Wound Healing - An Overview

Introduction

Globally, around two percent of hospitalized people have chronic wounds - a cut on the skin that does not undergo a repairing process in the expected time and order on its own. People of older age are at higher risk of developing chronic wounds because aging decreases the repairing or healing ability of the cells. As a result, 70% of such wounds occur again or repeatedly, and 32 % develop an infection.

If a wound does not heal in an orderly and timely manner, it burdens the patient, healthcare system, and society. This also impacts the quality of life of the patient, and their families, causing depression, stress, anxiety, etc. Untreated, non-healing, and poorly managed wounds may result in serious health consequences and even death. The existing data suggest that people who frequently visit a wound care center or a clinic face 30 % fewer hospital readmissions because of wound healing-related complications.

What Is a Wound?

A wound is a break in the skin or tissues because of a cut or injury.

What Is Wound Healing?

Wound healing is a natural biological process or response of the human body against an injury of tissues.

What Are the Types of Wound Healing?

There are four types of wound healing:

1. Acute Wound Healing - Wounds that heal quickly and promptly through a natural sequential process - normal wound healing.

2. Chronic Wound Healing - Wounds that do not heal on time and healing is delayed because of an underlying condition or reason - poor wound healing.

3. Primary Intention Wound Healing - Wounds that heal when the cut edges are closed through stitches (sutures). It is commonly used in surgical procedures where a surgeon intentionally cuts the skin in a straight, well-defined line (clean incision).

4. Secondary Intention Wound Healing - Wounds that are left open or a gap is left between the edges of the wound. This is done intentionally to provide a natural healing process.

5. Tertiary Intention Wound Healing - Wounds left open initially for natural healing are then closed through stitches (suturing).

What Are the Wound Healing Stages or Processes?

The wound healing process has 4 phases that occur at a specific time through a sequence. The 4 phases are described below -

1. Hemostasis: Just after an injury occurs to the tissues, the damaged blood vessels contract (narrow down) quickly, and the blood clot forms at the wound site. This prevents bleeding at the wound site and prevents the entry of bacteria inside the wound. Platelets present in the blood are the main contributors to hemostasis. Once the blood clot is formed sufficiently, the hemostasis process is stopped. At the same instant, cells start repairing the damaged blood vessels at the wound site.

2. Inflammation: It is an immune response of the body to protect from harmful foreign pathogens or germs at the wound site. Inflammation is carried out by immune cells such as neutrophils, mast cells, etc. These immune cells trap the harmful pathogens and kill them to protect the wound site. Inflammation at the wound or injury site increases the blood flow resulting in temporary redness and swelling. This phase may last for several days.

3. Proliferation:It is characterized by the rapid activation or production of different types of cells, such as keratocytes, endothelial cells, etc., at the wound site to close the wound. This phase may last for several weeks.

4. Tissue Remodeling: The wound achieves maximum strength through maturation in this phase. The wound contraction or closure starts and achieves maximum strength after a few weeks. This phase may last up to a few months. As the wound heals, a scar is formed, less flexible and less strong than the original. Sometimes the scar fades away with time, while some scars never fade and stay for a lifetime.

What Are the Signs of Wound Healing?

Given below are a few signs that may help to recognize whether the wound is healing or not -

1. If a cut causes the wound, it undergoes bleeding, followed by drying the blood and scabbing (forming a crust or layer over the wound).

2. After the scab is formed, swelling at the wound site may occur due to the body’s natural immune response. The wound site may appear red or pink.

3. Once the swelling is stopped, the cells in the body start repairing the wound. As a sign of repair, the wound shrinks a little, and the edges are folded inwards. The patient may feel stretched skin at the wound site.

4. After the healing is complete, a scar is formed that may fade away in a few years.

What Does a Healing Wound Look Like?

Initially, a wound may look red or pink and swollen. After the healing process is complete, it may become flat and look dull.

White Skin Around Wound Healing (Maceration): Sometimes, maceration appears around the wound. It occurs when the wound is exposed to moisture for a long time, such as during long baths, swimming, etc. Most macerations heal on their own and do not require medications.

What Causes Slow Wound Healing?

Given below are various factors that may result in poor or slow wound healing -

1. Poor oxygen levels at the wound site, as oxygen is important for healing.

2. Infection or contamination of the wound site because of the presence of microorganisms.

3. Prolonged inflammation because of the presence of bacteria at the wound site.

4. The age of the patient decreases the healing ability of the body.

5. Stress may result in compromised wound healing because it negatively impacts the body’s immune response.

6. Chronic diseases such as diabetes cause impaired cell functioning and hypoxia (low oxygen levels in cells).

7. Several medications, such as glucocorticoid steroids and non-steroidal anti-inflammatory drugs, interrupt the body’s immune system and inflammatory response, affecting wound healing.

8. Alcohol and smoking delay wound healing and increase complications such as infection, decrease in wound strength, etc.

9. Nutritional deficiencies and/or poor diet affect the healing process. This may require additional nutritional supplements as and when prescribed by the doctor.

How to Stop a Healing Wound From Itching?

Itching at the wound site signifies a normal healing process that goes away with time. Scraping off the healing wound may result in delayed healing and bleeding. Given below are a few ways to relieve itching -

• Keep the wound protected through the bandage.

• Keep the wound site moisturized.

• Apply an ice pack.

• Apply antihistamines as prescribed by the doctor.

How to Speed Up or Promote Wound Healing?

Wound healing may require extra protein, calorie, and nutrient intake. Grains, vegetables, fruits, and dairy products can act as essential wound-healing supplements and may promote fast healing.

What Vitamins Promote Wound Healing?

Vitamin A and vitamin C help the body to heal fast.

Which Mineral Is Essential for Wound Healing?

Several minerals are helpful in wound healing. Iron, zinc, and copper play an important role in this process.

What Food to Avoid for Wound Healing?

Food with high sugar and carbohydrates, alcohol, and caffeine may delay wound healing and should be avoided.

What Other Remedies Are There for Healing Wounds?

1. Wound Healing Antibiotics - Secondary intention wounds or surgical wounds may require topical (applied on the skin) antimicrobial agents that have both antiseptic properties and antibiotic resistance, such as penicillin. These medications should be taken with care only after being prescribed by the doctor.

2. Wound Healing Ointment - An ointment is an oil-based preparation that is applied to the skin superficially to aid healing because they have antiseptic and/or antimicrobial properties and they prevent infection of the wound site. These can be useful in minor or small wounds. These ointments should be applied only after consulting a doctor.

3. Wound Healing Cream - A cream is a water-oil-based preparation that is applied on the skin superficially to prevent infection and contamination at the wound site. Just like ointments, these also have antiseptic and/or antimicrobial properties and should be applied only after consulting a doctor.

4. Sleep - Taking proper rest and good sleep help in faster healing.

5. Tobacco Consumption - Consuming tobacco in any form such as smoking or chewing delays wound healing because tobacco interferes with the healing process and may increase the risk of complications.

Conclusion

It is important to understand what wound healing is and the factors that may impair or slow down this process. For example, taking a healthy diet and quitting bad habits such as alcohol and tobacco consumption can aid healing and reduce recovery time. But if the wound healing is delayed or slowed, it is best to see a doctor.