Wound Healing & Wound Care

A surgical incision and a dehisced wound both heal — but through entirely different pathways on entirely different timelines. Knowing which phase the wound is in drives every nursing decision.

Wound healing follows four overlapping phases. Hemostasis (seconds to hours) activates platelets and fibrin to form a clot. Inflammation (1–6 days) brings neutrophils then macrophages to clear debris — redness, warmth, and edema are expected, not signs of infection. Proliferation (4–24 days) builds granulation tissue (beefy red, moist), contracts the wound, and re-epithelializes from edges inward. Maturation/remodeling (21 days to 2 years) reorganizes collagen; the scar never regains more than about 80% of original tensile strength. Closure type determines the trajectory. Primary intention: clean surgical wound, edges approximated, minimal scarring, fastest healing. Secondary intention: wound left open to granulate from the base up — larger scar, longer timeline, higher infection risk. Tertiary intention (delayed primary): wound initially left open for drainage or debridement, then closed surgically once clean. Nurses assess wound phase by tissue color and characteristics: red/granulating is proliferative, yellow/slough signals stalled healing needing intervention, black/eschar indicates necrotic tissue.

Key Distinctions

Don't confuse the expected inflammation phase (warmth, redness, mild edema peaking at days 2–3) with wound infection (purulent drainage, increasing pain, fever after day 5). Students mix up secondary and tertiary intention — secondary stays open permanently; tertiary is intentionally delayed then closed. Granulation tissue is beefy red and healthy; hypergranulation rises above wound edges and impairs closure.

Clinical Pearl

Red is ready, yellow is yucky, black is bad. Wound bed color tells you the healing phase and whether the wound is progressing or stalled.

Wound Care Products & Dressings

Dressing selection is driven by one principle: match the dressing to the wound's moisture needs. Dry wounds need moisture donation; wet wounds need moisture absorption. Transparent films (like Tegaderm) are occlusive, retain moisture, and protect shallow wounds or IV sites — they have no absorptive capacity, so never place them on draining wounds. Hydrocolloids (like DuoDerm) provide a moist environment for partial-thickness wounds with minimal exudate; they self-adhere and are waterproof but should not be used on infected wounds because the occlusive seal traps bacteria. Hydrogels donate moisture to dry, necrotic, or granulating wounds and are soothing for painful wounds — they come as sheets or amorphous gel. Alginates (derived from seaweed) and hydrofibers absorb heavy exudate and are ideal for deep, heavily draining wounds; alginates form a gel on contact with wound fluid and require a secondary dressing. Foam dressings absorb moderate-to-heavy drainage while maintaining moisture balance and are commonly used over bony prominences. Wet-to-dry gauze, though still seen, is a form of mechanical debridement that is non-selective — it removes healthy and dead tissue alike and is largely being replaced by modern alternatives. Wound VAC (negative pressure wound therapy) applies sub-atmospheric pressure to promote granulation in large, complex wounds.

Key Distinctions

Don't confuse hydrogels (donate moisture to dry wounds) with hydrocolloids (retain moisture, used on minimal-exudate wounds) — the names sound alike but the moisture direction differs. Students often place transparent films on draining wounds, but films have zero absorption and will cause maceration. Alginates require exudate to work — placing an alginate on a dry wound causes it to stick and damages new tissue on removal.

Clinical Pearl

Think: "Dry wounds drink, wet wounds wick." Hydrogels hydrate (donate), alginates absorb (wick). Match the dressing to the moisture deficit.