

The second phase is called the defensive or the inflammatory phase as it focuses on destroying bacteria and removing debris. This stage essentially prepares the wound bed for the growth of new tissue. The injured blood vessels also leak some substances that cause inflammation. A type of white blood cell called neutrophils plays a significant role by entering the wound to destroy the bacteria and remove debris. These cells often reach their peak concentration within 24 and 48 hours after injury and then they reduce in number after three days. As the neutrophils leave the stage, specialized cells called macrophages arrive to continue clearing the debris. These cells also secrete special growth factors and proteins that attract other immune system cells to the wound and facilitate the process of tissue repair. This phase usually lasts for four to six days and is often associated with oedema, reddening of the skin, heat generation, and pain. The inflammation associated with this stage is natural and generally subsides within a few days.

The proliferative phase

The third stage starts when the wound is cleaned and here the main focus is on the filling and covering of the wound. The wound margins are gradually reduced until the wound is filled up. A special shiny, deep red granulation tissue fills up the wound bed and the new blood vessels are formed. The healthy granulation tissue is pink or red and uneven in texture. The myofibroblast cells cause the wound margins to contract and they are gradually pulled towards the centre of the wound. Finally, the new epithelial cells arise from the wound bed and the margins, until the entire wound is covered. The process is enhanced when the wound is kept slightly moist. The entire proliferative stage can last anywhere from 4 to 24 days depending on the nature of the wound.

The maturation phase

This is the final stage of healing when the new tissue gains strength and becomes more flexible. The collagen is restructured as the fibres reorganise. The collagen pattern changes from type III to type I and the wound fully closes with time. The cells that were used in the process of healing but are no longer needed are removed by the process of apoptosis.  When the collagen fibres come into play, they are thick and the wound surface is uneven. Gradually the fibres come together, absorb water, and cross-link with each other. This process reduces the amount of scar tissue and makes the skin stronger in terms of tensile strength. Even though there is an overall increase in the tensile strength of the tissue as it matures, it is only around 80 percent of that of uninjured skin. This final process starts around 21 days after an injury and can continue for a year or more.

The time taken for wounds to heal

wound healing kitAs mentioned earlier, the healing process depends on a number of factors and the time taken also depends on the nature of the wound. An open wound usually takes longer to heal than a closed wound. In general, after about a period of 3 months, most wounds are repaired. A large or deep cut will heal faster if sutures are applied to it. This helps as the total area that the body has to rebuild becomes smaller. This is the reason that surgical wounds heal faster than wounds of other kinds. Wounds will also heal faster or better when they are kept covered and a bandage also keeps the wound cleaner. Patients with specific medical conditions can find their wounds taking a long time to heal properly. These conditions include diabetes, obesity, high blood pressure (hypertension), and vascular disease. In case a wound gets infected before it is healed properly, the healing process can take a much longer time than normal. Any infection that causes pain or inflammation needs to be treated seriously. Some signs of a wound becoming infected are listed below.

  • A slow rate of healing or no healing at all
  • Prolonged swelling and redness around the area
  • Pain or tenderness
  • It can get hot or warm to touch
  • The wound can ooze pus or liquid

There are some serious conditions that can result from open wounds in rare cases. These can further delay the process of healing. Such conditions include the following.

Lockjaw

This infection is caused by bacteria that also cause tetanus. It can result in muscle contractions in the jaw and neck region.

Necrotizing fasciitis

This is a severe infection of the soft tissue below the skin. It is caused by a range of bacteria including Clostridium and Streptococcus that can lead to tissue loss and even sepsis.

Cellulitis

This is a bacterial infection of the skin that is not in immediate contact with the wound. It can spread easily into other areas of the skin.

Factors that prevent wound healing

The following factors reduce the rate of wound healing and should be avoided.

