John Maynard: How Wounds Heal: The 4 Main Phases of Wound Healing

How Wounds Heal: The 4 Main Phases of Wound Healing
John Maynard Product Manager, Ostomy and Wound Care | Shield HealthCare
http://www.shieldhealthcare.com/community/popular/2015/12/18/how-wounds-heal-the-4-main-phases-of-wound-
healing/#:~:text=The%20cascade%20of%20healing%20is,Inflammatory%2C%20Proliferative%2C%20and
%20Maturation.&text=Hemostasis%2C%20the%20first%20phase%20of,is%20to%20stop%20the%20bleeding
The body is a complex and remarkable machine, and the dynamic process of wound healing is a great example of how our
body’s different systems, along with the proper wound care products, work together to repair and replace devitalized
tissues. But how, exactly, does our body heal?
When the skin is injured, our body sets into motion an automatic series of events, often referred to as the “cascade of
healing,” in order to repair the injured tissues.
The cascade of healing is divided into these four overlapping phases: Hemostasis, Inflammatory, Proliferative, and
Maturation.
Phase 1: Hemostasis Phase
Hemostasis, the first phase of healing, begins at the onset of injury, and the objective is to stop the bleeding. In this phase,
the body activates its emergency repair system, the blood clotting system, and forms a dam to block the drainage.
During this process, platelets come into contact with collagen, resulting in activation and aggregation.
An enzyme called thrombin is at the center, and it initiates the formation of a fibrin mesh, which strengthens the platelet
clumps into a stable clot.
Phase 2: Defensive/Inflammatory Phase
If Phase 1 is primarily about coagulation, the second phase, called the Defensive/Inflammatory Phase, focuses on
destroying bacteria and removing debris—essentially preparing the wound bed for the growth of new tissue.
The 4 phases of wound healing. Healing begins with Hemostasis.
During Phase 2, a type of white blood cells called neutrophils enter the wound to destroy bacteria and remove debris.
These cells often reach their peak population between 24 and 48 hours after injury, reducing greatly in number after
three days.
As the white blood cells leave, specialized cells called macrophages arrive to continue clearing debris. These cells also
secrete growth factors and proteins that attract immune system cells to the wound to facilitate tissue repair.
This phase often lasts four to six days and is often associated with edema, erythema (reddening of the skin), heat and
pain.
Phase 3: Proliferative Phase
Once the wound is cleaned out, the wound enters Phase 3, the Proliferative Phase, where the focus is to fill and cover the
wound.
The Proliferative phase features three distinct stages: 1) filling the wound; 2) contraction of the wound margins; and 3)
covering the wound (epithelialization).
During the first stage, shiny, deep red granulation tissue fills the wound bed with connective tissue, and new blood vessels
are formed.
During contraction, the wound margins contract and pull toward the center of the wound. In the third stage, epithelial cells
arise from the wound bed or margins and begin to migrate across the wound bed in leapfrog fashion until the wound is
covered with epithelium.
The Proliferative phase often lasts anywhere from four to 24 days.
Phase 4: Maturation Phase
During the Maturation phase, the new tissue slowly gains strength and flexibility. Here, collagen fibers reorganize, the
tissue remodels and matures and there is an overall increase in tensile strength (though maximum strength is limited to
80% of the pre-injured strength).
The Maturation phase varies greatly from wound to wound, often lasting anywhere from 21 days to two years.
The healing process is remarkable and complex, and it is also susceptible to interruption due to local and systemic factors,
including moisture, infection, and maceration (local); and age, nutritional status, body type (systemic).
When the right healing environment is established, the body works in wondrous ways to heal and replace devitalized
tissue.
General Wound Care

http://www.shieldhealthcare.com/community/wound/2011/07/25/wound-care-101/
Gina Flores Caregiver Advocate | Shield HealthCare

A wound is a break in the outer layer of skin called the epidermis. Wounds are usually caused by cuts or scrapes.
Different kinds of wounds may be treated differently from one another, depending on the cause and level of severity. The
objective of proper wound care is to minimize the possibility of infection and scarring.
4 phases of the healing process:
1) Inflammatory phase: The inflammatory phase begins with the injury itself. Here you have bleeding, immediate
narrowing of the blood vessels, clot formation and release of various natural chemicals into the wound that begin the
healing process. Specialized cells clear the wound of debris over the course of several days.
2) Proliferative phase: In this phase, a matrix of cells forms. In this matrix, new skin cells and blood vessels will form. It
is the new small blood vessels or capillaries, that give a healing wound its purple-red or pinkish appearance. These new
blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support
the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build.
Collagen is the dominant substance in the final scar.
3) Remodeling phase: This begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue
stronger. The blood vessel density becomes less and the wound begins to lose its pinkish color. Over the course of 6
months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
4) Epithelialization: This is the process of laying down new skin, or epithelial cells. The skin forms a protective barrier
between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria.
Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean,
sutured wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to
scarring. Scarring occurs when the injury extends beyond the deep layer of the skin.
When should I consult a physician about my wound?
If you are in doubt about the seriousness of the wound, consult your physician. Symptoms that require medical attention
include:
 Any sort of pus or cloudy, creamy fluid Increasing redness around the wound
 Increased pain or swelling 48 hours after the wound occurs
 The wound won’t stop bleeding
 Fever
 Wound hasn’t healed in 10 days
 Numbness
 The wound is deep and you have not had a tetanus shot in the last 5 years

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How Wounds Heal: The 4 Main Phases of Wound Healing

Phase 1: Hemostasis Phase

Phase 2: Defensive/Inflammatory Phase

The 4 phases of wound healing. Healing begins with Hemostasis.

Phase 3: Proliferative Phase

The Proliferative phase often lasts anywhere from four to 24 days.

Phase 4: Maturation Phase

General Wound Care

Gina Flores Caregiver Advocate | Shield HealthCare

4 phases of the healing process:

When should I consult a physician about my wound?

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