Normal Wound Healing: Myths, Reality, and Tech Innovation

Most children end up with more than a few scrapes and scabs during their formative years. The all-too-familiar adhesive bandage (with or without a favorite cartoon character) is often part of a kind of daily childhood uniform. In this sense, normal wound healing is a part of every parent or caretakers life.

It starts with just a simple fall, which then scabs over, and within a few days, most wounds are healed. And in the meantime, kids have a killer scab or two to show off as a badge of honor, a rite of passage marking your journey through childhood! It’s all normal and routine.

While seemingly simple, wound care is actually a complex and dynamic process that involves a series of well-coordinated events at the cellular and molecular levels. This biological process, known as cutaneous wound healing, is essential for restoring the integrity of the skin and underlying tissues after injury.

But as anyone in wound care knows, not all wounds heal easily. Some take much longer than anticipated, and some never fully heal. Why is that? Let’s take a look into the stages of normal wound healing, acknowledge early myths, identify warning signs of complications, review normal and abnormal wound healing, and explore the wound care solutions available to document, monitor, and track wound healing.

Surprising Myths about Wound Healing

As with other healthcare-related fields, there are myths and misunderstandings. These are important to know as many people may still believe them. Here are three of the more common myths about normal wound healing.

1. Wounds heal better when left exposed to air. Wound care providers know that keeping a wound covered with a proper dressing helps it heal faster and reduces the risk of infection.
2. Scabs are essential for wound healing. While scabs do form as part of the healing process, they can actually slow down healing by creating a barrier to new tissue growth. Keeping the wound moist and covered (our parents were right) can promote faster and more effective healing.
3. Applying spider webs to a wound can help it heal. According to Science Daily, this belief dates back to ancient times when people thought that the sticky, silk-like webs could help close wounds and prevent infection. While spider webs do contain some antimicrobial properties, modern medicine has far more effective (and, thankfully, less icky) methods for wound care.

If those are the myths, what are the facts?

What Are the Stages of Normal Wound Healing?

Wound healing is a complex and dynamic process that involves the coordinated action of various cell types, growth factors, and other molecules. This intricate process can be divided into four distinct phases: hemostasis, inflammation, proliferation, and remodeling. Each phase plays a crucial role in ensuring proper wound healing, and any disruption or delay can lead to poor wound healing or even chronic wounds.

During the hemostasis phase, the body works quickly to stop bleeding through vasoconstriction and the formation of a blood clot. This is followed by the inflammatory phase, where white blood cells, particularly neutrophils and macrophages, migrate to the wound site to clear debris and prevent infection. The proliferation phase then takes over, characterized by the formation of new tissue, including the development of new blood vessels and collagen deposition. Finally, the remodeling phase involves the reorganization of collagen fibers, leading to the maturation and strengthening of the wound.

Understanding these phases and the role of growth factors in each is essential for promoting proper wound healing and preventing complications such as chronic wounds.

What Are the Stages of the Wound Healing Process?

Normal wound healing occurs in four overlapping phases or wound healing stages: hemostasis, inflammation, proliferation, and remodeling.

First Healing Stage: Homeostasis

Hemostasis is the initial phase that begins immediately after injury. The primary goal is to stop bleeding through vasoconstriction and the formation of a blood clot. Platelets play a crucial role by releasing factors that initiate the healing process.

Second Healing Stage: Inflammatory

Following hemostasis, the inflammatory phase kicks in, typically lasting a few days. During the inflammatory phase, inflammatory cells, including neutrophils and macrophages, migrate to the wound site to clear debris and prevent infection. These inflammatory cells release cytokines and growth factors that activate other cells and facilitate healing processes such as angiogenesis and the transition to the proliferative phase. The inflammatory phase is characterized by redness, heat, swelling, and pain.

Third Healing Stage: Proliferation

The proliferation phase involves the formation of new tissue and can last from a few days to several weeks. Key processes include angiogenesis (formation of new blood vessels), collagen deposition, granulation tissue formation, and epithelialization. Fibroblasts are the main cells involved, producing collagen and extracellular matrix to support new tissue.

Fourth Healing Stage: Remodeling

The final phase, remodeling, can last weeks, months and even years. During remodeling, collagen fibers are reorganized, and the wound matures and gains strength. This is when scars form. The scar tissue formed is usually less elastic and has a different texture compared to the surrounding skin.

Types of Wound Healing

Wound healing can occur through several different mechanisms, each with its own unique characteristics. The primary types of wound healing are primary intention, delayed primary intention, and secondary intention.

