The four phases of wound healing

The complicated mechanism of wound healing occurs in four phases:

hemostasis, inflammation, proliferation, and remodelling.

1. Hemostasis

Hemostasis is the first stage in wound healing that can last for two days. As soon
as there is a wound on the body, the blood vessels in the wound area constrict
to reduce the blood flow. This is known as vasoconstriction. At the same time,
clotting factors are released at the wound site to coagulate with fibrin, resulting
in a thrombus, which is more commonly known as a blood clot. The clot acts as
a seal between the broken blood vessels to prevent blood loss.

2. Inflammation

The second phase of wound healing is called the Inflammatory Phase. It involves
phagocytic cells that release reactive oxygen species, lasting for up to seven days
in acute wounds and longer in chronic wounds.
During this phase, white blood cells and some enzymes enter the wound area to
stave off infection by clearing bacteria and debris and preparing the wound bed
for new tissue growth. Physical characteristics of the phase include
inflammation or redness at the wound site, edema, heat, and pain.

3. Proliferation

Phase three of wound healing, the Proliferative Phase, focuses on filling and
covering the wound. As inflammatory cells undergo apoptosis, wound healing
progresses to the proliferation phase, which is characterized by the formation
of granulation tissue, angiogenesis (blood vessel formation),
wound contraction, and the process of epithelialization.
The new tissue is generally red or pink in appearance due to the presence of
inflammatory agents. The time it takes for tissue regeneration depends on the
production of collagen proteins by fibroblasts, which is a type of cell found in
the connective tissue. This phase of wound healing can last for four days to up
to three weeks or more.
4. Remodeling

Scar tissue formation characterizes the final Remodeling Phase (also known as
Maturation). It may occur over months or years, depending on the initial severity
of the wound, its location, and treatment methods. During this phase, the new
tissue gradually becomes stronger and more flexible. Collagen production
continues to build the tensile strength and elasticity of the skin. The build-up of
collagen in the granulation tissue leads to scar tissue formation, which is 20
percent weaker and less elastic than pre-injured skin.

The four phases of wound healing

The complicated mechanism of wound healing occurs in four phases:

hemostasis, inflammation, proliferation, and remodeling. Hemostasis, which
occurs just after injury, utilizes clotting factors which prevent further blood loss
from the wound site as well as the structural foundation for the future formation
of granulation tissue. The subsequent inflammation phase, involving phagocytic
cells that release reactive oxygen species, may last for up to seven days in acute
wounds and longer in chronic wounds.

As inflammatory cells undergo apoptosis, wound healing progresses to

the proliferation phase, which is characterized by the formation of granulation
tissue, angiogenesis (blood vessel formation), wound contraction, and the
process of epithelialization. The final remodeling phase, characterized by the
formation of scar tissue, may occur over a period of months or years, depending
on the initial severity of the wound, location, and treatment methods.
Infected wound healing stages

Chronic wounds do not follow the standard progression of wound healing seen
in acute wounds, and instead tend to arrest temporarily in one of the wound
healing phases (most commonly the inflammation phase). The healing process
of an infected wound may also be prolonged compared to that of a non-infected
wound. In infected wounds, pathogenic organisms enter the wound tissue and
disrupt normal skin flora, leading to increased inflammation and damage of
sensitive new tissue growth.

While some infected wounds may resolve without intervention, in order to

accelerate the wound healing process and ensure further complications (such as
cellulitis, osteomyelitis, or septicemia) do not occur, infected tissues should be
treated as soon as possible. Treatment of an infected wound differs in some
ways from that of a non-infected wound, as it involves eliminating the infection
with oral or topical antibiotics, draining or debriding the wound to remove dead
tissue, and applying antimicrobial dressings.

Granulation tissue, composed of endothelial cells, capillaries, keratinocytes, and

fibroblasts, is also an important component of wound healing. This connective
tissue can provide important indicators of wound healing progress; pink
granulation tissue is considered to be healthy and a sign that healing is
progressing normally, while dark red tissue may be a sign of infection.
Bacterial Overgrowth of granulation tissue, characterized by a white or yellow
film, is seen occasionally in infected wounds and must be removed before
healing can continue.
Wound healing is a multifactorial process involving blood cell coagulation,
inflammatory cell response, and granulation tissue formation. Several factors
and conditions may contribute to the occurrence or persistence of a chronic
wound, such as weakened immune function, comorbidities, venous
insufficiency, and lack of proper circulatory function.

The immune system plays an integral role in wound healing by mobilizing stem
cells, promoting cell differentiation, and stimulating growth factors which
ultimately result in neoangiogenesis, or the formation of new blood vessels.
When immune activities are disrupted through medications or comorbidities,
the process of wound healing may become stalled, leading to persistent
or chronic wounds.