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Normal Wound Healing Process
 
Normal wound healing follows four predictable phases which are:
1. Hemostasis, 2. Inflammation, 3. Proliferation, and 4. Remodeling. The inflammatory phase of wound healing is crucial, but often the most problematic for chronic wounds. During normal wound healing, the inflammatory phase is characterized by classic visible signs including erythema, edema, heat and pain, while at the molecular level, vascular permeability allows for sequential leukocyte migration to the wound bed. Leukocytes then signal key inflammatory cells that are responsible for destroying bacteria and eliminating debris and dead tissue, so that wound healing can occur.

 

Conditions that reduce leukocyte migration and impact wound debridement
 Diabetes:Abnormal leukocyte migration has been observed in the wound bed of patients with diabetes. This phenomenon is due to a dysfunction in the chemotactic adhesion of neutrophils and monocytes to the endothelial cells that line blood vessels.  The migratory dysfunction of the defense system cells leads to a decrease in debridement and infection control and finally to a slowing of the healing process.  Substance P, a neuropeptide that contributes to vasodilation and leukocyte migration, is present at lower levels in diabetic patients, which is believed to contribute to the difficulty in healing diabetic wounds. 
 

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Age: Aging decreases nitric oxide release from the endothelial cells. This in turn reduces capillary permeability, which then limits key cells responsible for inflammation from entering the wound, thus impacting the host response to a wound.1

 

Obesity: Poorly vascularized adipose tissue in obese patients contributes to a reduction in leukocyte access to wound sites, therefore slowing down the inflammatory response and healing of tissue.1

 

Paralysis: Patients with spinal cord paralysis often have a deficient nutritional status and a slower immune response due to diminished receptors responsible for adhesion of leukocytes.1

 

Vascular conditions: Vascular conditions such as atherosclerosis, edema (venous, lymphatic), vasoconstriction in response to sympathetic stimuli (i.e. smoking, stress, cold, medicine and pain), and hypovolemia experienced during heart failure, have been shown to narrow the lumen of arteries. This in turn is believed to influence the migration ability of leukocytes that are attracted to the wound site.1 

 

Click Here to Download the complete article "Patient Conditions that Impact the Efficacy and Cost of Wound Debridement"

Author

PV Mayer

Dr. Perry Mayer is the Medical Director of The Mayer Institute (TMI), a center of excellence in the treatment of the diabetic foot. He received his undergraduate degree from Queen’s University, Kingston and medical degree from the Royal College of Surgeons in Ireland.

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