In adults, optimal wound healing should involve four continuous and overlapping phases: Haemostasis, inflammation, proliferation, and remodelling .
Overview of Wound Healing
The inflammatory phase occurs immediately following the injury and lasts approximately 6 days. The fibroblastic phase occurs at the termination of the inflammatory phase and can last up to 4 weeks. Scar maturation begins at the fourth week and can last for years.
In adults, optimal wound healing should involve four continuous and overlapping phases: Haemostasis, inflammation, proliferation, and remodelling .
Epithelialization. All dermal wounds heal by three basic mechanisms: contraction, connective tissue matrix deposition and epithelialization. Wounds that remain open heal by contraction; the interaction between cells and matrix results in movement of tissue toward the center of the wound.
Stage 1: just erythema of the skin. Stage 2: erythema with the loss of partial thickness of the skin including epidermis and part of the superficial dermis. Stage 3: full thickness ulcer that might involve the subcutaneous fat. Stage 4: full thickness ulcer with the involvement of the muscle or bone.
The three main types of wound healing are primary, secondary, and tertiary. Minor wounds go through the stages of wound healing fairly quickly. More severe wounds will take longer to heal. Any symptoms of infection, as well as any major injuries, should prompt a visit to a doctor for a full diagnosis and treatment.
Phase 1: Hemostasis
The objective of the hemostasis phase of wound healing is to stop any bleeding. To do so, your body activates its blood clotting system. When your blood clots at the opening of a wound, it prevents you from losing too much blood and it is the first step of your wound closing up.
Wounds healing by primary intention are wounds that have been closed using stiches, skin glue, staples, etc. Most surgical incisions are an example of wounds that are healed by primary intention healing. Secondary intention healing is when a wound is left open. No sutures or other materials are used to close the wound.
Wound healing occurs in an organized sequence of overlapping phases that results in tissue reconstitution. This process involves hemostasis, inflammation, proliferation, and ends with the formation of mature scar tissue.
The Centers for Disease Control and Prevention created a surgical wound classification system (SWC: I, clean; II, clean/contaminated; III, contaminated; and IV, dirty) to preemptively identify patients at risk of surgical site infection (SSI).
In the proliferation phase, the provisional wound matrix formed during haemostasis is replaced by granulation tissue, consisting of a large amount of fibroblasts, granulocytes, macrophages, blood vessels, in complex with collagen bundles, which partially recovers the structure and function of the wounded skin [35].
4 stages of wound healing with pictures
There are several important stages of wound healing, following four processes: hemostasis, inflammation, proliferation and maturation. Depending on the internal and external patient conditions, some wounds can worsen or improve a quicker pace than usual.
Stage 3 involves the full thickness of the skin and may extend into the subcutaneous tissue layer; granulation tissue and epibole (rolled wound edges) are often present. At this stage, there may be undermining and/or tunneling that makes the wound much larger than it may seem on the surface.
Wound healing occurs in four stages, haemostasis, inflammation, proliferation and remodelling, and the appearance of the wound will change as the wound heals.
Granulation tissue is a type of new connective tissue, and microscopic blood vessels have three main functions. Immune: Protects the wound surface from microbial invasion and further injury. Proliferative: Fills the wound from its base with new tissue and vasculature.
Stage 2:Partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough or bruising. May also present as an intact or open/ruptured blister. Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed.
Class 3 – Contaminated: Wounds classified as contaminated can be the result of an injury, operations with major breaks in sterile technique, or spillage from the gastrointestinal tract. Class 4 – Dirty contaminated: These wounds came in contact with feces or pus during the surgery.
It can take anywhere from three months to two years for a stage 4 bedsore to properly heal. In some cases, if the damage is too great, a stage 4 bedsore might never heal completely.
Instead, the full-thickness ulcer is filled with scar tissue composed primarily of endothelial cells, fibroblasts, collagen, and extracellular matrix. A Stage IV pressure ulcer, therefore, can't become a Stage III, Stage II, or subsequently Stage I pressure ulcer.
Stage II Pressure Ulcer: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
Slough is present only in stage 3 pressure injuries and higher. Slough may be present in other types of wounds such as vascular, diabetic, among others. You are most likely not seeing a biofilm.
Grade 1: Superficial ulcer, partial or full-thickness. Grade 2: Ulcer extends to ligament, tendon, joint capsule or deep fascia without abscess/osteomyelitis. Grade 3: Deep ulcer with abscess, osteomyelitis or joint sepsis. Grade 4: Gangrene localized to forefoot or heel. Grade 5: Extensive gangrene.