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Guest Post…Wound Healing Part II

Here is Part II of Karen’s article on Wound Healing. Enjoy!


The four phases of wound healing are:

* Haemostasis,
* Inflammation,
* Proliferation or Granulation
* Remodeling or Maturation


During this phase, which is initiated immediately, damaged blood vessels must be sealed off rapidly to prevent critical blood loss. The immediate response is for the blood vessels to constrict long enough for the platelets to intervene. These blood cells organize themselves to form a stable mesh, commonly known as a clot, at the site of the damaged blood vessels. In this way the site is plugged and the loss of blood abated. Platelets also secrete other substances which contribute to the process and initiate subsequent steps.


Inflammation is commonly recognized by its characteristic signs of redness, swelling, heat and pain. This phase usually lasts up to four days after injury and its purpose is to protect the body against bacterial onslaught and to clean up the wound site. The presence in such large numbers of various different blood cells, all with their own roles to play, is what typically causes the previously mentioned characteristic signs. Some cells protect against infection, others clear up the debris left after bacteria have been eliminated. Some cells also direct the next stage.


Granulation commences about four days after wound formation and lasts until about the 21st day, depending on the size of the wound. It is characterized by the presence in the wound of pebbled red tissue. During this phase, the wound contracts significantly as new tissue is produced. The cells involved secrete collagen constructing a framework on which deeper skin tissue is first regenerated and then finally the outer protective layer of skin.


The final stage can last up to two years. It is in this phase that tensile strength is acquired as the tissue and skin are remodeled. It is important to be aware that the healing process continues throughout this phase, even though it is no longer apparent to the naked eye. This means that whatever you do once you are no longer receiving medical attention is significant as it will determine how well you heal.


In healthy individuals with no underlying factors to interfere with healing, an acute wound such as an operative incision should heal within three weeks with remodeling occurring over the next year or so. Remember that what is visibly taking place at the surface is also occurring in the deep tissues, including the bone, muscle and other supporting tissues, all of which will have been “injured” in the process of replacing your knee. All of these tissues will also be healing at the same rate and according to the same principles as the site of the wound that has been stitched. The stitches are there merely to hold the tissues in place whilst they get on with the job of healing themselves.

If you only retain one thing from this article, it should be that healing is a natural process. All that any of us can do to influence it, is to act to remove obstructions and hindrances which might delay it, and ensure that the best possible conditions are in place to promote and enhance it.


Karen Newby is a district nurse (also known as visiting or home nurse) with a practice in Paris, France. She specializes in the care of patients in the post-operative period, and in particular, the care of their wounds. However, she also speaks as someone who has experienced the satisfaction of putting her 30-years professional experience to use in a personal context by assisting your mother through a tkr.


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