Wound Care Concierge Part IV: The Stages of Wound Healing

Paul M. Graham, DO

Proper wound care is vital to preserving the integrity of our largest organ system, the skin. Many factors play a role in wound healing. Occasionally, normal healing is disrupted, requiring medical intervention to reinitiate the healing process. Below is a brief description of the stages of wound healing highlighting the important characteristics of each. Normal wound healing typically progresses through each stage in chronological order. If one of these stages is slowed or halted, a chronic wound may develop. Stay tuned for information on chronic wounds in an upcoming Wound Care Concierge article.

 

1. Hemostasis Phase – initial insult or injury followed by initiation of bleeding. In this stage, bleeding is stopped by the formation of a blood clot by platelets at the area of injury along with active blood vessel constriction.

 

 

 

2. Inflammatory Phase – Migration of inflammatory and immune cells to the site of injury. Immune cells remove bacteria and cell signals are released to attract and upregulate additional immune cells for further clean up of wound debris (neutrophils). These cells also secrete growth factors for the initiation of the proliferation phase.

 

3. Proliferative Phase – Collagen deposition, formation of new blood vessels (angiogenesis), and migration and growth of new skin cells (epithelialization) occurs. Epithelial cells “leapfrog” over each other and form a thin layer of skin that bridges the wound.

 

 

4. Remodeling Phase – Collagen continues to be laid down at the wound site by fibroblast, forming numerous cross linkages and increasing the strength and integrity of the wound. Contraction of the wound occurs by the action of myofibroblast. At 3 weeks following repair, the wound holds approximately 20% of the tensile strength of normal skin and at 1 year, the wound holds 80% of the tensile strength of normal skin. If the remodeling phase is disrupted or prolonged, an enlarged scar called a hypertropic scar or a keloid may develop and may require additional treatment to improve the cosmetic outcome of the scar.

For more information regarding wound healing, please make sure to take a look at our Wound Care Concierge Series at the links below:  

• Wound Care Concierge Part 1: Introduction to Wound Care,
• Wound Care Concierge Part II: Nutrition
• Wound Care Concierge Part III: The Power of Protein and More

Photo Credit: Shield Healthcare

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