Wound Healing: In Depth

Stages of Wound Healing

Wound healing is a natural body function by which by which the body repairs itself after injury. There are 3 basic stages:

1. Inflammatory Phase – this stage begins immediately after injury and the body has stopped any further blood loss by coagulating (clotting.) Once the blood loss has stopped, the body immediately sends fluids containing plasma proteins, blood cells and antibodies to the wound site causing swelling, pain, fever, and redness around the wound site. Neutrophils and macrophages are also dispatched to the injury site to clean, scavenge for bacteria, and prepare the injury site for healing. This phase lasts 2 to 4 days after the injury. The injured site will be swollen and painful because of the inflammation; most of the pain will subside when the inflammation reduces naturally.

   

2. Proliferation Phase – this stage overlaps with the ending of the Inflammatory Phase by a day or so. As the inflammation is subsiding, the body beings work in earnest on mending the injury. Fibroblasts have begun to enter and collect in the wound by around day 3 after the injury; this marks the start of the transition from Inflammatory Phase to Proliferation Phase. Granulation tissue will begin to be seen in the wound by the end of the first week, this tissue will continue to grow until the wound is healed. This tissue contains the new blood vessels and other components to fill in the damaged tissue. Granulation tissue is normally bright red, moist, soft to the touch, and has a bumpy appearance. As a Pilonidal surgical wound heals, these masses keep growing and contracting and eventually the cavity fills up from the bottom. This takes approximately 8 weeks for a standard open healing excision wound and 4 weeks for a closed (sutured) wound.

   By about day 5 you will begin to notice Exudate in the wound (Exudate is the by-product of healing, it is a gooey greenish-white substance that will look like pus but isn't).

   By about day 5 post-surgery your need for pain medication should drop off sharply unless your surgeon put a long-acting anesthetic into the wound. If you did get the anesthetic you won't feel much pain at all until about day 3 or 4, then there may be a few days where you suddenly experience pain, this can be alarming since you were lulled into a false sense of being pain-free.

   

3. Remodeling and Maturation Phase – this stage overlaps with the Proliferation Phase towards the end of healing. It is the process of remodeling of the collagen fibers laid down in the proliferation phase. Nerve endings are re-growing and tissue is rearranging itself. In short, there is a lot of activity still happening long after your wound has healed on the surface. You may continue to feel tugging and tension from deep inside the wound for quite a while as the new tissue stabilizes. This will be a time when Pilonidal Paranoia strikes! Every twitch from the wound will send you into a panic, everyone goes through it. This final phase continues for up to 18 months after your wound has closed.

   

Additional Reading:

• The Phases of Cutaneous Wound Healing (pdf)
• The Ethicon Wound Closure Manual (230 pages!) (pdf)
• Principals of Wound Healing (pdf) - Canadian Assoc. of Wound Healing
• Wound Healing and Nutrition (pdf) - Healthyfellow.com

Scar Tissue

The final result of wound healing is scar tissue. Sometimes, the body will get a little gung ho and over heal. This builds up too much scar tissue and usually your surgeon will use the much dreaded Silver Nitrate to burn off the excess scar tissue. This usually happens in the final stages of healing and it is applied via a long Q-Tip. Some people barely notice and others will feel a burning sensation for hours. Silver Nitrate is also sometimes used to spur healing in a wound that has slowed or stopped. Also see the You and Your Scar page for more about your healed scar.