Wound Healing Stages: Cleansing Phase Explained

Wound Healing Stages

• Wound healing is natural.
• The body tries to heal wounds itself.
• Wound healing happens in overlapping stages.

Cleansing Phase (=Exudation Phase)

• Phase lasts from day 1 to 3/4.
• Two processes occur in parallel during this phase.

Part 1

• Bleeding clears foreign bodies.
• Blood loss is reduced by blood vessels pulling together (vasoconstriction).
• Blood clotting seals the wound with fibrin and platelets.
• Wound edges stick together, forming a scab for protection.

Part 2

• Inflamation starts, increasing blood flow with redness and warmth.
• Inflammation is part of wound healing and should last a maximum of 48 hours.
• Immune cells like leukocytes and macrophages clean up cell debris and bacteria.
• Pus forms due to bacterial infection creating waste like melted tissue.
• Fluid buildup (wound edema) swells, and the pressure causes pain.
• A red, oozing wound with a yellow fibrin layer indicates this phase.
• Fibrin, a protein in blood, helps close wounds and forms when blood clots.
• Fibrin looks yellowish but, unlike pus, cannot be wiped away.

Granulation Phase (Day 2-14)

• The wound granulates, with cells moving in from nearby tissue.
• Connective tissue increases cell division to make up for tissue loss.
• Epithelium (new skin) can only form once tissue loss is balanced.
• New blood vessels grow to supply the wound, giving it a red color.
• Granulation shows the wound is healing well and following secondary wound healing.
• The wound is grainy, moist but not wet, and red.

Epithelialization Phase

• Starts around day 3 and can last up to a year
• New tissue (epthel) forms, made of collagen and elastin fibers.
• Scars form from this tissue, which are stiff due to high collagen, low elastin.
• Wound edges pull together, and the scab falls off.
• Healing completes when new epidermis forms.
• Healed wounds need moisture and protection from infection, requiring scar care.
• The wound has a pink color, new skin and a scar is formed

Factors Promoting Wound Healing

• Patient's nutrition is important: proteins, vitamins, zinc, iron, copper and calcium.
• Clean acute wounds with liquid antiseptics; use semi-solid forms around the area.
• Other supportive methods include anti-inflammatories for closed wounds.
• Complementary medicine: TCM, leech therapy, homeopathy (Arnica C6/C30), Schüssler salts, Bach flowers.
• Phytotherapeutics: Hamamelis, Arnica flowers, chamomile flowers, marigold flowers.

Preferred formulas include

• Solutions, lotions or hydrocreams, best for moist wounds
• Sprays, to avoid touching the wound
• Gels, best closed wounds for their cooling.
• Avoid wound powders that clump or ointments that block fluid outflow/promote infection.
• Use ointment compresses only for superficial wounds to avoid blocking secretion.

Scars

• Narbe forms when new tissue fills the wound with collagen.
• It is not elastic as, not all epidermal patterns regenerate; the surface remains smooth and shiny.
• Scar tissue lacks hair, oil, and sweat glands and can restrict movement.
• Scars shrink and fade over time, from reddish to lighter.
• Taking 100 days for scars to reach 70% of the strength of normal tissue.
• Scar maturation can take up to two years, after which scars will no longer change.

Types of scars

• Atrophic scars: pale, sunken from melanocyte loss (pigment cell migration is possible).
• Hypertrophic scars: red and raised, often from burns – may become atrophic later on.
• Keloid: raised hypertrophic scar that grows beyond original wound borders.

Symptoms and Therapy

• Scars are mostly asymptomatic but can itch or hurt occasionally.
• Limiting movement (due to unelastic tissue), especially near joints occur.
• A therapy for Narbe is not always needed, but should involve sun protection to prevent melanocyte loss.

Other therapies involve

• Wound healing support with Bepanthen cream
• Local Glucocorticoid remedies like Sanadermil
• Silicon remedies like Bepanthen Narben-Gel
• Injection of glucocorticoids directly to prevent excessive growth.
• Cryotherapy: Freezing with Stickstoff
• Filling atrophic scars with Hyaluronsäure
• Using pressure
• Laser treatment to remove layers of scars

Wound Healing Disorders

• Wound healing disorders are categorized as local or systemic.

