As well as systemic and local factors, a number of the wound’s own inherent characteristics affect the rate of wound closure and wound healing. It is important to understand these factors so that they can be managed optimally as part of an overall strategy to help achieve wound closure. There are eight wound characteristics that affect healing.
Wound Characteristics Affecting Wound Healing
- Mechanism of onset – In general, wounds due to an underlying pathology such as venous or arterial ulcers are slower to heal than acute wounds. Among acute wounds, traumatic wounds heal more slowly than clean, surgical wounds.
- Time since onset – The longer a wound has been in existence, the longer it will take to heal. In other words, wounds existing for a relatively short period of time (say around 2 months or less) have a greater chance of a successful outcome than those with a longer history.
- Wound location – Wounds occurring on bony prominences, on areas of decreased vascularity, in areas with fewer epidermal appendages and in areas where the skin is thickest tend to be slow to heal.
- Wound dimensions – As well as wound size and depth which would be expected to affect the rate of healing, wound shape also has an important effect. Linear wounds are generally the fastest to heal, followed by square or rectangular wounds, with circular wounds requiring the greatest time.
- Temperature – In general, the colder the wound, the longer it takes to heal. This is because at higher temperatures the vasculature dilates allowing tissue oxygen levels to be elevated, while the risk of infection is also reduced.
- Wound hydration – An appropriate level of wound hydration is required for optimal healing. If the wound is too dry, a crust forms over the wound, epithelial cell migration is inhibited, and the wound fails to move through the inflammation phase. If the wound is too moist, the wound edge becomes macerated. Achieving the correct moisture balance requires appropriate dressing selection and true skill on the part of the practitioner.
- Necrotic tissue or foreign bodies – Necrotic tissue and foreign bodies in the wound both prolong the inflammatory response and increase risk of infection. Meticulous debridement is the best way to remove these obstacles to wound healing.
- Infection – Infection slows wound healing by prolonging inflammation, encouraging wound dehiscence, and increasing scarring. Addressing wound infection should always be the priority of a wound care specialist.
To learn more about managing the factors that affect wound healing, and all aspects of wound care, wound certification can be effective and highly beneficial. As well as demonstrating your commitment to the area, a certification in wound care offers you a better understanding of the pathophysiology of wounds, improving your day-to-day treatment practices.
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Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.