Whether you work in a hospital setting, an outpatient clinic, a doctors office, or a specialty setting, this pandemic has.Understanding the pathophysiology of wound healing can help clinicians to better comprehend the needs of a wound to help it progress through the stages of wound healing.If a wound is on a normal healing trajectory, it will generally heal in four to six weeks.
Alternately, chronic wounds are wounds that fail to heal in the normal four- to six-week standard healing time. Infection should be controlled or prevented through good hand washing; prevention, reduction, or elimination of biofilm; and prevention of cross-contamination. Initially, vasoconstriction occurs to prevent the body from bleeding out rapidly. Platelets are delivered to the site of injury to stop bleeding, forming a clot. This starts the inflammatory response and activates inflammatory cells. ![]() Fibroblasts provide a structure that allows extracellular components to form a scaffold that cells can migrate across. Cellular debris and bacteria are removed, and cellular migration is encouraged. It is also characterized by hemostasis, as well as chemotaxis and increased vascular permeability. The inflammatory phase is where chronic wounds typically get stuck. Cells involved in this stage of wound healing include macrophages, fibroblasts, endothelial cells, mast cells, B cells, andor myofibroblasts. This phase can last several weeks and is the phase that occurs right before the remodeling phase. Ultimately, a scar forms, leaving up to 80 tensile strength for life. White blood cells and thrombocytes release mediators and cytokines, speeding up the inflammatory process. Polymorphonuclear neutrophils enable phagocytosis of bacteria and cellular debris, thereby decontaminating the wound. If the wound is not properly decontaminated, however, or if conditions are not right for the wound to continue on to the next stage of wound healing, the inflammatory stage may become prolonged and lead the wound into chronic status. Biofilms can lower the wound beds pH and reduce oxygen levels; they can also produce a barrier that prevents cellular migration and stops antibiotic and antibody penetration. Pro-inflammatory cytokine levels are increased in the presence of bacteria, and if bacteria levels are not reduced, these cytokines may stay elevated, prolonging the inflammatory phase. When the inflammatory phase lasts too long, a buildup of matrix metalloproteases occurs that, at high levels, can damage the extracellular matrix. ![]() For infection, a wound culture and systemic antibiotics may be needed. As clinicians evaluate the wound, they should continue to identify areas that are stalling wound healing and preventing the wound from achieving closure. Remember, a wound bed that is too dry prevents cell migration and can cause other issues that delay wound healing. A wound bed that is too wet can cause maceration, encourage bacterial growth, and also delay wound healing. A well-trained eye and proper assessment can lead the way to wound healing. Treasure Island, FL: StatPearls; 2019.. Accessed November 5, 2019. Koppen CJ, Hartmann RW. Advances in the treatment of chronic wounds: a patent review.
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