Ask the treatment expert ... about signs of wound healing

Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

What should I see if a wound is healing as expected?

There are four stages to look for. There are individual differences in the timing of the phases. Comorbid medical conditions can slow wound healing and at times stall it.

The first phase is called the “Hemostatic Phase.” During this phase, the wound is stabilized, foreign objects are attacked and clotting occurs. This is accomplished through vasoconstriction of the vessels, platelet aggregation in the wound bed and the appearance of thromboplastin.

The “Inflammatory Phase” surges when vasodilatation and phagocytosis occur. Vasodilatation is an increase in the permeability of the capillaries. This allows white blood cells to enter the area. Phagocytes clear the wound bed of debris and dissolve the clotting that occurred during the hemostatic phase. The wound edges may appear red and swollen and may be warm to touch. Pain may occur.

The third stage is the“Proliferative Phase.” There are three activities that occur during this phase, beginning with the formation of granulation tissue. This is a granular type tissue that fills in the wound deficit composed collagen fibers. This tissue is also very vascular due to angiogenesis, or the formation of new blood vessels. As the wound fills with granulation tissue, the wound also contracts, and the edges begin to be pulled together while epithelial cells begin to grow across the moist wound bed. At the end of this phase of wound healing, the wound is completely resurfaced with skin or epithelial cells.

The final stage is called the “Maturation Phase.” The new collagen tissue (scar tissue) becomes stronger or increases in tensile strength. As it matures, the amount or size of the tissue mass decreases. It will never be more than 80% as strong as original tissue.