  • Dead skin and foreign materials interfere with the healing process and hence they should be cleaned. Cleaning should be done gently without causing any further damage.
  • Open wounds often develop into bacterial infections. In such a case, the body will fight the infection rather than proceed with healing the wound.
  • Continuous bleeding will keep the wound edges apart and prevent wound healing.
  • A patient who remains immobile for a long period is at risk of bedsores because of constant pressure and friction on certain areas of the skin.
  • The body needs nutrients like vitamin C, zinc, copper, and protein to heal a wound and for the formation of collagen. An improper diet and poor food choices will deprive it of the same and interrupt healing.
  • Wounds in elderly people take more time to heal.
  • Some drugs or treatments can interfere with the body’s inherent healing process.
  • Cigarette smoking impairs the healing mechanism and also increases the risk of further complications.
  • Dryness of the skin can reduce healing and some wounds like ulcers, which are exposed to the air may not heal. As said before, a moist environment is a need for the effective functioning of the various cells involved in the healing process.

Conclusion

The process of wound healing happens in multiple stages and takes time. So, even though the wound can appear red, swollen, and watery in the beginning, this may very well be a part of the healing process. A scar from a wound may look uneven at first but it generally gets flatter and duller in colour. With the right care, most wounds will heal completely without a scar. However, larger wounds will need some extra care and they are likely to leave a scar.

 

If the wound does not improve in 4 weeks or the healing is not complete in 8 weeks, it is considered a chronic non-healing wound.
If your wound dressing is not waterproof, avoid submerging it or getting it wet in water.
A small amount of serous fluid drainage from the wound site is normal. It indicates that the wound is healing. However, if there is excess serous drainage, it may indicate the bacterial presence in the wound site.

 

Dos and Don'ts

Dos
  • Wash the wound with running water.
  • Small abrasions or cuts can be left uncovered.
  • Check for wound infection signs.
Don'ts
  • Use topical antibiotics without the doctor’s consultation.
  • Apply iodine on minor wounds or cuts. Studies show that iodine can delay the natural process of wound healing.
  • Scratch the wound site.

 

 

 

