Introduction
Wound healing is a biological process by which the body repairs injured tissues after trauma, surgery, or infection. It involves cell proliferation, tissue regeneration, and remodeling to restore normal function and integrity.
Incidence
- Common in surgical procedures, trauma cases, burns, and chronic
ulcers.
- Diabetics and immunocompromised patients are at
high risk of delayed healing.
- Poor wound healing leads to infection, scarring, and chronic
wounds.
Definition
Wound healing is a complex
physiological process involving hemostasis, inflammation, proliferation,
and remodeling to repair tissue damage.
Classification
of Wounds
1. Based on
Cause
- Traumatic wounds – Cuts, lacerations,
punctures, abrasions.
- Surgical wounds – Incisions made during
surgery.
- Burn wounds – Thermal, chemical,
electrical, radiation burns.
2. Based on
Depth
- Superficial wounds – Involves only the
epidermis (scrapes, minor cuts).
- Partial-thickness wounds – Involves the epidermis
and part of the dermis (blisters, second-degree burns).
- Full-thickness wounds – Extends into subcutaneous
tissue, muscle, or bone.
3. Based on
Healing
- Acute wounds – Heal within 4-6 weeks
(e.g., surgical wounds).
- Chronic wounds – Persist longer due to
poor healing (e.g., diabetic ulcers, pressure sores).
Phases of Wound
Healing (Mnemonic: HIP-R)
- H – Hemostasis (Blood clotting & fibrin formation)
- I – Inflammatory Phase (WBC infiltration, cleaning debris)
- P – Proliferation (New tissue formation, angiogenesis)
- R – Remodeling (Scar formation, collagen remodeling)
1. Hemostasis
Phase (Immediate - Few Hours)
- Vasoconstriction → To prevent further
bleeding.
- Platelet aggregation → Clot formation.
- Fibrin clot formation → Acts as a temporary
plug to stabilize wound edges.
2. Inflammatory
Phase (0-3 Days)
- Neutrophils and macrophages clean the wound by removing
bacteria and dead cells.
- Increased blood supply → Leads to redness,
swelling, and warmth.
3.
Proliferation Phase (3-24 Days)
- Fibroblasts produce collagen to build new tissue.
- Angiogenesis (new blood vessel formation) occurs.
- Re-epithelialization (new skin growth) starts.
4. Remodeling
(Maturation) Phase (21 Days - 1 Year)
- Collagen reorganization strengthens the scar.
- Wound contraction helps reduce size.
- Final scar formation occurs (may take months).
Factors
Affecting Wound Healing
1. Local
Factors
- Infection – Delays healing by causing inflammation.
- Oxygenation – Low oxygen levels impair
collagen synthesis.
- Edema – Increases pressure, reducing blood supply.
- Wound tension – Excessive movement
disrupts healing.
2. Systemic
Factors
- Diabetes mellitus – Poor blood circulation
leads to delayed healing.
- Malnutrition – Deficiency of proteins,
vitamins (Vit C, Zinc) slows repair.
- Smoking & Alcohol – Reduces oxygen and immune
function.
- Aging – Older age leads to slower cell regeneration.
Clinical
Features of Poor Wound Healing
- Persistent redness and swelling.
- Delayed wound closure (more than 4-6 weeks).
- Increased discharge or pus formation.
- Necrotic tissue formation.
- Foul smell (suggests infection).
Laboratory
Investigations
- Complete Blood Count (CBC) – Checks for infection (↑
WBC).
- C-Reactive Protein (CRP) – Elevated in ongoing
inflammation.
- Wound Culture – Identifies bacterial
infection.
- Serum Albumin – Low levels indicate poor
nutrition.
- Glucose Levels (HbA1c) – To assess diabetes control.
Management of
Wound Healing
General
Measures (Mnemonic: WOUND CARE)
- W – Wash hands before dressing change.
- O – Oxygenation improvement (quit smoking, control diabetes).
- U – Use antiseptic solutions (betadine, saline).
- N – Nutrition-rich diet (proteins, Vitamin C, Zinc).
- D – Dressings (moist wound healing approach).
- C – Compression therapy for venous ulcers.
- A – Antibiotics for infected wounds.
- R – Repositioning in bed-ridden patients to prevent pressure ulcers.
- E – Examine for complications (infection, necrosis, delayed
healing).
Allopathic
Treatment (Mnemonic: DRESS-UP)
- D – Debridement (Removal of dead tissue).
- R – Revascularization (Angioplasty for ischemic wounds).
- E – Enzymatic debridement (Collagenase ointment).
- S – Skin grafting (For large wounds).
- S – Systemic antibiotics (If infection present).
- U – Ultrasound therapy (Enhances healing).
- P – Pain management (NSAIDs, local anesthetics).
Surgical
Treatment
- Suturing of wounds (For clean surgical cuts).
- Excision of necrotic tissue in gangrenous wounds.
- Flap surgery for large non-healing
wounds.
- Vacuum-assisted closure (VAC) therapy for
chronic wounds.
Homeopathic
Treatment
- Calendula Officinalis
- Best antiseptic and wound healing remedy.
- Prevents infection and promotes granulation
tissue.
- Used in surgical wounds, lacerations, and
burns.
- Wound with thick yellow pus.
- External application as Calendula lotion speeds
up healing.
- Arnica Montana
- Wounds due to trauma, falls, and bruises.
- Soreness all over the body.
- Prevents septicemia and reduces swelling.
- Useful post-surgery to prevent hematoma
formation.
- Skin feels sensitive to touch.
- Silicea
- Promotes expulsion of pus in abscesses.
- Chronic non-healing wounds and ulcers.
- Helpful in diabetic foot ulcers and surgical
wounds.
- Wounds with offensive-smelling pus.
- Cold, clammy hands and feet.
- Hepar Sulphuris
- For infected wounds with abscess formation.
- Extreme sensitivity to touch.
- Offensive pus discharge, yellow-green in color.
- Better in warm conditions, worse in cold air.
- Useful in post-surgical wound infections.
- Hypericum Perforatum
- Wounds involving nerves and nerve pain.
- Sharp, shooting pain at injury site.
- Crushed fingers, puncture wounds, lacerations.
- Prevents tetanus in deep wounds.
- Better with warm applications.
Mnemonic for
Homeopathic Treatment (CASH-H)
- C – Calendula (Prevents infection, antiseptic).
- A – Arnica (Trauma wounds, bruises).
- S – Silicea (Expels pus, chronic ulcers).
- H – Hepar Sulph (Sensitive, infected wounds).
- H – Hypericum (Nerve pain, deep wounds).
