By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
The rate of wound closure is affected by systemic and local factors, as well as a number of the wound’s own inherent characteristics. It is important to understand these factors so that they can be managed optimally as part of an overall strategy to help achieve wound closure.
The eight wound characteristics that affect healing are described briefly below:
1. Mechanism of onset
In general, wounds due to an underlying pathology such as venous or arterial ulcers are slower to heal than acute wounds. Among acute wounds, traumatic wounds heal more slowly than clean, surgical wounds.
2. Time since onset
The longer a wound has been in existence, the longer it will take to heal. In other words, wounds existing for a relatively short period of time (say around 2 months or less) have a greater chance of a successful outcome than those with a longer history.
3. Wound location
Wounds occurring on bony prominences, on areas of decreased vascularity, in areas with fewer epidermal appendages and in areas where the skin is thickest tend to be slow to heal.
4. Wound dimensions
In addition to wound size and depth, which would be expected to affect the rate of healing, wound shape also plays an important role. Linear wounds are generally the fastest to heal, followed by square or rectangular wounds, with circular wounds requiring the greatest time.
In general, the colder the wound, the longer it takes to heal. This is because at higher temperatures, the vasculature dilates allowing tissue oxygen levels to be elevated, while the risk of infection is also reduced.
6. Wound hydration
An appropriate level of wound hydration is required for optimal healing. If the wound is too dry, a crust forms over the wound, epithelial cell migration is inhibited, and the wound fails to move through the inflammation phase. If the wound is too moist, the wound edge becomes macerated. Achieving the correct moisture balance requires appropriate dressing selection and true skill on the part of the practitioner.
7. Necrotic tissue or foreign bodies
Necrotic tissue and foreign bodies in the wound both prolong the inflammatory response and increase risk of infection. Meticulous debridement is the best way to remove these obstacles to wound healing.
Infection slows wound healing by prolonging inflammation, encouraging wound dehiscence, and increasing scarring. Addressing wound infection should always be the priority of a wound care specialist.
To learn more about managing the factors that affect wound healing, and all aspects of wound care, wound certification can be effective and highly beneficial. While demonstrating your commitment to the area, a certification in wound care also offers you a better understanding of the pathophysiology of wounds, improving your day-to-day treatment practices.
Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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