The Skin and Wound Healing

Skin is the largest organ in the body and performs a wide variety of different functions. It is
composed of a predominantly cellular epidermis and an underlying dermis.
The epidermis contains mostly keratinocytes, among which are interspersed melanocytes,
Merkel cells, Langerhans cells, and other resident immune cells.

Keratinocytes are responsible for the production of keratin, a fibrous structural protein that
contributes to the strength and waterproofing of skin.
Melanocytes protect against ultraviolet (UV) light, producing melanin, the dark pigment that
gives the skin its color.
Langerhans cells are professional antigen-presenting cells and play critical roles in both
protective immune responses in the skin and maintenance of immune homeostasis.
Merkel cells have been associated with discrimination of light touch. The epidermis also
contains dermal appendages, such as hair follicles, sebaceous glands, eccrine sweat glands, and
apocrine glands.

Types of wound
Wounds can be separated into open or closed wounds. In a closed wound the surface of the
skin is intact, but the underlying tissues may be damaged. Examples of closed wounds are
contusions, hematomas, or stage 1 pressure ulcers. With open wounds the skin is split or
cracked, and the underlying tissues are exposed to the outside environment.
Types of Wound healing
There are three types of wound healing:
1. If the edges of the wound can be readily approximated, wound healing of superficial or
partial- thickness wounds (i.e., epidermis and dermis) will usually occur by primary
intention. There will be little to no evidence of a scar.
2. When the wound covers a larger surface area and the margins cannot be readily
approximated and/or tissue damage extends deeper than the dermis and into the
subcutaneous tissue wound healing occurs by secondary intention.
3. In wounds that contain a large degree of tissue damage, necrosis, or foreign debris,
treatment may include delayed closure to ensure removal of these materials before
closure of the skin. This process is known as delayed primary or tertiary healing.

In adults, optimal wound healing should involve four continuous and overlapping phases:
hemostasis, inflammation, proliferation, and remodeling.

Factors affecting the wound healing

Intrinsic factors include: age, nutrition, and hydration levels, location and depth of the wound,
medications, and co-morbidities.
Extrinsic factors include: support surfaces, friction, and shear.

Wound care in Physiotherapy

The most common wounds that are treated by wound care physical therapist are:
 Necrotic wounds.
 Stage III, IV or unstageable pressure ulcers.
 Diabetic wounds.
 Chronic wounds.
 Venous and/or arterial wounds.
 Extremity wounds with edema.
  Non-healing surgical wounds.

Physical therapy wound care begins with a comprehensive evaluation and development of an
individualized care plan.
Common treatment approaches can include:
 Measurement and documentation of the wound characteristics
 Cleaning of the wound
 Debridement (removal) of any dead tissue
 Selection and application of wound dressing
 Application of compression if necessary
 Education of the patient, caregivers and/or family members regarding wound care and
dressing changes.
Available treatment modalities may include:

 Ultrasound mist therapy

 Electrical stimulation
 Pulsed lavage
 Whirlpool
 Negative pressure vacuum therapy
 Compression therapy.
 Disclaimer: The above information has been obtained from Physiopedia [1]. Use of this text
is intended for educational purposes only.
1. https://physio-pedia.com/The_Skin_and_Wound_Healing?
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