Wound Healing
The Stages of Wound Healing
A wound occurs when there is a break or opening in the skin or mucous membranes. Wounds are usually caused by trauma. They occur frequently in EB, due to defects in the skin proteins which cause EB. Wound Healing is a complex process that starts the moment an injury occurs and can continue for weeks or months.
This process follows a pattern:
The Inflammatory Stage: This stage starts immediately after the injury occurs and lasts from two to five days.
The Proliferative Stage: This stage will begin about two days after the injury occurs, and can last up to three weeks.
The Remodeling Stage: This stage will begin about three weeks after the injury, and can last up to two years.
Remember that this process is somewhat different in EB because wounds are acute, not chronic in nature. Often they do not reach the remodeling stage in areas of high friction as these areas re-blister frequently
In the Inflammatory stage, there is bleeding and the blood vessels narrow (vasoconstriction) platelets collect in the area (platelet aggregation) and a clot is made with assistance from thromboplastin (clotting factor). Specialized cells- neutrophils, macrophages and monocytes - come to the wound site and ingest cell debris, along with microorganisms, to clean up the wound bed.
In the Proliferative Stage, the framework for the cells is created. Blood vessels are regrown and fibroblasts lay down collagen. The wound edges start to knit together, and there is regrowth of epithelial cells (epithelialization)
In the Remodeling Stage, the new collagen forms a more formal, stronger structure. Epithelialization continues and the wound is healed.
Preparing the Wound Bed
When wounds are healing slowly or appear not to be healing, the condition of the wound bed should be considered.
- The first step is to assess the ability to heal. Consider the following factors:Is the blood flow adequate?
- Is the person anemic?
- Are there adequate iron stores?
- Is the wound infected?
- Are steroids being used?
- add padding to protect areas at risk for injury. This may not always be feasible with EB (i.e., you MUST wear shoes to work).
- Address nutritional requirements:
- More protein is needed to heal wounds.
- Caloric needs are higher.
- Mineral deficits are common in EB so supplements are often needed
- Treat the itch to prevent scratching because scratching will interfere with healing!
- Utilize dressings that support the healing process. Non-adherent dressings are essential to the wound healing process in EB.
- Monitor the size, location and look of the wound. What are the changes? Does the wound look better or worse?
- Evaluate if the wound care plan is a success- is the wound healing? If not, the wound care plan needs to be rethought and adjusted.
- If adjusting the wound care plan does not improve healing, different treatments may be needed to heal the wound. Your wound care specialist may consider biological dressings or skin grafts.
Sibbald RG, Orsted HL, Coutts PM, Keast DH. Best practice recommendations for preparing the wound bed: update 2006. Adv Skin Wound Care. 2007 Jul;20(7):390-405;. PMID: 17620740
