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Wound healing - duration and phases

Wound healing - duration and phases



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When a wound closes, we call it wound healing because the damaged body tissue is rebuilt by new tissue. This is a self-healing of the body, which can be medically supported, for example by ointments, but also by adapted behavior of those affected. However, wound healing can also stop, making the injury a chronic wound, which can be dangerous.

Healing wounds - the most important facts

  • Wound healing is (for example, in contrast to operations) not an artificial process, but a biological process.
  • It replaces destroyed tissue with newly formed cells, blocks pathogens and ultimately forms new layers of skin.
  • The new fabric is not identical to the old one, and on top of that it is less elastic at the wound suture. A scar forms.
  • Medical treatments do not cause healing, but promote it. They ensure a germ-free environment and a humid, warm environment in which the tissue can build up optimally.
  • Complications can occur during healing. Risk factors here range from careless behavior on the part of those affected, which stress the wound too early and too heavily, to diseases such as hardening of the arteries (arteriosclerosis) and diabetes, which hinder the healing process. Chronic wounds such as pressure ulcers can also develop.
  • Every miracle should be checked for tetanus vaccination (tetanus) because it only works for ten years.

How does wound healing work?

It brings separated tissue back together. This process begins immediately when a human (or animal) is injured. Platelets attach to the damaged tissue to close it.

What does medicine do?

The healing effect is not triggered by medicine, but rather accompanies it by creating an environment in which healing proceeds as best as possible. It is usually associated with pain, which is alleviated or eliminated by doctors by administering pain medication.

Medicine always endeavors to promote the healing process in such a way that no scar is visible after the healing is complete. However, the appearance of the scar is not just about aesthetic aspects, because if it does not grow together well, it can hinder those affected even after successful healing.

With preventive vaccinations, modern medicine prevents life-threatening complications that can arise on the wound, such as a stiffness. However, blood poisoning can also result from the wound and lead to the death of the person affected within a short time, since infectious germs that form on the wound enter the bloodstream. If foreign particles could get into the wound, for example in the event of an accident, disinfection is essential.

For severe wounds, such as those caused by burns, measures such as skin grafts can also be considered. If the wound is large and open, as in a long surgical incision, the doctors close the wound edges with sutures, staples or glue. After this first aid, the medical staff cares for the wound. At regular intervals nurses or nurses clean the wound and its surroundings and change the wound covering, which is done by plasters or bandages.

The phases of healing

Wound healing takes place in several successive phases, although there is no consensus in medicine about how these phases can be differentiated. Roughly speaking, we differentiate between the cleaning and inflammation phase, immediately after the wound has arisen, the granulation phase and the regeneration phase.

In the inflammatory phase, the wound bleeds heavily - blood vessels are destroyed. This bleeding can be life-threatening due to the loss of blood in large wounds, but at the same time it has the positive effect that foreign bodies are washed away from the injury, which could infect the wound.

However, the blood vessels narrow quickly so that the blood flow stops. The blood vessels then widen again, the skin in the wound area becomes red and the temperature increases locally.

The capillary walls become more permeable and blood cells can migrate to the wound region. Lymphatic fluid leaks from damaged lymphatic vessels. This additional fluid causes the tissue around the wound to swell. Now liquid emerges from the wound (wound exudate) and rinses out broken tissue, foreign bodies, pathogens and germs. This phase lasts for several days. From a biochemical perspective, the immune system is particularly active in this inflammatory phase (in two respects). First, because it kills bacteria, viruses and other pathogens, and second, it starts the healing itself.

The granulation phase

After the inflammation phase, collagen fibers form and build new connective tissue on the wound. Cells are stored in it, creating granules, a “granular tissue”. This fills the wound from the inside and ensures that it contracts and closes.

How successful this process is depends heavily on the physical condition of those affected. People who are undernourished and / or malnourished can only form the tissue granules slowly. This also applies to sufferers who suffer from metabolic diseases or whose biochemical systems have been damaged, for example by alcoholism. Stress also has a major impact on the duration of wound healing. The formation of the tissue is a highly complex process. The fibroblasts produce mucopolysaccharides on which the loose (collagenous) connective tissue can develop.

In healthy people, the new tissue, in the case of small wounds, forms within a few hours. In the case of tiny wounds, new tissue formation takes place within minutes, while in the case of large wounds it can take weeks until enough new connective tissue fills the wound. This phase, in which the granules fill the wound, usually begins on the second day and continues until the end of the second week of wound healing. In the case of larger wounds, coherent tissue develops from the collagen fibers on the sixth day.

