How To Help Wound Healing

Therapy Achievements provides help with wound healing for patients with lymphedema, burns, radiation/chemotherapy and more.

Wounds come in all shapes and sizes. Some are due to burns or injury while others may be due to pressure or venous insufficiency. Some can heal fast and some can take a very long time to heal.  It is helpful to know the basics about how to heal a wound when deciding if you need help.

What Is a Wound?

A wound is an opening in the skin that causes a loss of the protective function of the skin.  It can result from a multitude of reasons and range from minor to severe.  Likewise, wound healing treatment can be quick and easy or prolonged and difficult.

Who Gets a Wound?

Wounds can occur for numerous reasons:

• Trauma - as a result of a blow, a cut, or a surgical incision
• Burns - caused by hot liquid spills, steam, electrical current, fire, chemical exposure, or frostbite
• Pressure / Sheering - when there is friction, shear force, or prolonged pressure
• Neuropathic ulcers - because of disease, such as diabetes or carcinomas

How Does a Wound Occur?

Every wound is unique, and understanding how it occurred is important because treatment may be different depending on the cause. However, not all wounds have a clear or singular origin—many result from a combination of factors.

But before we jump in to talk about how wounds heal, let's talk a little bit about the anatomy of the skin.  The skin is composed of three primary layers, each with specific functions:

Epidermis: This is the outermost layer of the skin. It is avascular (lacking blood vessels) and acts as a protective barrier against environmental elements. The epidermis also contains melanocytes, which produce melanin—the pigment responsible for skin color.

Dermis: Located beneath the epidermis, the dermis is the thickest skin layer. It is composed of collagen and elastin, providing strength and elasticity. This layer houses hair follicles, sweat glands, blood vessels, and a network of sensory nerves that detect touch, pain, temperature, pressure, and vibration.

Hypodermis (Subcutaneous Tissue): The deepest layer of the skin, the hypodermis consists primarily of fat and connective tissue. It cushions internal structures, helps regulate temperature, and provides energy storage.

How Does a Wound Heal?

So now that we know a little bit about the skin structure and the importance of determining the cause, let's dive into how wounds heal.  Regardless of the cause, all wounds heal in a predictable pattern of events:

• Inflammation:   1 - 10 days
• Proliferation:  3-38 days
• Maturation & Remodeling: 9 days - 2 years

Wound Healing Stage 1:  Inflammation

The body's immediate response to a wound is to prevent excessive blood and fluid loss. To do this, blood vessels constrict, and clotting begins to seal the injury. Once this initial stabilization occurs, the healing process is set into motion.  During the inflammation phase, several important actions take place:

• Immune cells rush to the site: Macrophages and other specialized cells move in to remove bacteria, damaged tissue, and debris. These cells are transported by interstitial (cellular) fluid and, as part of the process, blood vessels shift from constriction to dilation. This widening allows more fluid and immune cells to reach the injured area quickly.
• Histamine is released: This chemical increases the permeability of capillaries, allowing proteins, white blood cells, and healing factors to flood the wound site.
• Heat and swelling develop: As circulation increases, tissue temperature rises. This makes the environment less favorable for harmful bacteria and viruses, which often thrive only within narrow temperature ranges. The increase in fluid (edema) and heat causes the familiar signs of inflammation: redness, warmth, swelling, and pain.

This inflammation phase typically lasts from 1 to 7 days after the injury, setting the foundation for the next stages of healing.

Wound Healing Stage 2:  Proliferation

Once the wound has been cleared of bacteria and debris, the body shifts focus to rebuilding.  During this phase, specialized cells lay the groundwork for new tissue and begin closing the wound. These cells lay the foundation for new skin to stand on and start the process of granulated tissue for scar formation. This stage typically occurs between 3 to 21 days after the injury.  Key cells involved in this stage include:

• Fibroblasts: These cells produce essential proteins that form a collagen matrix, which replaces the initial clot (or fibrin mesh) and provides structure for new tissue growth.
• Endothelial Cells: These begin forming new blood vessels, a process called angiogenesis, to supply the increased oxygen needed by healing cells. In fact, support cells consume three to five times more oxygen when active than at rest. This surge in blood flow gives the healing tissue its characteristic bright red, granular appearance, known as granulation tissue.
• Myofibroblasts: These cells play a crucial role in drawing the wound edges together, helping to contract and reduce the size of the open area.

