The skin may result to tissue damage caused by injury, infection, trauma or pathological processes. Wound healing involves a complex sequence of overlapping events, but also consists of predictable sequence of events consisting primarily of tissue regeneration and tissue repair (Flanagan, 2013). Wound healing involves three processes, namely primary, secondary and tertiary intention healing. The major events occuring during the primary intention healing process are the deposition of the connective tissue and epithelialization (Sussman and Jensen, 2007). This process is usually associated to surgical incision healing where the tissue surface has been stitched or stapled when there is very few tissue loss. The secondary intention healing process usually takes place when there is significant tssue losses and the edges of the tissues cannot be sutured together. The wound is left open to allow the tissue to close and heal on its own. During the healing process, scar formation is possible because the wound extends deeper into the tissue layers. The wound healing period also takes longer than the primary intention healing. During the tertiary intention healing the wound is left open up to 3 to 5 days in order to allow the edema or infection to subside or for the exudate to drain (Hess, 2013). This process of healing is usually called delayed primary closure because the tissues are not immediately sutured or stapled or closed. The primary intention healing offers the fastest healing process and ideal cosmetic outcomes from a wound healing.
Four phases of wound healing also occur. The first phase involves hemostasis which occurs immediately after the initial tissue injury. During this phase, a clot is formed to prevent further bleeding on the injured tissue. The inflammation phase then follows which is considered to be the defensive phase because host of cells will infiltrate the wound site in order to remove the bacteria that were destroyed by leukocytes and to clear the wound area from cellular debris. The macrophages will also replace the leukocytes in order to stimulate the inflammatory response as well other biochemical actions to produce the production of cytokines and growth factors that are essential in tissue repair. The proliferation phase soon follows where the new granulation tissues are rebuilt through fibroblast stimulation to form collagen, giving the tissues tensile structral form and strength. Once the tensile strength occurs on the tissue and the wound closes, the maturation phase then follows. This phase remodels the collagen of the tissues and the process may take months to years to complete (Hess, 2013).
Various factors affect wound healing. Malnutrition can delay the course of healing and may prolong hospitalization and increases the chance of other complications. Because oxygenation is crucial in forming leukocytes to destroy bacteria and the stimulation of collagen synthesis by the fibroblasts, inadequate blood supply to the wound site may result in complications like atherosclerosis and peripheral vascular disease (McCann, et al., 2007). Infections can also increase the risk to complications and it also delays the healing process. The presence of chronic conditions like diabetes and malignancies also delays wound healing and increase the risk of complications. The patient’s age can also affect the wound healing process.
Wound complications may also occur, the most common of which are infection, hematoma, seroma formation, wound rupture, venous and pressure ulcers, wound dehiscence, neuropathy, epidermolysis and ischemia. Complications during wound healing are usually caused by the occurence of abnormal physiological processes of healing in response to environmental and systemic stimuli. The patient’s health status and medical history or the combination of these factors can cause complications of wound healing (Mani, Romanelli and Shukla, 2012).
References:
Flanagan, M. (2013). Wound Healing and Skin Integrity: Principles and Practice. New York: John Wiley & Sons.
Hess, C.T. (2013). Clinical Guide to Skin and Wound Care. New York: Lippincott Williams & Wilkins.
Mani, R., Romanelli, M. and Shukla, V. (2012). Measurements in Wound Healing: Science and Practice. New York: Springer London.
McCann, J.A. et al. (2007). Wound Care Made Incredibly Easy! Sydney: Lippincott Williams & Wilkins.
Sussman, C. and Jensen, B. (2007). Wound Care: A Collaborative Practice Manual. Philadelphia: Lippincott Williams and Wilkins.