Primary intention healing occurs when the wound edges are brought together, typically through sutures, staples, or adhesive strips. This method allows the wound to heal quickly with minimal scarring, as the edges are closely aligned, facilitating efficient tissue repair.

Delayed primary intention healing, on the other hand, involves a period where the wound edges are not immediately brought together. This delay can be due to the need to clear infection or other complications. Once the wound is clean, the edges are then approximated, leading to a slower healing process compared to primary intention.

Secondary intention healing occurs when the wound is left open and heals through the natural processes of granulation and contraction. This method is often used for larger or more contaminated wounds and typically results in more significant scarring due to the extensive tissue repair required.

Factors Affecting Wound Healing

Several factors can significantly impact the wound healing process, including age, nutrition, and the presence of underlying medical conditions. For instance, older adults often experience delayed wound healing due to decreased collagen synthesis and reduced blood flow. These age-related changes can impede the body’s ability to repair damaged tissue efficiently.

Nutrition also plays a vital role in wound healing. Malnutrition can hinder the healing process by reducing the availability of essential nutrients and growth factors needed for tissue repair. Adequate protein, vitamins, and minerals are crucial for supporting the various phases of wound healing.

Chronic conditions such as diabetes and obesity can further complicate wound healing. Diabetes, for example, can impair blood flow and increase inflammation, leading to slower healing and a higher risk of infection. Obesity can also reduce blood flow and increase the likelihood of complications, making effective wound management more challenging, as well as inhibiting wound repair.

What Are the Warning Signs of Abnormal Wound Healing?

For most wound care providers, one of the most troubling occurrences in the process is a non- or slow-healing wound. Whether a wound heals quickly and normally depends on many factors, including age and the patient’s overall health.

Any interruption in the natural process may indicate abnormal healing or slow down wound repair. Persistent redness and swelling that do not subside after a few days may indicate an infection or chronic inflammation. Increased pain or discomfort that does not improve over time can be a sign of infections or other complications.

Wounds that do not show signs of healing within the expected timeframe may be chronic wounds like those related to diabetes or heart disease. Diabetic foot ulcers (DFUs) are a type of chronic wound that may not show signs of healing within the expected timeframe. Unusual discharge (a.k.a. exudate), such as blood, fluid, or pus, or anything excreting a foul odor, can also indicate an infection.

Of course, those who are very young, older, or patients who can’t communicate (whether due to a language barrier or other inability for patient and provider to communicate with each other effectively) may be unable to share information. That means you as the provider will need to be their voice and carefully monitor and analyze the wound to ensure it is progressing.

What Should Healthcare Providers Know About Abnormal and Normal Wound Healing?

It takes more than just looking at a wound to ensure wound healing. A thorough assessment of the patient’s overall health, including factors like diabetes, nutrition, and circulation, is essential for effective wound management and timely wound healing. Nutritional support plays a critical role in chronic wound healing, as deficiencies in key vitamins and minerals can impair tissue repair and hinder recovery.

Regular evaluation of the wound’s size, depth, and appearance helps in tracking the healing progress and identifying any complications early. Proper wound care techniques, including cleaning and dressing, are vital to prevent infections and manage delayed primary wound healing, which occurs when wound edges are not immediately reapproximated, particularly in contaminated wounds.

Educating patients in a home setting about proper wound care, signs of complications, and when to seek medical attention is also crucial for successful wound healing and overall long-term health—after all, some complications of abnormal wound healing can affect other systems in the body. Collaboration with specialists, like dermatologists, surgeons, and infectious disease experts, can enhance wound care outcomes and improve wound repair.

Additionally, strong communication among care team members, either verbally or via a robust electronic health record (EHR) platform, also ensures vital data is communicated to the right providers at the right time.

Can Technology and Growth Factors Aid in Wound Repair?

There’s good news on this front: technology can be a big help in treatment and monitoring of wound healing and wound repair.  While wound care EHRs are a major technological advancement for wound care, today there are many other solutions available as well.

For example, smart bandages include sensors that monitor wound conditions as well as the ability to deliver medication directly to the wound, jump starting wound healing phases. These innovations represent the future of wound care, offering more precise and effective insights and actions.

Advancements in technology have also introduced leading-edge tools to track and manage wound healing. Artificial intelligence (AI)-powered mobile imaging solutions are at the forefront of this revolution. These tools offer several benefits. AI algorithms created by analyzing millions of data sets can provide precise measurements of wound dimensions and depth, helping to monitor wound repair progress objectively. By analyzing wound images over time, AI can predict healing outcomes and identify potential complications in wound repair early.

