Temperature, moisture, blood flow and nutrient availability, pH, bioburden and more are all factors in the microenvironment within and surrounding a wound. ¹ All of these factors come together to create an environment that is conducive or non-conducive to healing.
The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds.
Decreased pH and oxygen tension, interruption of blood supply, and mechanical interference by exudate are all factors that contribute to non healing.
Temperature is the most critical and effective way to promote wound healing or to delay it. Figure 1 shows this effect. As temperature increases, the speed that suberin formation and wound healing is completed increases, that is, it takes less time for the cut to heal.
A moist environment has been proven to facilitate the healing process of the wound by preventing dehydration and enhancing angiogenesis and collagen synthesis together with increased breakdown of dead tissue and fibrin.
The beneficial effects of a moist versus a dry wound environment include: prevention of tissue dehydration and cell death, accelerated angiogenesis, increased breakdown of dead tissue and fibrin, i.e., pericapillary fibrin cuffs, and potentiating the interaction of growth factors with their target cells.
Factors that can slow the wound healing process include: Dead skin (necrosis) – dead skin and foreign materials interfere with the healing process. Infection – an open wound may develop a bacterial infection. The body fights the infection rather than healing the wound.
If stress continues, the body has a more difficult time fighting off toxins and controlling inflammation which is a necessary element to wound healing. This effect was further supported by a clinical study that assessed wound healing progress and cortisol levels in 24 individuals after a small punch biopsy was made.
Proper wound hygiene remains one of the most important tenets to optimize healing outcomes in hard-to-heal wounds. Proper wound hygiene may help reduce the likelihood of infection, accelerate healing times, and decrease the resources required for wound care.
Environmental hazards—like water and air pollution, extreme weather, or chemical exposures—can affect human health in a number of ways, from contributing to chronic diseases like cancer or to acute illnesses like heat exhaustion.
Soothing colors, natural light, pleasant sounds, cleanliness, visual stimuli such as artwork. Reducing environmental stressors such as noise, glare from lights, and poor air quality. Comfortable rooms with seating that can be arranged for visits from family and friends.
External factors that can lead to injury can be separated into five major categories: physical, chemical, thermal, electrical, and ionizing radiation. Physical injuries are those that are related to mechanical interactions and are the most common types of acute injuries from external forces seen in medicine.
Cellular and molecular events during normal wound healing progress through four major, integrated, phases of haemostasis, inflammation, proliferation and remodelling.
Wound healing occurs in four stages, haemostasis, inflammation, proliferation and remodelling, and the appearance of the wound will change as the wound heals. The goal of wound management is to understand the different stages of wound healing and treat the wound accordingly.
Wound repair is classically simplified into four main phases: haemostasis, inflammation, proliferation and dermal remodelling [4], which result in architectural and physiological restoration following damage (figure 1). The following sections describe these stages in detail.
Stress has been shown to have a negative impact on wound healing. Although both the direct and indirect mechanisms of stress may be responsible for slowed healing, the most prominent impact is through the effects of stress on cellular immunity.
When the body has an overabundance of cortisol, the high levels interfere with the production of anti-inflammatory substances called cytokines. The result is that your injured area remains inflamed and is very slow to heal.
Depression is often associated with wound duration, odor of wounds, and furthermore with pain and immobility. On the other hand, depression might reduce wound healing itself via psychoimmunological effects.
Wound healing can be delayed by factors local to the wound itself, including desiccation, infection or abnormal bacterial presence, maceration, necrosis, pressure, trauma, and edema.
Eating well during wound healing helps you heal faster and fight infection. During healing your body needs more calories, protein, fluid, vitamin A, vitamin C, and zinc. The best source of these nutrients is food. If you are not eating enough healthy food, you may need to take a supplement.
While it is best to eat a variety of foods to ensure you get all the nutrients you need for wound healing, some good choices include: Foods high in minerals: oysters, spinach, nuts such as cashews, legumes such as peanuts, dairy products, black beans and lentils, bananas, and fish.
Moisture in the wound is essential for healing; however, excessive moisture is harmful. Normally, the fluid coming from the wound is very rich in protein-melting enzymes which help to remove dead tissue from the wound bed. Because these enzymes can melt protein, they can also melt the normal skin around the wound.
Surgical wounds are more likely to heal slower during summers as overexposure to the sun rays affects the healing of wounds. Surgical scars and wound heal more quickly during winter months.
If the wound environment is dry, the cells will have to find moisture deep in the wound bed so that they can migrate. This slows down the healing process. In fact, studies show that moist wounds heal 50 % faster than dry wounds.