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GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
dandelion weight loss
Caralluma Fimbriata: How to eat this cactus to lose weight Caralluma fimbriata is a miracle cactus that can be safely consumed by most for losing weight and boosting…
beta 2 glycoprotein 1 igm
Beta 2 Glycoprotein 1 IgM The Beta 2 glycoprotein 1 IgM test detects IgM class of antibodies in the blood.The presence of beta-2…
eating disorder anorexia
Eating Disorders: Lifestyle choice or a psychological condition? Is eating disorder just a harmless bad habit? Or does it represent grim psychological disorders? Do you want…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
Ovarian cyst diagnosis and treatment
Ovarian cysts Know everything about ovarian cysts, its causes, types, diagnosis and treatment options such as home remedies and surgical…
Ovarian cyst diagnosis and treatment
Ovarian cysts Know everything about ovarian cysts, its causes, types, diagnosis and treatment options such as home remedies and surgical…
Heart diseases patient
Heart Valve Surgery A heart valve surgery is a procedure to replace or repair the diseased heart valves. The most commonly…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
Oxidative Stress: Understanding the most lethal phenomenon happening in your body right now Free radicals cause damage to the body, which is known as oxidation.  The amount of oxidation caused by…
Shilajit: A miracle Himalayan herb for an active and happy life The Himalayas contain more wonders than you thought. Shilajit is a miracle herb that is widely used in…
Anhedonia: Does the chronic inability to feel joy affect you too? How often do you feel dragged down by an invisible force? Do you feel an inexplicable emotional numbness…
biopsy procedure
Biopsy Biopsy is a procedure of studying a live tissue sample collected from a specific organ for diagnosing a…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Green, brown, & bitter: The instant advantages of including fenugreek in your diet Did you know the earliest usage of fenugreek can be traced back to the Egyptian civilization? Find out…
How can berberine supplements help you live longer and healthier? Berberine is a turmeric look-alike herbal extract that is credited with numerous health benefits ranging from diabetes cure…
Glucose-6-Phosphate Dehydrogenase (G6PD) test Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that is found in every cell of the body and it plays…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
rosacea-treatment--before-_-after
The best and safest ways to treat rosacea Rosacea is a skin disease that is characterized by reddish hives and rashes on the face. Read more…
General adaptation syndrome: Understanding stress, one step at a time The struggle of the body to produce hormones during a stressful situation is the main theme of general…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
APL IgM Test
Antiphospholipid Antibody(APL)-IgM test The antiphospholipid antibodies are specific protein in the body directed against the phospholipids. It is used to detect…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
helping friend with depression
Support and care tips for helping people with depression Read to find out what is depression, its causes and symptoms. Also check out the steps describing how…
Blood Disorders cancer
Immunotherapy immunotherapy is a treatment that boosts the body's immune system to identify the cancer cells and fight cancer.
Lung cancer xray
Lobectomy Lobectomy is a surgery where a lobe of the diseased lung is removed. It is mainly done to…
heartfail_2
Open Heart Surgery An open heart surgery is a major procedure performed to treat heart diseases like congenital heart problem, heart…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
BRAT Diet: What is the right way to follow this diarrhea-relieving diet? BRAT diet, a simple diet consisting of just bananas, rice, applesauce, and toast, can help you combat the…
lipoprotein A
Lipoprotein (A) Test Lipoprotein (A) test is used to measure and monitor the levels of LDL(Low-Density Lipoprotein) in the bloodstream in…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
Vitamin K2: 8 reasons why you need this bone-building & cancer-fighting nutrient Vitamin K2 is claimed to be essential for your bone health, for reducing the risk of cancer, and…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
anti ds dna test
Anti Ds-DNA antibody Test The  Anti Ds-DNA antibody test is used to diagnose the disease called lupus or more aptly the SLE(Systematic…
Ca 19.9 test
CA19.9 Test CA 19.9 is a cancer antigen that exists on the surface of cancer-causing cells. The levels of CA…
Vagus nerve: 7 health benefits of stimulating the “gut-brain” connection As a matter of fact, there are two vagus nerves namely the left and the right but is…
Chest X-Ray A chest x-ray is a diagnostic test that uses x-rays to visualize the structures inside your chest. It…
CLA: A breakthrough weight loss supplement with minimal side effects Tried every weight loss supplement in the market with no substantial gain? Why not try CLA supplements, derived…
HSV-1_IGG
Herpes Simplex Virus I (HSV)-IgG Test Herpes simplex virus I(HSV)-IgG is an Immunoglobulin protein that acts as an antibody & stays in the blood…
What is Qigong and how can it help you channelize you inner “Qi”? Qigong is an integrated way of performing a traditional exercise regimen that can help in promoting health, mental…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
6 arguments in favour of glucosamine and where can you find it Studies have shown that glucosamine works by preventing the breakdown of cartilage of the joints. This is usually…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
Bronchoscopy procedure
Bronchoscopy Bronchoscopy is a procedure where in a scope is inserted into the lung pathway to observe any growth…
Hydroquinone: Is it the best topical treatment for hyperpigmentation? Darkening of the skin due to high melanin levels is called hyperpigmentation.  Hydroquinone interferes with melanin production thus treating…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
Milk Thistle skin
Milk Thistle: Find possible cures for fatal diseases in these purple blooms Milk thistle is well-known for treating liver conditions. However, did you know that it comes with a plethora…
Tamarind: The top health benefits of this staple Asian ingredient Did you know this sweet and sour pulpy fruit does more than just add a tangy flavor to…
Hibiscus: Nourish your beauty and health with these vibrant blooms Hibiscus is a trumpet shaped flower found abundantly in tropical countries. It has been historically used for its…
Erythritol: A healthy sugar substitute or yet another marketing ploy? Erythritol is a popular choice of a healthy alternative sweetening agent in foods. But how healthy can a…
Trisodium Phosphate: How a paint thinner made its way into your breakfast Ever thought how toxic chemicals find their way into our foods? How can they harm our body? And…
folate test
Folate test The Folate test measures and monitors the levels of folic acid in the blood. This test is also…
hsv-igg
Herpes simplex virus (HSV)-IgG Test Herpes simplex virus I(HSV)-IgG is an Immunoglobulin protein that acts as an antibody which stays in the blood…
Alp enzyme-test
ALP test – Alkaline Phosphate ALP or alkaline phosphate is an enzyme mainly produced by the liver and gallbladder. ALP test measures the…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
sodium chloride
Halotherapy: How inhaling salt can work wonders for your body Halotherapy is quickly gaining popularity amongst those with respiratory diseases. It has shown promise in its treatment.
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…

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