These solutions can integrate with the EHR, providing a comprehensive view of the patient’s wound history and treatment plan. They are paradigm-shifting for providers, enabling them to use sophisticated apps on smart phones, tablets or other devices to securely take images that help to consistently measure and analyze key wound features. Mobile imaging wound solutions also allow healthcare providers to assess and monitor wounds remotely, reducing the need for frequent in-person visits.

It’s important to note that the role of these technologies is to provide the guidance and insights wound care providers need to make better decisions and not to replace hands-on care from experienced specialists.

Complications of Wound Healing

Complications during the wound healing process can arise from various factors, leading to issues such as infection, delayed healing, and wound contraction. Infection is a common complication, occurring when bacteria or other microorganisms enter the wound, causing inflammation and further delaying the healing process.

Delayed healing can result from poor nutrition, inadequate blood flow, or underlying medical conditions. This can lead to chronic wounds that are difficult to treat and manage. Wound contraction, another potential complication, involves the shrinking of the wound as it heals, which can sometimes lead to restricted movement or function, particularly if the wound is near a joint.

Other complications include dehiscence, where the wound edges separate, exposing underlying tissues, and evisceration, a more severe form of dehiscence where internal organs protrude through the wound. Hematoma and seroma, which involve the accumulation of blood or fluid in the wound, can also cause swelling and delay the healing process.

Ask the Right Questions

Understanding the normal stages of wound healing and recognizing the signs of complications are crucial for effective wound management. There are also important questions to ask, including:

Is there any sign of infection? To detect early signs of complications like redness, swelling, or discharge.

Has the wound size changed? To monitor for reduction in size.

Is there any pain or discomfort? To assess for unusual pain, which might signal infection or other issues.

Are there any changes in the wound’s appearance? To observe for healthy granulation tissue or any necrotic tissue.

How is the surrounding skin? To check for maceration or other skin issues that could affect healing.

What SDOH factors may be inhibiting wound healing ability? To ensure optimal care for all patients, Social Drivers of Health (SDOH) must also be factored into the normal wound healing process. The Centers for Medicare & Medicaid Services (CMS) defines Social Drivers of Health (SDOH) as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functional, and quality-of-life outcomes and risks. These risks play a role, even in wound healing.

Various factors such as glucocorticoids, stem cells, NSAIDs, and surgical techniques can significantly influence wound repair by either promoting or inhibiting the wound healing process.

These are some of the crucial questions to help ensure comprehensive monitoring and timely intervention. That last point on SDOH is an important one to explore. Unhoused patients, those living in unsanitary conditions, with literacy challenges or facing other situations may encounter many obstacles in the healing process. Providers and others along the continuum must address those issues to meet emerging payer SDOH requirements, and potentially their personal or organizational mission.

Stay Informed about New Healing Techniques

The study of wound healing – how and why wounds heal or don’t – is complex fascinating, and will continue to evolve. It is also vital for providers in the profession. Recognizing the stages of healing and the warning signs of complications is essential.

The body’s process of healing skin wounds involves multiple stages, including hemostasis, inflammation, proliferation, and remodeling. Factors such as infection, underlying health conditions, and proper treatment play crucial roles in ensuring effective recovery and keeping the wound site clean.

The good news is that advances in our understanding of normal healing as well as innovative technologies and expanded best practices have helped improve the process for everyone. Mobile imaging solutions, smart bandages, stem cells, and more will continue to change the way we treat wounds. Most importantly, these innovations will help to improve the health and quality of life for patients.

Understanding the intricacies of wound healing and staying informed about the latest technological advancements can significantly improve wound care practices. Knowledge is your best ally in the journey toward optimal wound healing.

Future of Wound Healing

The future is bright, with numerous advancements in technology and research paving the way for new treatments and therapies. One such innovation is negative pressure wound therapy, which has been shown to promote healing by reducing edema and encouraging the formation of granulation tissue. This therapy involves applying a vacuum to the wound, which helps to draw out excess fluid and stimulate blood flow.

Research into the use of growth factors and stem cells is also showing promising results. As biological agents stem cells can enhance the body’s natural healing processes, promoting tissue repair and regeneration. Growth factors, in particular, play a crucial role in the various phases of healing, making them a focal point of ongoing research.

Advances in wound dressings and topical treatments are also being developed, with a focus on creating a moist environment that promotes wound healing and reduces bacterial colonization. These new dressings are designed to be more effective and easier to use, improving patient outcomes and quality of life.

Overall, the future of wound healing is filled with exciting developments that hold the potential to revolutionize the way we treat and manage wounds, offering hope for faster, more effective healing for patients worldwide.