Wounds: Stages of Healing

About this course

Wound healing is a natural physiological reaction to tissue injury. It is a complex, dynamic process supported by a myriad of cellular events that must be tightly coordinated to efficiently repair damaged tissue. Derangement in wound-linked cellular behaviors, as occurs with diabetes and aging, can lead to healing impairment and the formation of chronic, non-healing wounds. The effective management of wounds is complex, and to maximize outcomes for patients, it is recommended that those involved in their care and treatment have the appropriate knowledge and skills to adequately treat wounds.

Learning objectives

• Review the stages of wound healing
• Identify symptoms of wound infection
• Relate causes of wounds to the various wound types
• Describe available treatment options for wounds
• Differentiate between the various wound types

Course outline

31 sections · finish in any order across devices

1. 1

   Introduction

   A wound disrupts the normal structure and function of the skin and soft tissue architecture.1 It can be described as damage or injury to the living tissue due to multiple agents.2 There are different types of wounds caused by different agents, and wounds can vary in severity.2 For instance, an acute

   4 min

2. 2

   Description

   Open wounds

   4 min

3. 3

   Description

   Class I

   4 min

4. 4

   Stages of Wound Healing

   Wound healing is a natural physiological reaction to tissue injury.16 It is a complex, dynamic process supported by a myriad of cellular events that must be tightly coordinated to efficiently repair damaged tissue.17 Derangement in wound-linked cellular behaviors, as occurs with diabetes and aging,

   4 min

5. 5

   Hemostasis

   When an injury occurs, the initial phase is always an outpouring of lymphatic fluid and blood. It is during this process that adequate hemostasis is achieved.16 Both the extrinsic and intrinsic coagulation pathways are activated and play a role in stopping blood loss.16 Platelets, principal contribu

   4 min

6. 6

   Inflammation

   The inflammatory phase begins with hemostasis and chemotaxis. Both the white cells and thrombocytes speed up the inflammatory process by releasing more mediators and cytokines.16 Besides the platelet-derived growth factor, other factors promote collagen degradation, the transformation of fibroblasts

   4 min

7. 7

   Proliferation

   The proliferation or granulation phase does not occur at a discrete time but is ongoing all the time in the background.16 It is characterized by extensive activation of keratinocytes, fibroblasts, macrophages, and endothelial cells to orchestrate wound closure, matrix deposition, and angiogenesis.17

   4 min

8. 8

   Dermal Remodeling

   Remodeling of the extracellular matrix spans the entire injury response, beginning with the initial deposition of a fibrin clot, and ending several months later with the formation of a mature, type I collagen-rich scar.17 Thus, it starts at around week 3 and can last up to 12 months.16

   4 min

9. 9

   Symptoms of Wound Infection

   An improper repair process can cause severe damage like the loss of skin and initiation of infection, with consequent harm to the neighboring and deep tissues.18

   4 min

10. 10

    How Wound Infection Occurs

    As soon as the skin is impaired, typical microorganisms of the normal skin flora and exogenous bacteria and fungi can soon access underlying tissues, which offers a humid, warm, and nutrient-rich environment for their development.18 However, when the healing is delayed, the normal microbiota of the

    4 min

11. 11

    Causes of Wounds

    Wounds can be internal or external, acute or chronic, and are caused by different agents.4 Wounds of internal origin mainly result from impaired circulation, neuropathy, or medical illness. Wounds of external origin may be caused by an outside force or trauma that causes open or closed wounds.4 Belo

    4 min

12. 12

    Description

    Impaired circulation

    4 min

13. 13

    Description

    Contusions

    4 min

14. 14

    Description

    Mechanical agents

    4 min

15. 15

    Description

    Venous ulcer

    4 min

16. 16

    Wound Management

    Wound healing has been under the aegis of basic nursing practices, such as wound covering management, therapeutic nutrition, mobility, and psychosocial support.8 Thus, nurses play a critical role in treating and managing acute and chronic wounds.8

    4 min

17. 17

    Wound Debridement

    Debridement, the removal of damaged tissue from a wound, is the first line of care for chronic wounds.5 Debridement is also useful for wounds that have devitalized tissue, contamination, or residual suture material.1 The procedure includes irrigating the wound with normal saline or clean water with

    4 min

18. 18

    Characteristics

    Surgical

    4 min

19. 19

    Wound Packing

    Wound packing is considered basic standard care.1 It is associated with significant dead space or undermining and is important to reduce physiological dead space, absorb exudate/seroma collection, and reduce the potential for infection.1 Undermined wounds are those that have large soft-tissue defect

    4 min

20. 20

    Moisture Control

    Moisture control is also an essential part of wound care, as moist wounds have the potential to heal quicker and have less risk of infection.5 In addition to faster wound healing, wounds treated with occlusive dressings are associated with less prominent scar formation.1

    4 min

21. 21

    Wound Dressing

    A wound dressing that is correctly applied and changed frequently can significantly impact the speed of wound healing, the strength and function of the repaired skin, and the cosmetic appearance of the resulting scar.1 No single wound dressing is perfect for all wound types; thus, the selection is m

    4 min

22. 22

    Dressing Type

    Draining

    4 min

23. 23

    Antiseptics and Antimicrobial Agents

    If a wound has already become infected, antibiotics or antiseptics should be used to kill or slow the growth of the micro‐organisms causing the infection and prevent it from getting worse or spreading.14 They also help heal the wound by reducing the population of microorganisms present in the wound.

