Ask the Treatment Expert about ... epibole

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

I've heard the term epibole used for wound healing but don't understand exactly what it is, how to recognize it or what the proper treatment is. Can you explain?

Epibole is a form of wound healing that stalls wound closure in full-thickness wounds. Wounds heal in an organized, structured manner. The normal sequence of wound healing occurs when the wounded area deficit fills with granulation tissue as it contracts. Contraction pulls the wound edges toward each other. The wound also begins to resurface as epithelial cells migrate across the wound to meet each other to form a new epithelial layer to cover the wound. 

In chronic wounds, the edges may roll or bend down toward the wound bed rather than migrate across the wound. If the roll or bend makes contact with epithelial cells within the same area, the body receives the communication that the healing process is complete, that the migration of the epithelial cells is complete, and that the wound is healed.

The wound edges appear as rolled-over or curved with an open wound exposed. The wound edge may appear elevated and firmer than surrounding tissue or skin. The color is often different from surrounding skin. 

It is very unusual for a wound with epibole of the wound edges to heal. Prevention and intervention are imperative. Prevention measures include light packing of the wound bed, protection of the skin surrounding the wound bed, and protection of the wound and surrounding area from pressure, shear and friction.

Treatment requires debridement of the involved tissue, often referred to by wound care specialists as reinjury. Debridement of the wound edges will restart the wound healing sequence. Consult with a physician for debridement procedures or orders. All options of debridement should be considered, based on the resident's condition.