Wound Healing Healing is quality of living tissue, it is also referred to as regeneration (renewal) of tissues.

Healing can be considered in terms of types of healing, having to do with the caregivers decision on whether to allow the wound to seal itself or to purposely close the wound, and phases of healing, which refer to the steps in the bodys natural processes of tissue repair. The phases are the same for all wounds, but the rate of healing depends on factors such as the type of healing, the location and size of the wound, and the health of the client.

Inflammatory Phase The inflammatory phase is initiated immediately after injury and lasts 3 to 6 days. Two major processes occur during this phase: hemostasis and phagocytosis. Hemostasis results from vasoconstriction of the larger blood vessels in the affected area, retraction of injured blood vessels, the deposition of fibrin (connective tissue), and the formation of blood clots in the area. The blood clots, formed from blood platelets, provide a matrix of fibrin that becomes the framework for cell repair. A scab also forms on the surface of the wound. Consisting of clots and dead and dying tissue. Below the scab, epithelial cells migrate into the wound from the edges. The epithelial cells serve as barrier between the body and the environment, preventing the entry of microorganisms. The inflammatory phase also involves vascular and cellular responses intended to remove any foreign substances and dead and dying tissues. The blood supply to the wound increases, bringing with it oxygen and nutrients neede in the healing process. The area appears reddened and edematous as a result. During cell migration, leukocytes move into the interstitial space. These are replaced about 24 hours after injury by macrophages, which arise from the blood monocytes. These macrophages ingulf microorganisms and cellular debris by a process. The macrophages also secrete an angiogenesis factor (AGF), which stimulates the formation of epithelial buds at the end of injured blood vessels. The micricirculaory network that results sustaining process and the wound during its life. This inflammatory response is essential to healing.

Proliferation Phase The proliferation phase, the second phase in healing, extends from day 3 or 4 to about day postinjury. Fibroblasts, which migrate into the wound starting about 24 hours after injury, begin to synthesize collagen. As the amount of collagen increases, so does the strength of the wound, thus the chance that the wound will open progressively decreases. Capillaries grow across the wound, increasing the blood supply. Fibroblasts move from the bloodstream into the wound, depositing fibrin. As the capillary network develops. When the granulation tissue granulation matures, marginal epithelial cells migrate to it proliferating over this connective tissue base to fill the wound. Initially, wounds healing by secondary intention seep blood tinged drainage. Later, if they are not covered by epithelial cells, they become covered with thick, gray, fibrinous tissue that is eventually converted into scar tissue. Maturation Phase The maturation phase begins about day 21 and can extend 1 or 2 years after the injury. Fibroblasts continue to synthesize collagen. The collagen fibers themselves. Which were initially laid in a haphazard fashion, reorganize into a more orderly stracture. During maturation, the wound is remodelled and contracted. The scar becomes stronger but the repaired area is never as strong as the original tissue. In some individuals, particularly dark-skinned persons, an abnormal amount of collagen is laid down. This can a result in a hypertrophic scar, or a keloid. Phase Inflammatory (also called lag or exudative phase) Duration 1-4 days Events Blood clots forms Wound becomes edematous Debris of damaged tissue and blood Clots are phagocytosed Collagen produced Granulation tissue forms Wound tensile strength increases Fibroblasts leave wound Tensile strength increases Collagen fibers reorganize and tighten

Proliferative (also called fobroblastic or connective tissue phase) Maturation (also called differentiation, resorptive, remodelling, or plateau phase

5-20 days

21 days to months or even years

to reduce a scar size.