    4 min

24. 24

    Iodine-Based

    The role of iodine in wound care is primarily as an antimicrobial agent.15 The microbicidal activity of iodine appears to involve the inhibition of vital bacterial cellular mechanisms and structures and oxidizes nucleotides and fatty/amino acids in bacterial cell membranes.15

    4 min

25. 25

    Honey

    Honey has broad-spectrum antimicrobial activity due to its high osmolarity and high concentration of hydrogen peroxide.1 Medical-grade honey products are now available as a gel, paste, and impregnated into adhesive, alginate, and colloid dressings.1 However, sufficient evidence is unavailable to ens

    4 min

26. 26

    Growth Factors

    Platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), etc., are important growth factors for wound healing.1

    4 min

27. 27

    Role of Nutrition in Wound Healing

    Despite the obvious advantages, some healthcare professionals do not always appreciate the link between nutrition and wound healing, and the patient’s diet is often not considered until their wound becomes infected or fails to heal in a timely manner.20

    4 min

28. 28

    Vitamins

    Successful activation of the clotting cascade and formation of the fibrin clot during hemostasis requires calcium and vitamin K. It is required to modify some proteins used for coagulation and bone metabolism.20

    4 min

29. 29

    Amino Acids

    Arginine is an amino acid that is not essential in a healthy individual, but its metabolic demand increases during surgery, trauma, and in psychologically stressful circumstances, which often involve a wound.20

    4 min

30. 30

    Other Considerations

    Lastly, the importance of water to wound healing is often overlooked. Water provides a structural component in the cytoplasm of skin cells as well as an environmental component, allowing the migration and maturation of epidermal cells.20

    4 min

31. 31

    Conclusion

    As soon as the skin is impaired, typical microorganisms of the normal skin flora and exogenous bacteria and fungi can soon access underlying tissues, which offers a humid, warm, and nutrient-rich environment for their development, and the formation of a wound. The presence of a wound represents a co

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Samaneh Online Medilib. www.medilib.ir. https://www.medilib.ir/uptodate/show/15912
• Wounds: Types, Classification of wounds, Treatment and Wound care. Jotscroll. Published 2018. https://www.jotscroll.com/forums/11/posts/171/wounds-types-classification-of-wounds-treatment-and-wound-care.html
• Kielo E, Suhonen R, Salminen L, Stolt M. Competence areas for registered nurses and podiatrists in chronic wound care, and their role in wound care practice. Journal of Clinical Nursing. 2019;28(21-22):4021-4034. doi:10.1111/jocn.14991
• Causes of Wounds. Woundcarecenters.org. Published 2014. https://www.woundcarecenters.org/article/wound-basics/causes-of-wounds
• Bowers S, Franco E. Chronic Wounds: Evaluation and Management. American Family Physician. 2020;101(3):159-166. Accessed October 31, 2022. https://www.aafp.org/pubs/afp/issues/2020/0201/p159.html#causes-of-chronic-wounds
• NHS Choices. Overview - Venous leg ulcer. NHS. Published January 11, 2019. https://www.nhs.uk/conditions/leg-ulcer/
• Packer CF, Manna B. Diabetic Ulcer. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK499887/
• Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Advances in Wound Care. 2019;8(2):39-48. doi:10.1089/wound.2019.0946
• Different Types Of Wounds - Wound Care Surgeons. https://www.woundcaresurgeons.org. Accessed October 31, 2022. https://www.woundcaresurgeons.org/blogs/know-about-different-types-of-wounds#:~:text=Open%20wounds%20are%20the%20wounds
• Acute Wound - an overview | ScienceDirect Topics. Sciencedirect.com. Published 2014. https://www.sciencedirect.com/topics/engineering/acute-wound
• Herman TF, Bordoni B. Wound Classification. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK554456/
• Choo J, Nixon J, Nelson A, McGinnis E. Autolytic debridement for pressure ulcers. Cochrane Database of Systematic Reviews. Published online June 17, 2019. doi:10.1002/14651858.cd011331.pub2
• Maliyar K, Mufti A, Sibbald RG. The Use of Antiseptic and Antibacterial Agents on Wounds and the Skin. Local Wound Care for Dermatologists. Published online 2020:35-52. doi:10.1007/978-3-030-28872-3_5
• Norman G, Dumville JC, Mohapatra DP, Owens GL, Crosbie EJ. Antibiotics and antiseptics for surgical wounds healing by secondary intention. Cochrane Database of Systematic Reviews. Published online March 29, 2016. doi:10.1002/14651858.cd011712.pub2
• Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, Pyon JK, Wa CTC, Villa MA. Povidone iodine in wound healing: A review of current concepts and practices. International Journal of Surgery. 2017;44:260-268. doi:10.1016/j.ijsu.2017.06.073
• Wallace HA, Zito PM. Wound Healing Phases. Nih.gov. Published January 19, 2019. https://www.ncbi.nlm.nih.gov/books/NBK470443/
• Wilkinson HN, Hardman MJ. Wound healing: cellular mechanisms and pathological outcomes. Open Biology. 2020;10(9):200223. doi:10.1098/rsob.200223
• Negut I, Grumezescu V, Grumezescu A. Treatment Strategies for Infected Wounds. Molecules. 2018;23(9):2392. doi:10.3390/molecules23092392
• Infected wound: Recognition, treatment, and when to see a doctor. www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/325040#treatment
• Bishop A, Witts S, Martin T. The role of nutrition in successful wound healing. JCN. 2018;4(32).
• Barchitta M, Maugeri A, Favara G, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. International Journal of Molecular Sciences. 2019;20(5):1119. doi:10.3390/ijms20051119
• Welsh L. Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review. International Wound Journal. 2017;15(1):53-61. doi:10.1111/iwj.12822
• Peate I, Stephens M. Wound Care at a Glance. John Wiley & Sons, Incorporated; 2020.

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