Lokal

• Local issues: poor blood flow, old wounds, and tension.

Systemische

• Systemic issues: medications, age, and conditions.
• Wundheilstörungen can be caused by Antiogonistic , Non Steroidal Antiphlogistica e.g. Aspirin and Glucocorticoide.

Wound Assessment

• Beurteilen it is akute or chronische Wunde? Notfallmassnahmen like Auspülen bei
• Verbrennungen or sofortige Blutstillung should be taken

Factors to consider are

• The wounds position like Augen-Nasen-Ohren
• Die Größe des Infektionsrisiko, which depends on size and Tiefe
• Komplikationen can be assessed by Kopfschmerzen or Übelkeit
• If a doctor is needed this must be done within six hours

Wound Complications

• Even small injuries can become infected when wound healing is impaired.
• Entzündete Wunden necessiate an Arzt
• If there is Eiter present one can say that there is an Infektion.

Infektion or Entzündung

• An Infektion can cause Entzündung.
• Entzündung can occur without Infektion.

An Infektion is caused by

• Mikroorganismen.
• Entzündung is a reaction to Reize.
• Entzündung has 5 signs, Überwärmung, Roötung, Schwellung, Schmerz and eingeschränkter Funktion.

Signs for more serious Lokalinfektion are

• Abszesse, Farbe of the Wundsekrets and bläuliche Verfärbung

Systemische Infektion = Sepsis

• This results in lebensbedrohliche Organfunktionsstörungen.
• Additional signs can be Lymphknoten and erhöhte Körpertemperatur

Narbenpflege

• Spezialitäten
• Bepanthen PRO Narben Gel with Massageroller
• Fettreiche Cremes will help Heilungsprozess and the Gewebeneubildung

Using Wundauflage

• They should be enough saugfähig, dem Patient and Intervall is important

Trockene Wundauflagen

• Ziel: protect, Sekret aufsaugen, Bsp beschichtete or unbeschichtete Kompressen
• Good for Operationwunden or Bagatellverletzungen etc.
• Gazekompressen for arzneistoffträger by stark nässenden Wunden
• The Verbände soll Blut und Wundsekret and schützen.
• Mull (Binden) is used

Vor- und Nachteile von Sprühpflaster

• Es entsteht einen wasserfesten Film.
• Great for Stellen.
• Don't use for secreting Wunden
• Wundschnellverband and Pflästerli is good to have.

Beschichtete Wundauflagen

• Combined Kompressen has two Schichten.

Dermaplast plus-Kompressen

Eigenschaften

• Protection, Reizlosigkeit and no Verkleben

Feuchte Wundauflagen

• Goal of Wundbehandlung is to protect, create an ideal Wundheilungsmilieu and protect exchange of Gas and Water.
• Used with Hydrofaser and Folien
• Also Silberhaltige Wundauflagen

Reinigungsphase

• Frequency needed by Hydrokolloid

Granulationsphase

• You have created optimal Bedingungen

Geeignet bei:

• Wunden
• Ziel: Heilung der Wunde VOrteile: Shutz vor Wasser und Bakterien

Alginate

• Nehmen Blut und wundsekret and bilden Gel by nässenden des wundsekret

Alginate is suited when

• Not by grossblutenden because it hemmt das Keimwachstum
• Other good Silberhaltige Wundauflagen

Aktivkohle und Schaumstoffe

• Kombiniert mit materials by Infizierten und chronischen Wunden mit Geschwürbildung. Can only be Maximial 1 Tag
• Schaumstoffe optimal by nässenden and nicht-infektionsfreien

Fixing of Wundauflagen

• Elastische Binden und Gazebinden
• Help by Anlegen
• Müssen nachts abgenommen werden.
• Flawa Fixelast is an elastische Gazebinden Heftpflaster Befix and achtung vor Allergien Tapes and other medicals are used and technique muss erlernt sein
• Netz- oder Schlauchverband also exist

Explore the natural process of wound healing, focusing on the initial cleansing or exudation phase, which lasts from day 1 to 3/4. Bleeding clears foreign bodies while blood vessels constrict, and clotting seals the wound. Inflammation and immune cells work to clean debris, leading to pus formation and potential wound edema.