SU5.1-2 | Wound Healing and Wound Assessment — Summary & Reflection

KEY TAKEAWAYS

Wound healing is one orderly, overlapping programme: haemostasis, then inflammation (neutrophils then orchestrating macrophages), then proliferation (fibroblasts and collagen, angiogenesis, granulation tissue, epithelialisation and contraction), then remodeling/maturation over months, by which the scar reorganises and regains at most about 70–80% of normal tensile strength. The same biology plays out by primary intention (clean apposed edges, sutured), secondary intention (open wound granulating to completion) or tertiary intention / delayed primary closure (contaminated wound left open then closed once clean). Healing is impaired by local factors (infection, ischaemia, foreign body/devitalised tissue, tension, irradiation) and systemic factors (diabetes, malnutrition with vitamin C and zinc lack, steroids/immunosuppression, smoking, age, jaundice, uraemia) — most of them modifiable, so optimising them is real treatment. At the bedside, assess any wound with a structured history (mechanism, time, contamination, healing-factor risk profile, tetanus status), a systematic examination (site, size, edges, bed, surroundings, neurovascular status) and precise, dated documentation.

REFLECT

Think back to a wound you have seen that healed badly — a surgical incision that broke down, a leg ulcer that would not close, or a traumatic wound that became infected. Map its course onto the four phases and ask which phase stalled. Then list the local and systemic factors that were working against it: which were modifiable, and which were optimised in time? Finally, recall how the wound was documented when the patient first presented — was the record precise enough that someone seeing it days later could judge whether it had improved or deteriorated? How will understanding this programme change the way you assess, optimise and document the next wound you are asked to manage?