From the Desk of Lindsay Lupton, MSN, CNP, CWS
Acute vs Chronic Wounds
Wounds can be classified into two broad categories, acute and chronic, based on time to heal and cause of the wound. Medically, the term “acute” refers to a sudden onset of symptoms, illness or injury. Acute wounds most commonly occur because of surgery or trauma and heal in a timely, organized and predictable fashion. Conversely, chronic wounds are characterized by delayed healing and inability to progress through the expected, orderly healing trajectory.
Successful wound healing has four distinct phases: hemostasis, inflammation, proliferation and maturation, and takes two to four weeks. Hemostasis, the first phase, occurs immediately after wounding through blood vessel constriction and clot formation. This stage of healing lasts up to two days. The clot and wounded tissue release chemical messengers, signaling the migration of immune cells that clear bacteria and cellular debris. This is known as the inflammatory phase and lasts three to five days. These cells also initiate the tissue repair cascade which begins the proliferative phase. In this third stage of healing, various specialized cells promote new blood vessel growth, collagen synthesis and granulation tissue formation which develops into a provisional matrix of reparative dermis. This process is called re-epithelialization. The inflammatory and proliferative phases overlap and generally lasts five to fourteen days. In the final phase of healing, maturation, the newly generated epithelium matures and remodels to approach the architecture of the normal surrounding tissue. This process begins around fourteen days and can take up to two years to complete, depending on the degree of tissue destruction.
Although no exact designated timeframe exists, wounds persisting greater than six weeks duration are considered chronic. Failing to progress through the four phases, the wound stalls in an inflammatory cycle and cannot enter the proliferative stage. The most common reason is underlying disease processes like diabetes, venous insufficiency, decreased circulation or obesity. Other factors known to delay wound healing are bacterial load and certain medications.
Fortunately, wound specialists exist to help patients identify causes of chronic wounds and ways to overcome them. The therapeutic partnership between wound specialist and patient unlocks the door to sustainable health habits that can correct systemic disease. Additionally, through advanced wound dressing selection and tissue grafting, the microenvironment of the wound is optimized, and healing becomes possible.
If you or a loved one has a chronic wound, schedule your consultation with our wound specialist today!
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