The regeneration

In this phase, the cover fabric is restored. The surface closes as soon as the wound is filled with sufficient granules, on the one hand by shrinking, but mostly by newly formed cells on the surface. The cells move from the edge of the wound to the middle.

Regeneration works smoothly when the area around the wound is moist and warm, as new cells can easily pull into the wound. However, if the wound dries out, the healing process is delayed. The regeneration process can be promoted with ointments and moisturizers.

The granulated tissue builds up collagen fibers and in this way restores the skin layers until a new skin layer is created on the surface. Since new tissue replaces the previously destroyed layer of tissue, the skin is not as before, which is reflected in the formation of a scar that has no elastic fibers. At the beginning, this protrudes from the surrounding skin, but it sinks later as soon as the tissue tightens. Initially the scar is red in appearance, but it turns white after about a year. In addition, it becomes more resistant and the collagen fibers strengthen.

Wound healing disorders

Medical support is necessary simply because the healing can easily be disturbed by external and internal factors. The result is often ugly scars and chronic wounds, in severe cases even infections that can be life-threatening.

  1. If the healing wound is stressed early and / or too heavily, you run the risk that it or the scar that forms can break open. This is not only associated with pain, it also leads to poorer results of the healing process, so that the scars deform, for example, deformed.
  2. If the patient is lying on one side, pressure ulcers can develop, which heal with difficulty and delay healing. Pressure ulcers are a chronic wound.
  3. If a wound is very large or infected, this often leads to massive granulation tissue, which often results in oversized and unaesthetic scars.
  4. Diseases such as diabetes or hardening of the arteries (arteriosclerosis) have a negative effect on healing. With arteriosclerosis, both the blood transport and the oxygen supply are restricted. Diabetes causes poor circulation in the body, making the immune system unable to fight off infectious diseases.

What can you do yourself?

If you have a large wound that bleeds profusely, please see a doctor immediately. For cuts and lacerations, stop the bleeding first. To do this, take a clean piece of cloth, preferably gauze, cotton or gauze, and press it into the wound.

If the wound, such as a knee abrasion due to a fall from the bicycle, is dirty, it must first be cleaned thoroughly to prevent infections and to speed up the healing process. A clean cloth soaked in lukewarm water is suitable for this. If there are larger foreign objects such as pebbles in the wound, remove them with tweezers. Caution: If a particle is deep in the tissue or is difficult to remove, leave it to the doctor to remove it.

After cleaning the wound, you should apply an antiseptic ointment as soon as the wound is dry. This way you prevent infection.

If the wound extends over a larger area, if it is deep or dirty, you should definitely seek medical help.

A moist and warm climate is recommended for wound healing. For small wounds you can do this with a plaster, for larger wounds with a wound dressing. In this microclimate, a low pH also protects against pathogens. The tissue regenerates faster, the wound remains more elastic and less hard scab forms, which can break open as the wound heals. If the wound is moist, you hardly suffer from the painful tensions. You can also support regeneration with breathable ointments, which ensure that the wound does not dry out. Turmeric is a natural medicine - its anti-inflammatory and wound-healing properties have already been investigated in various studies. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Dr. med. Andreas Schilling

Swell:

  • Isolde Rojas, David A. Padgett, John F. Sheridan, Phillip T. Marucha: Stress-Induced Susceptibility to Bacterial Infection During Cutaneous Wound Healing, Brain Behavior and Immunity, (accessed June 26, 2019), ScienceDirect
  • Hans Lippert (ed.): Wundatlas - Compendium of complex wound treatment, Georg Thieme Verlag Stuttgart, 3rd edition, 2012
  • Th. Einsiedel, M. Bischoff, S. Kolodziej, M. Vogel, L. Kinzl, A. Schmelz: Reperfusion, infection control and defect coverage - current status of wound treatment - an overview, Georg Thieme Verlag Stuttgart, (available on June 26, 2019), Thieme
  • Martina Barchitta, Andrea Giuseppe Maugeri, Giuliana Favara et al .: Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin, International Journal of Molecular Sciences, (accessed June 26, 2019), MDPI
  • Mustafa Hussain, Wei Long Ng, Dan Liu et al .: Healing of Chronic Wounds - An Update of Recent Developments and Future Possibilities, Tissue Engineering Part B Reviews, (retrieved on June 26, 2019), Liebert


Video: Wound Healing: Part 1 - Concept of Regeneration, Repair, Granulation Tissue u0026 Angiogenesis HD (August 2022).