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).
Tags
SURGERY