Together, these cells help create a stable foundation for the final stage of healing—tissue remodeling and maturation.

Wound Healing Stage 3:  Maturation & Remodeling

 

The final phase of wound healing is maturation, which involves resurfacing the wound and strengthening the new tissue.

• Epithelial cells begin migrating across the granulated wound bed in a single layer, moving inward from the edges. As they reach the center, they begin to proliferate, gradually covering the wound.  If the wound lacks adequate granulation tissue, this migration may be impaired. The wound edges can become rolled or curled—a condition known as epibole—which halts the resurfacing process.
• Contact inhibition signals the epithelial cells to stop migrating once the wound is fully covered, preventing overgrowth.

Once the wound is resurfaced, it enters the remodeling phase, where the tissue gradually regains strength and structure:

• Fibroblasts recede as their job is completed.
• Collagen fibers reorganize and cross-link to increase tensile strength, transforming the initial soft scar into a more mature, durable one.
• Collagenase, an enzyme, plays a critical role by balancing the breakdown (lysis) and production (synthesis) of collagen—a process known as fibroplasia.

This phase can continue for weeks to months, and while the tissue never regains 100% of its original strength, mature scar tissue can approach about 80% of normal skin tensile strength.

Scars:  What to Expect and What You Can Do

Even after a scar has fully matured and remodeled, it will never regain the same tensile strength as normal, uninjured skin.  About one year after wound closure, scar tissue is typically only 15% as strong as healthy skin.  After two years, it may reach 70–80% of normal strength—but rarely more.  In addition to reduced strength, scars can sometimes lead to other complications:

Keloid Scars: These are thick, raised scars that result from an overproduction of collagen during the maturation phase of healing. Essentially, the body doesn't receive the signal to stop collagen production, leading to excessive growth beyond the original wound edges. While anyone can develop keloids, they are more common in individuals with darker skin tones.

Contractures: Scar tissue naturally pulls the edges of a wound together, but this can sometimes cause the skin to tighten excessively. When this happens near joints or over large surface areas, it may restrict movement and affect the underlying muscles, tendons, or joints.

Adhesions: These occur when scar tissue causes two normally separate surfaces to stick together. For example, skin may become "stuck" to the muscle or tendon below, limiting smooth movement. Internally, adhesions can cause organs or tissues to become abnormally joined, leading to pain or restricted function.

The Good News:
Even after a scar has matured, there are effective ways to reduce its appearance and improve tissue flexibility. Treatments like scar massage, silicone gels or sheets, stretching, and specialized physical therapy can help flatten raised scars, release adhesions, and restore mobility. 

Why Won't My Wound Heal?

Although wound healing generally follows a predictable pattern, the rate of healing can vary widely depending on several factors. Some wounds progress smoothly, while others stall or become chronic. Factors that affect healing speed include:

• Size of the wound: Larger surface areas take longer to heal.

• Wound edges: Jagged or irregular edges are more difficult for the skin to pull together than clean, defined edges.
• Wound depth: Deeper wounds require more tissue regeneration and take longer to heal.
• Moisture balance: A wound that is too wet or too dry can disrupt the healing process.

When a wound fails to progress through the normal phases of healing, it may become chronic and require medical intervention. Several factors can contribute to this:

Age-Related Factors:  As we age, our skin undergoes changes that make healing more difficult, including:

• Reduced blood flow to the skin (decreased dermal vascularity)
• Lower collagen density, which weakens the skin’s structure
• Breakdown and fragmentation of elastin, reducing flexibility
• Flattening of the basement membrane, which impairs cell migration
• Fewer mast cells, which play a role in initiating the inflammatory response

Absence of Inflammation:  Inflammation is a necessary first step in healing, and without it, the process can’t move forward. Inflammation may be suppressed by:

• Overuse of anti-inflammatory medications, chemotherapy, or steroids
• Underlying medical conditions such as malnutrition, immune disorders, or leukemia
• Chronic Inflammation

Excessive Inflammation:  On the other hand, excessive or prolonged inflammation can also stall healing by preventing the wound from progressing to the next stage. Causes include:

• Foreign bodies in the wound bed (e.g., retained gauze fibers)
• Repeated trauma, such as pulling off new tissue during dressing changes
• Cytotoxic agents, like overuse of hydrogen peroxide or betadine, which damage healthy cells
• Excessive use of antibacterial agents, which may kill not only harmful bacteria but also the healthy cells needed for healing

Wound Care Specialist:  When do you need help? 

