Wound Healing Stages – Have a Clear Idea

Wound Healing StagesEffective wound management aims at faster healing of wounds. A wound may fail to heal if one or more of the healing stages are interrupted. There are many factors that delay healing such as infection, age, stress, diabetes, obesity, medications, alcoholism, smoking, and lack of nutrition.

Wound Healing Stages

The duration of each stage depends on the size of the wound.

  • Hemostatis and Inflammation – Hemostatis begins when the skin is broken and ends when blood loss is controlled. This stage is the body’s natural response to injury. Platelets, neutrophils and macrophages are the key cellular components of this phase. Platelets help immediate formation of the blood clot. It releases cytokines to attract inflammatory cells to the site of the wound. Neutrophils remove bacteria and debris from the wound by release of enzyme. Macrophages produce nitric oxide and aid in the antimicrobial activities of neutrophils in the wound. Finally cytokines and growth factors that promote collagen deposition will be released. This phase may last 3 to 5 days. Chronic inflammation can be detrimental to healing and can lead to loss of wound integrity.
  • Proliferation – Three steps in the proliferative phase includes re-epithelialization, granulation tissue formation and wound contraction. Re-epithelialization begins as early as 24 hours post injury. Granulation tissue is generated that consists of macrophages, fibroblasts, immature collagen, blood vessels, and ground substance. During the wound contraction, myofibroplasts link up across the wound bed and over time pull the wound closed.
  • Maturation or Remodeling – This final phase that can last from 20 days to even months or years is a dynamic process that increases the tensile strength of the wound. While in many acute wounds (surgical wounds), skin edges are brought close together, in chronic wounds (pressure ulcers), they are not close. Such wounds are at a greater risk of becoming infected.

Documentation Helps in Holistic Care

Documenting wound changes and assessment data helps in examining the stage and severity of the wound, determine the status of healing, preparing a plan of care and reporting observed changes in the wound over time. All wounds should be assessed regularly and outcomes of the assessment documented. Now most wound clinics use advanced documentation tools. Wound EMR is an effective tool that facilitates more structured documentation. This wound specific EMR is also loaded with templates that allows nurses to extract the patient’s history, wound assessment details and other information more quickly.