Process of Wound Healing

Process of Wound Healing

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Wound healing is the process by which skin or other
body tissues repairs itself after trauma. This process is
divided into phases i.e.
Blood clotting (haemostasis)
Inflammation
Tissue growth (proliferation) and migration
Angiogenesis
Tissue remodeling/ re-epithelialization (maturation)

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Blood clotting (haemostasis) – is the mechanism
that stops the bleeding. This is done through
vasoconstriction and vessels seal themselves off as the
platelets create substances that form a clot and
halts/stops bleeding.
Inflammation – this is a way of alerting the body of
the injury. The injured area presents with the signs of
inflammation – redness (hyperaemia), warmth
(hyperaemia), pain (irritation of nerve endings,
chemical mediators), swelling (exudation of fluid),
loss of function (pain). Inflammation is important but
if it goes on for long, it can prevent regeneration.
Outcomes of inflammation.

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 Proliferation/Tissue growth and migration
After inflammation, the body releases several kinds of
cells responsible for proliferation e.g. leukocytes.
Proliferation is similar to homeostasis as cells work to
further constrict the blood vessels.
Outcome of acute inflammation
Abscess formation
Progress to chronic inflammation
Resolution goes back to normal
Repair – healing by scarring or fibrosis

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Angiogenesis – once the bleeding is under control,
the body begins the process of rebuilding new blood
vessels to replace the veins and arteries that were
damaged – either by creating new sections or adding
into existing portions.

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 Tissue Remodeling/
Re-epithelialization /Maturation

This involves regrowing of the damaged skin, the

epidermis consisting of keratinocytes. This process
involves creation of the several layers of the skin, cells
which are no longer needed are removed by PCD or
apoptosis.
Synthesis- although it is seen as the last step,
synthesis often happens almost simultaneously.
Certain proteins form blood clots which helps further
prevent bleeding as new skin and veins are formed. It
involves alignment of collagen to provide strength to
the healthy tissue

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Factors affecting wound healing
The wound healing process is not only complex but
also fragile, and susceptible to interruption or failure
leading to the formation of non-healing or chronic
wounds.
Factors that contribute to non healing or affecting
wound healing may be divided into:

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Local factors
Moisture- keeping the wound moist rather than dry
makes the wound healing more rapid and with less pain
and scarring.
Mechanical factors
 Oedema
 Infection- introduce microorganisms to the wound
thus slowing the process of wound healing
Ischaemia and necrosis
Foreign bodies – sharp small foreign bodies in the
wound will cause delayed healing
Low oxygen tension to the wound
Low perfusion to the wound
Low blood perfusion

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Systemic factors
Inflammation- is a normal part of wound healing for
removal of contaminating microorganism, failure to
which microbial clearance is incomplete
Oxygenation – important for cell metabolism and
energy production in form of ATP
DM– causes immunosuppression thus reduced
capability in the healing of acute or chronic wounds
Diabetics also are prone to developing chronic diabetic
ulcers due to hypoxia
Nutrition - malnutrition or nutritional deficiencies
have an impact on wound healing following trauma or
surgical wounds. Nutrients e.g. proteins, CHO,
glutamine, polysaturated fatty acids, vitamin A, C, E,
magnesium, copper, zinc and iron play a significant role
in wound healing.
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 .
Obesity – obese patients develop wound complications
including skin wound infections, wound dehiscence,
haematoma formation, pressure ulcers and venous
insufficiency causing chronic venous ulcers.
Medication/Drugs – drugs e.g. those that interfere with
clot formation or platelet formation. Drugs that interfere
with inflammatory response and cell proliferation have
the capacity to interfere with wound healing e.g.
glucocorticoids steroids, NSAIDs, chemotherapeutic
agents.

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Metabolic diseases – inherited single gene anomalies
or autosomal recessive disorders.
Immunosuppression – from diseases, drugs,
nutrition etc
Connective disorders – involving fibroblasts,
adipocytes, macrophages, mast cells and leukocytes.
Smoking- cause delay in the speed of wound repair
notably in the proliferative and inflammatory phases.
It also increases the likelihood of certain
complications e.g. wound rupture, wound and flap
necrosis, decrease in wound tensile strength and
infections
Others- venous arterial deficiencies, infections

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Intentions of Wound Healing
Primary intention- is the healing of a clean wound
without tissue loss. The wound edges are able to be
brought together so that they are adjacent to each
other (approximated). It is seen in small wound that
close easily. Wound closure is performed with sutures
(stitches), staples, or adhesive tape/glue. Healing is
fast with minimal scarring or infection. Examples of
wounds that heal by primary intention include well
repaired lacerations, well reduced bone fractures, cuts,
surgical incisions, healing after flap surgery.

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Secondary intention
Secondary intention is implemented when primary
intention is not possible. This is usually due to wounds
that being created by major trauma in which there is
significant loss in tissue or large tissue damage, with large
gaps between wound margins.
The wound is allowed to granulate and fibrosis
predominates over epithelial regeneration.
Healing process is slow with more inflammation with and
granulation tissue formation and more scarring due to
infection.
Examples of wounds that heal by second intention
include:- infarction wounds, large/extensive burns, big
ulcers, extraction sockets, poorly reduced fractures, severe
lacerations, pressure ulcers/sores.
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Tertiary intention
Also called delayed closure or secondary suture. The
wound is initially cleaned, debrided and observed for
4-7 days before closure. Examples is healing of wounds
by use of tissue grafts.
This type of healing is desired in case of contaminated
wounds. By the fourth day, phagocytosis of
contaminated tissues, process of epithelialization,
collagen deposition and maturation are occurring.
If cleansing (surgical toileting) is incomplete, then
chronic inflammation ensues resulting in prominent
scarring.

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Complications of Soft Tissue Injuries
Chronic pain
Stiffness
Abscess formation
Decreased range of movement
Scar formation
Loss of digit/hand

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