HOW WOUNDS HEAL

EQUUS - - Eq Casereport -

Wounds that are stitched closed are said to heal by “first in­ten­tion.” The edges of the su­tured wound will im­me­di­ately be­gin to come to­gether as new cells to re­pair the area. You won’t be able to see the work the body is do­ing be­low the sur­face of the skin, but rest as­sured it’s hap­pen­ing.

For those wounds that can­not be su­tured and are left open, the process is called “sec­ond in­ten­tion heal­ing.” With each ban­dage change, you’ll be able to ob­serve the three phases of this type of heal­ing:

1. GRAN­U­LA­TION

Dur­ing this phase, the body fills any tis­sue de­fect be­low the level of the skin sur­face with gran­u­la­tion tis­sue, which is pri­mar­ily a mix of blood ves­sels and col­la­gen. Bumpy and red or red­dish yel­low, gran­u­la­tion tis­sue fills the depths of the wound first then works its way to the sur­face. Gran­u­la­tion tis­sue in a wound is a sign that heal­ing is oc­cur­ring.

2. EP­ITHE­LIAL­IZA­TION

This phase of heal­ing be­gins after gran­u­la­tion tis­sue has filled the en­tire wound de­fect. At that point, new skin cells—called ep­ithe­lial cells—be­gin to form at the edges of the wound and spread across the new bed of gran­u­la­tion tis­sue to meet each other in the center. You’ll rec­og­nize ep­ithe­lial cells as the pink­ish look­ing rim around the gran­u­la­tion tis­sue of the heal­ing wound. Ep­ithe­lial cells can move only lat­er­ally, not up or down, which is a con­se­quen­tial lim­i­ta­tion: The wound-heal­ing com­pli­ca­tion known as proud flesh oc­curs when gran­u­la­tion tis­sue rises above the edge of the wound, pre­vent­ing ep­ithe­lial cells from cov­er­ing it.

3. CON­TRAC­TION

This phase over­laps with ep­ithe­lial­iza­tion and is what ul­ti­mately re­duces the size of the wound. Mus­cle fibers within gran­u­la­tion tis­sue con­tract as the de­fect is filled, pulling the edges of the wound to­gether. When heal­ing is un­in­ter­rupted, this hap­pens quickly, with some equine wounds shrink­ing lit­er­ally overnight.

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