[Animad]

Normal Wound Healing

Normally wound healing takes place over 3 stages which help your body to repair. These stages can be disrupted however by infection/ picking/ pulling at the wound this can cause problems either by stopping the wound from keeping healing or going back to a previous stage.

This article is looking at the stages a wound normally goes under when healing and so what you should expect to see so you know if what you’re seeing is normal or not.

Stage 1- Inflammation
· Starts straight after you cut and lasts for 3-5 days; the worse the cut generally the longer it lasts especially if the area is one where the skin moves a lot of is under a lot of tension.
· Chemicals in your body realise some damage has been done and if blood vessels are damaged it starts bleeding which helps clean the wound. Your body will act to stop any bleeding by narrowing damaged vessels & clot blood; these early clots can easily become infected so be aware of that and wound care should be started ASAP after the wound has been made.
· 5-10minutes later blood supply around the area increases (and so it is normal for it to be reddened, allowing more nutrients to get to the damage) and the vessels become ‘leaky’. Specific cells are then attracted to the area to clear up as much debris as possible. The vessels becoming leaky means it is normal for the area to become swollen. The added fluid in the area also dilutes and debris in the wound to reduce its affect.. The fluid seen here can leak from wounds and is clear, sticky, thin and has no smell to it; it helps healing by keeping the area moist and isn’t a sign of infection. It can also form the scab
· After 30-60minutes White Blood Cells get to the area staying there for the next few days (longer if it becomes infected). These aim to remove more debris and destroy as much bacteria as they can.
· The White Blood Cells also signal out commands for the blood vessels to be repaired and new ones created which can increase any reddening
· Through this stage pain is usual and the inflammation increases it through several means

Stage 2- Repairing
· Starts as soon as the inflammation reduces until the wound closes and heals
· The body starts to use the scaffold across the wound to repair it as some cells start to move into it and at the same time blood vessels are made which loop up into it so the cells have what they need to repair the wound.
· In Deep Wounds ONLY; The blood vessels and some white blood cells as well as cells surrounding the wound start to lie below the scab (or at the bottom of the wound if a scab is not present) to create a pink tissue with red spots. This looks quite moist and is called Granulation tissue; a healthy sign of healing but is only seen in cuts that go all the way through the skin; it’s not needed in others. If healthy this granulation tissue (or, if present the scab covering it) protects the wound from bacteria entering and so it should be left alone. If it doesn’t develop over some areas the wound needs to be checked out if it is deep.

Granulation tissue can often be confused with infection as they both produce a discharge. Infectious discharge tends to be yellow- green in colour and smelly whereas granulation tissue, especially when left with a dressing on, can be seen to have a white, 'gooey' discharge in the gaping wound.
This, though commonly mistaken for pus is NORMAL. When your body is healing there are cells which end up no longer being needed as well as tissue fluid which exits your body through the wound to moisten the area and aid healing. These cells along with the fluid and the fact that a lot of the cells in the area are white blood cells during normal healing means the discharge is white and it is a sign things are going well and healing as this also contains chemicals in it which will stimulate healing further.

One easy way I think would be helpful to remember is if the discharge is green-yellow/ smells or the wound is becoming more reddened/ painful/ swollen/ warm, then these are signs that there is an infection brewing so if you're unsure and you have these signs then it is a good idea to see your doctor to see if it is infected.

· Over time this scaffold will reduce in size, bringing the edges of the wound closer (if it’s gaping or the it is a graze where the top areas will be pulled closer) and from the 6th Day of healing Collagen (which is a protein) starts to form strands which lie across the wound and become stronger before they pull at the edges of the wound to bring them closer every day. This will also happen if you damage a muscle, making it shorter which causes a lot of problems later on so you should seek help if you ever feel you may have injured a muscle.
· Over the top of this, cells then start to move into the wound towards the centre leading to new skin being formed at the edges (if a wound is closed with stitches you may see that the surface looks closed over due to this after 2-3days. It is only the surface of the wound, below this healing hasn’t really occurred so stitches must stay in longer).
· The size of the wound determines closure. If the edges touch it can be within a couple of days. Gaping wounds on the other hand can take several weeks.

Stage 3- Remodelling
· The cut has now healed but the tissue that replaces it isn’t normal skin, it is scar tissue which isn’t as strong and unlike skin doesn’t stretch. To cope, body then continuously alters the scar attempting to make it stronger
· If it isn’t strong enough more layers are built in which makes the scar raised
· Overtime as the collagen is organised the best way it puts the edges of the scar together making the scar smaller and reducing the number of layers when then they are not needed so it flattens
· Overtime the cells don’t need as much blood and so the blood supply reduces back to that of normal skin and with this the scar fades.
· This always occurs normally with scars (unless a defect means it becomes a Keloid Scar) but massaging the scar and using Cocoa Butter/ Vit E cream/ Bio-Oil/ Scar Reducing Pads can speed up the process however it still takes weeks.