If your wound is not healing, it may be time to see a wound care specialist. These professionals are trained in treating acute, chronic, and non-healing wounds. Their primary goal is to create the ideal environment for healing by optimizing conditions and removing barriers to recovery.  Here’s how a wound care specialist can help:

1. Manage Comorbid Conditions

Healing is harder when the body is dealing with other health issues. Wound care specialists work with your care team to help you manage underlying conditions that may be slowing down healing, such as:

• Diabetes
• Poor circulation
• Obesity
• Malnutrition

They may refer you to dietitians, physical therapists, or weight management experts to support whole-body health and improve healing potential.

2. Clean the Wound and Remove Dead Tissue (Debridement)

Keeping the wound clean and free of dead tissue is essential. Dead tissue not only slows healing, but also increases the risk of infection and causes odor.  Debridement is the process of removing this tissue, and your wound care specialist is trained in several techniques, including:

• Irrigation with saline or water
• Enzymatic debridement using topical agents to dissolve tissue
• Biological methods, such as maggot therapy
• Sharp debridement using instruments like scalpels and tweezers

Your specialist will also ensure dressings are changed as often as needed and that proper cleaning occurs at every change.

3. Prevent and Manage Infection

Too much bacteria in a wound bed can lead to poor-quality tissue, delayed healing, and increased drainage. If your wound isn’t healing, your specialist may order a wound culture to identify harmful bacteria and guide antibiotic treatment.  They closely monitor for signs of infection and work with your physician to keep bacteria under control—balancing treatment to avoid harming healthy tissue.

4. Maintain Proper Moisture Balance

For optimal healing, a wound must stay moist—but not too wet. The right dressing creates this balance:

• Moisture-retentive dressings help hydrate dry wounds
• Absorptive dressings manage excess drainage
• Barrier products protect surrounding skin from adhesives and moisture damage

Your wound care specialist selects and adjusts dressings based on your wound’s unique needs and ensures timely dressing changes to prevent complications.

5. Support Adequate Nutrition and Hydration

Good nutrition is essential for wound healing. Without the right building blocks, the body cannot repair damaged tissue. A wound care specialist may recommend:

Protein

• Crucial for forming collagen, antibodies, and immune cells
• Required for wound contraction and scar formation
• Chemotherapy patients may need extra due to absorption issues

Carbohydrates and Fats

• Provide the energy protein needs to build tissue
• Glucose is the primary fuel for cell activity
• An unbalanced diet high in carbs and fats but low in protein leads to poor tissue structure—like building a house on a straw foundation

Vitamin C

• Supports collagen synthesis and immune function
• Promotes healthy granulation tissue

Vitamin A

• Essential for the inflammatory phase of healing
• Often depleted in autoimmune disease or steroid use
• May be taken orally (up to 25,000 IU/day) or applied topically in high doses under medical supervision

Zinc

• Key for collagen production, protein synthesis, and immune function
• Depleted by stress, diarrhea, open wounds, and chronic illness
• A common, yet overlooked, reason for slow wound healing

Vitamin E

• Promotes cell wall stability and immune health
• Caution: Too much vitamin E can actually reduce collagen formation and suppress inflammation, which is why it may slow scar formation if misused

Iron

• Vital for oxygen transport and collagen maturation

When to See a Specialist

If your wound shows no improvement within two weeks, worsens, or becomes painful, red, or foul-smelling, it's time to consult a wound care professional. Early intervention can prevent complications and improve healing outcomes.

What To Do Now?

Now that you understand the basics of wound healing, you can better assess whether your wound is progressing as it should—or if it’s time to seek expert help.  If your wound isn't healing or you're unsure whether it's on track, Therapy Achievements is here for you. Our certified wound care therapists have advanced training in tissue healing, anatomy, and the most up-to-date wound management protocols.  We offer:

• Expert wound care by physical and occupational therapists specially trained in advanced healing techniques
• Mobility and positioning support to reduce pressure and promote circulation
• Collaborative care with your physician to identify and address barriers to healing
• Personalized treatment plans that target your unique needs for faster, more effective recovery

Don’t wait for a wound to become a bigger problem. If you’re concerned about how your wound is healing, let us be part of your healing team.  Call Therapy Achievements at 256-509-4398 today—we’re ready to help.