Wound Healing

Skin- the body’s first line of defense against invasion by infectious microorganism. It is the sensory organ
for pain, touch and temperature.

2 layers of pain: 1. Epidermis, 2. Dermis

Epidermis---has five layers; 1. Stratum corneum

2. Stratum lucidum
3. stratum granulosum
4. stratum spinosum
5. stratum germinatum
Stratum corneum- flattened dead keratinized cells. It prevents dehydration of underlying cells and
serves as a barrier to the entry of certain chemicals.

Dermis- consist of collagen, blood vessels, and nerves.

Collagen composed 70% of dermis and is extremely important in wound healing.

The dermis restores the physical properties of the skin and it’s structural integrity.

Risk for local or systemic infection, impaired circulation, and breakdown of tissue directly impairs the
wound healing ability of the skin layers.

Factors affecting wound healing; a. location, b. severity, c. extent of injury, d. tissue layer involved

Partial thickness wound healing (loss of tissue limited to epidermis and partial dermis)- heals by the
process of regeneration.

Full thickness wound healing(total loss of skin layers as well as some deeper tissue) heals by scar
formation.

Factors that prevent the ability of cells and tissue to regenerate, return to normal situation.
Tissue perfusion and oxygenation
Nutrition status
Infection
Diabetes mellitus
Age
Stress
Immunosuppression
The healing process in full thickness wound healing;
1. Hemostasis 2. Inflammatory 3. Proliferative 4. Remodeling

1. Hemostasis phase- blood vessels constrict. Clotting factors activate coagulation pathways to
stop bleeding. Clot formation seals the disrupted vessels so blood loss is controlled. Growth
factors are released, which attract cells needed to begin the repair process.
2. Inflammatory phase- vasodilation occurs allowing plasma and blood cells to leak into the
wound, noted as edema, erythema and exudate. Leukocyte arrives in the wound to begin
wound clean up. Macrophage- a type of WBC appear and begin to regulate the wound repair.
3. Proliferative phase- Epitheliazation(the construction of new epidermis) begins. New granulation
tissue is formed. New capillaries created restoring the delivery of oxygen and nutrients to the
wound bed. Collagen is synthesized and begins to provide strength and structural integrity to
the wound.
4. Remodeling phase- collagen is remodeled to become stronger and provide tensile strength to
the wound
Types of Healing
1. Primary intention- occurs when the edges of a clean surgical incision remains close together.
The wound heals quickly. Tissue loss is minimal or absent.
2. Secondary intention- wounds that are left open and allow to heal by scar formation. There is
tissue loss and open wound edges.
3. Tertiary intention- also called delayed primary intention or closure. Occurs when surgical
wounds are not closed immediately, but left open for 3-5 days to allow edema and infection to
diminish. Then the wound edges is sutured or stapled. Scarring is minimal.