Overview

Wound healing is a complex biological process through which the body repairs tissue damage caused by injury, surgery, or disease. It involves a series of well-coordinated stages that restore the integrity of the skin and underlying tissues. The process typically follows four key phases: hemostasis, inflammation, proliferation, and remodeling (maturation). Proper wound healing is essential to prevent infection, restore function, and achieve aesthetic recovery. Disruptions in this process can lead to delayed healing or chronic wounds.

Causes

The stages of wound healing are triggered by any event that causes a break or injury to the skin. Common causes that initiate the wound healing process include:

• Accidental injuries: Cuts, scrapes, lacerations, abrasions, and punctures.
• Surgical procedures: Incisions made during medical surgeries.
• Burns: Thermal, chemical, or electrical burns causing tissue damage.
• Pressure ulcers: Sores caused by prolonged pressure on the skin, common in bedridden individuals.
• Chronic diseases: Conditions like diabetes or vascular disease that impair normal wound healing mechanisms.

Symptoms

During normal wound healing, individuals can expect specific signs that reflect each stage:

• Hemostasis phase: Immediate bleeding followed by clot formation to stop blood loss.
• Inflammatory phase: Redness, swelling, warmth, and mild pain as immune cells clear debris and prevent infection.
• Proliferative phase: Development of new tissue, visible granulation tissue (pink/red), and reduced wound size.
• Maturation phase: Scar formation, strengthening of new tissue, and gradual fading of redness.

Delayed healing or complications may include persistent redness, increasing pain, pus formation, foul odor, and failure of the wound to close properly.

Diagnosis

Diagnosis of wound healing status involves clinical evaluation and, in some cases, additional investigations:

• Physical examination: A healthcare professional assesses the wound's appearance, size, and condition during follow-up visits.
• Wound measurement: Documenting dimensions and depth over time to monitor progress.
• Infection assessment: Checking for signs of infection such as warmth, swelling, discharge, and fever.
• Laboratory tests: In chronic wounds, wound cultures or blood tests may be done to detect infection or underlying health issues.
• Imaging studies: Rarely, imaging like ultrasound or MRI is used to assess deeper tissue damage or osteomyelitis (bone infection).

Treatment

Managing the wound healing process involves supporting each phase and preventing complications:

• Hemostasis phase: Applying pressure, dressings, or sutures to control bleeding.
• Inflammatory phase: Keeping the wound clean, using topical antibiotics if needed, and managing pain.
• Proliferative phase: Promoting tissue growth with moist wound dressings, nutritional support, and avoiding wound disruption.
• Maturation phase: Continued care to minimize scarring and enhance tissue strength with protective care.

Additional supportive treatments may include:

• Debridement: Removal of dead or infected tissue to promote healing.
• Advanced dressings: Use of hydrocolloid, foam, or antimicrobial dressings based on wound type.
• Offloading: Reducing pressure on wounds in pressure ulcer cases.
• Treating underlying conditions: Managing diabetes, infections, or circulatory issues that impair healing.

Prognosis

The prognosis for wound healing is generally good in healthy individuals with proper care. Acute wounds often heal within days to weeks, progressing through all stages smoothly. Surgical wounds typically heal without complications when managed appropriately. Chronic wounds, like diabetic ulcers or pressure sores, can take months and may require specialized care.

Factors such as age, nutritional status, comorbidities, and infection can affect healing speed. With appropriate wound management and early intervention, most wounds heal successfully, reducing the risk of complications like infections, chronic wounds, or excessive scarring.