The Healing Process

Wound healing is a highly comples process, which is not yet fully understood,. However, there are many things that are known about the healing process. It comprises three phases, which overlap:

• Inflammation
  
  Tissue damage and the activation of clotting factors; the release of protoglandins and histamine causes the injured area to become more permeable and to vasodilate
  
  
• Proliferation
  
  The new blood vessels supported by connective tissue infiltrate the wound
  
  
• Maturation
  
  Involves re-epithelialisation, wound contraction and connective tissue reorganisation.

Healing is complete when the skin surface has reformed and the skin has regained most of its tensile strength.

Vasoconstriction		Haemorrhage controlled or reduced
				Haemostasis
Activation of endothelial cells, platelets and clotting cascade		Clot formation

The Wound bed should be kept warm, well-hydrated, pain free and well oxygenated. The wound should be protected from external moisture or trauma.

Properties of a good dressing:

• Will remove excessive exudate from the wound but will not allow the wound to dry out so as to maintain a moist environment.
• Will allow gaseous exchange so that oxygen, water vapour and carbon dioxide can pass into and out of the dressing.
• Will be thermally insulating so as to maintain the wound core temperature at approximately 37°C.
• Will be impermeable to micro-organisms to minimise contamination of the sound from outside.
• Will be free from either particulate or toxic contamination.
• Will be non-traumatic and will not adhere to the wound so that, on removal, no damage is done to granulating tissue.

Sodium chloride 0.9% for gentle irrigation of wounds is an effective method of wound cleansing. Although bacteria are still unlikely to be removed it will clear the wound of visible debris and allow the wound to be properly assessed, ie gravel grazes.

Gentle irrigation will help remove remaining dressing materials which have become incorporated into wound tissue. If wound cleansing is required, it is advisable to warm any fluid as this prevents the cooling of the wound which would inhibit cell mitosis.

Cotton wool or gauze swabs should NOT be used for wound cleansing as these materials shed fibres and increase the risk of wound infection (5).

* For Children's Wound Cleansing Protocol, click here

For more information, refer to Infection Control Policy Manual, 1.8 Skin Disinfection Section, Page 20.