Understanding Skin Healing – During healing, your body works to repair damaged tissue. Explore the four stages of wound healing, learn the processes behind them, and discover how they protect your body. Updated: 11/21/2023
When the skin is injured, the body automatically triggers a series of events called the healing cascade to repair the damaged tissue. The healing cascade is a complex and dynamic process of replacing lost cellular structures and tissue layers. The wound healing process is divided into four stages of overlapping and continuous tissue repair.
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Certain conditions, such as age, diabetes, smoking, and poor nutrition, may delay wound healing.
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Wounds are injuries that break the skin or other body tissues. These include cuts, bruises, scratches, and punctures. Injuries can happen from accidental falls, blows, or weapons, and they can happen anywhere, at work, inside the house, or while walking across the street. There are two types of wounds:
During hemostasis, the wound is closed with clots. This stage begins when the body bleeds. In the first stage, blood vessels constrict and restrict blood flow. The platelets then work together to seal the cracks in the blood vessel wall. Finally, coagulation occurs. During this process, the blood changes from a liquid to a gel and clots. The enzyme thrombin creates an insoluble protein called fibrin, which forms a fibrous mesh that blocks blood flow.
The hematopoietic phase is rapid. After a blood vessel is interrupted, platelets adhere to the underlying endothelial surface within seconds. After this, the first fibrin fibers begin to adhere after about sixty seconds. A clot (also called a thrombus) forms when the fibrin mesh begins to form. A thrombus can detach from the vessel wall and travel through the circulatory system, increasing the risk of stroke, pulmonary embolism, or heart attack.
When damaged vessels leak transudate, inflammation begins immediately after the injury, which causes local edema. The inflammatory phase is characterized by cell migration, increased vascular permeability, limiting further damage, wound closure, and removal of cellular debris and bacteria. Basically, this stage prepares the wound bed for new tissue. Symptoms of inflammation are:
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These symptoms are triggered by white blood cells, growth factors, nutrients, and enzymes. Inflammatory cells such as neutrophils, monocytes, and endothelial cells adhere to the fibrin layer formed by platelet activation. Neutrophils activate phagocytosis of cellular debris and bacteria, enabling wound decontamination. This stage usually lasts 4-6 days.
Also called the fibroblast repair phase. The proliferative phase is characterized by the following main events: formation of granulation tissue to fill the wound, neovascularization, contraction of the wound edge, and re-epithelialization. During the proliferative phase, new tissue called granulation tissue, composed of collagen and extracellular matrix, replaces the original clot. New blood vessels are also formed, which keep the granulation tissue healthy and allow it to receive oxygen and nutrients. Myofibroblasts contract the edge of the wound and pull it toward the center of the wound. During healthy healing, granulation tissue is usually pink or red in color and does not bleed easily. When granulation tissue becomes dark, it may be a sign of infection, ischemia, or poor blood supply.
At the end of the proliferative phase, epithelial cells reappear in the lesion. This process is called epithelization and occurs faster when the wound is moist and hydrated. This stage can last several weeks. Usually 4-24 days.
Angiogenesis is the process of formation of new blood vessels that supply oxygen and nutrients to various tissues of the body. It is a vital activity required for growth, development and wound healing. The process is controlled by chemical signals in the body, such as vascular endothelial growth factor (VEGF). When VEGF and other endothelial growth factors bind to receptors on endothelial cells, the internal signaling of these cells is activated, creating conditions for the growth and survival of new blood vessels.
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The maturation phase is called the remodeling phase, and the wound becomes most robust as it matures. This occurs when the collagen fibers reorganize and the wound closes completely. Through programmed cell death (apoptosis), cells that are no longer needed for wound repair are removed. Collagen is located along the stretch lines, water is reabsorbed, and collagen fibers are interconnected. This cross-linking reduces the thickness of the scar and makes the skin firmer. Scars are a physical reminder of the healing phase that promotes tissue regeneration.
Ripening usually begins 21 days after injury and can last a year or more. The healing process is susceptible to interruptions caused by factors such as moisture, infection, and nutritional status. The maximum tensile strength of incisional wounds occurs after approximately 11 to 14 weeks. Usually, the healed wound area remains weaker than the intact skin and is about 80% of its original tensile strength.
Ulcers generally heal in 4-6 weeks. If it does not heal during this time, it is considered a chronic wound. Many factors can inhibit or slow down the healing process. Some of them are defects in collagen synthesis, insufficient blood supply to tissues (ischemia), and low oxygen content in arterial blood (hypoxia). These factors can be caused by certain conditions such as diabetes, malnutrition, and smoking.
Wounds are injuries that break the skin or other body tissues. When the skin is damaged, the body automatically initiates the following stages of wound healing.
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During hemostasis, the wound is closed with clots. This stage begins when the body bleeds. Inflammation begins immediately after the injury, which causes local swelling. The inflammatory phase is characterized by cell migration, increased vascular permeability, and removal of cellular debris and bacteria. This phase usually lasts 4-6 days and prepares the wound bed for new tissue. Symptoms of inflammation are:
The proliferative phase is characterized by the following main events: formation of granulation tissue to fill the wound, neovascularization, contraction of the wound edge, and re-epithelialization. During the proliferative phase, new tissue called granulation tissue, composed of collagen and extracellular matrix, replaces the original clot. New blood vessels (angiogenesis) are also formed to deliver oxygen and nutrients to new tissue. This stage can last from 4 to 24 days.
Maturity is when the wound reaches its maximum strength. This occurs when the collagen fibers reorganize and the wound closes completely. This stage begins 21 days after the injury and can last a year or more. The healing process is susceptible to interruptions caused by factors such as moisture, infection, and nutritional status. Usually, healed wound areas are still weaker than uninjured skin, which has 80% of the original tensile strength.
Whether it’s from a sport or a medical problem or an accident like falling down some stairs, you can get a nasty injury. A wound is simply an injury to an organ or tissue that causes the organ or tissue to malfunction. It’s oral, but I know you can relate to it because you’ve had sores on your skin before. Skin is an organ of your body. A wound, let’s just say a cut, has disrupted the normal cohesion or integrity of the skin. The skin is broken, which means that I have interrupted the normal continuity.
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That wasn’t hard to figure out, was it? Probably not. In this case, let’s move on to the three stages of wound healing. I promise to make it easy for you.
The first phase of wound healing is the coagulation/inflammatory phase. Sometimes this stage is divided into two separate stages. However, since both sides of this phase begin to occur at almost the same time, it is easier to combine it.
Coagulation is another word for blood clotting, and inflammation is a local defense response to injury that helps liquefy, destroy, and wall off damaged tissue.
What happens at this stage is as follows. After cutting the skin, the broken blood vessels in the skin begin to bleed. Not good. The body does not want to bleed. That’s why platelets (cells that clog blood vessels) stick to damaged blood vessels and begin the steps that lead to blood clotting. A blood clot closes the opening of the broken vessel and the bleeding stops. Oh!
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Platelets and other cells release chemicals that help attract inflammatory cells called white blood cells to the area. These guys are here to destroy any chemical or biological agents that enter the body as a result of the injury and keep them walled behind the prison-like compound. White blood cells produce inflammatory compounds
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