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Wounds and Wound Healing
Everyone get wounds during their lifetime. There are several kinds of wounds spanning from
the most superficial graze wound to deeper and more difficult to heal wounds. Since they all
look different, they often demand various treatments in order to achieve optimal wound
healing and cause the least amount of pain and scarring.
A wound can be defined as an opening in the skin where tissue is damaged in a number of
ways. They can be categorized broadly as acute and chronic wounds. Acute wounds usually
heal well without complications, while chronic wound are more difficult to heal.
Chronic wounds cause both a lot of pain to patients suffering from them as well as major
costs for the society. A chronic wound is often a sign of that something is not right in the
body, as for instance diabetic foot ulcers. Among the causes of such wounds are an impaired
blood circulation and a diminished sense of pain. Other examples of wounds that can
become chronic wounds include leg ulcers, pressure wounds as well as wounds after
surgery and radiation therapy. Difficult to heal leg ulcers is one of the most common chronic
wounds and treatment costs are escalating worldwide. Effective wound healing therefore
contributes to minimizing patient suffering and to cutting down the substantial costs for
Wound Healing
When a wound heals it normally goes through four basic phases: 1) coagulation, 2)
inflammation, 3) proliferation and 4) maturation.1
1) Coagulation
When the skin is damaged blood platelets migrate to the wound to help the blood coagulate
and a scab is formed which gives a temporary protection.
2) Inflammation
Our immune system also reacts immediately at skin damage and during the inflammatory
phase the wound is cleaned from bacteria, debris and dead cells. This inflammatory phase
continues until the wound is cleaned and takes approximately 1-6 days2.
3) Proliferation
Following the inflammatory phase, there is a proliferation of new cells that is taking place at
the bottom of the wound. The immune cells and the blood platelets excrete growth factors
that stimulate the proliferation of different kinds of cells and small blood vessels, which are
important in order to provide oxygen. Thereafter, the most superficial skin layer, the epithelial
cells, migrates across the open wound from the edge of the wound and from hair follicles.
After approximately 7-10 days a thin covering layer has formed 7.
4) Maturation
The maturation phase continues for a long period of time. During this phase there is a
proliferation and remodelling of collagen which gives the tissue strength and elasticity as well
as the characteristic scarring of deeper wounds.
Pain during wound healing
Painful wounds have a major negative impact on patients’ quality of life. In addition,
unresolved pain affects wound healing negatively3. Therefore it is of critical importance to
minimize the patient’s pain as much as possible.
No matter what the cause of the pain is, the patient’s psychosocial environment will have an
impact on the patient’s experience of pain. Factors such as gender, age and the patient’s
earlier experience of pain will all influence the experience of pain 8. Therefore, there is a
need for a holistic understanding in order to minimise pain at wound healing.
What are the causes of pain when a wound heals? There are several causes of pain. For
instance, dead cells in the wound excrete substances that irritate nerve endings and cause
pain. The wound can also be inflamed which results in a heightened sensitivity both in the
wound and surrounding skin 8.
Many have probably experienced both pain and irritation over dressings and plasters that
gets stuck and leaves ugly marks on the skin. If a dressing is not of good quality, it can both
get stuck in the wound and on the surrounding skin. A dressing that gets stuck in a wound is
not only painful, the tissue in the wound can become damaged which prolongs the healing
process. Since the surrounding skin also can have heightened pain sensitivity it is important
that the dressing doesn’t adhere too aggressively to it on removal.
Wound dressings for optimal healing
An effective gentle wound treatment therefore demands wound dressings of good quality that
does not get stuck in the wound. The dressings should stick fittingly to the surrounding skin
so they maintains properly in place. At the same time they should be easily removed without
damaging the wound or surrounding skin.
Wound dressings with soft silicone, such as dressings with the Safetac Technology, have
both these features which make them suitable to treat most kinds of wounds4.
Just as there are several kinds of wounds, there are several kinds of wound dressings. There
is, however, some general features that all wound dressings of good quality should have 9.
For instance, the dressing should protect the wound from damage and not cause allergic
reactions. It is also important that the wound is kept moist since it helps the migrating skin
cells to proliferate and cover the surface.
The dressing must however have the capability to absorb superfluous wound liquid. In
addition, it is very important that the dressing causes the least pain possible during dressing
related procedures.
In summary a wound dressing with good quality should
 Not be toxic
 Maintain a moist environment
 Absorb superfluous wound liquid
 Not get stuck in the wound
 Not adhere to aggressively to the surrounding skin
 Protect against injury and infection
 Adjust to the body’s shape
 Cause least possible pain
 Be cost effective
Rubin’s Pathology: Clinicopathologic foundations of medicine/editor-in-chief, Emanuel Rubin; associate
editors, Fred Gorstein… [et al.]. Lippincott Williams & Wilkins. 4th ed.0-7817-4733-3.
Rorsman, Hans. Dermatologi och venerologi, Studentlitteratur (2007)
Minimizing Pain at wound dressing-related procedures. A consensus document from World Union of Wound
Healing Societies. (2004)
Thomas S. Atraumatic Dressings.
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