© 2014 BY TRIGOcare International GmbH

Phases of healing

Necrosis

Necrotic tissue in wounds should be debrided. Surgical (mechanical) debridement should be the therapy of first choice, and should be carried out under either local or general anaesthesia.Treatment of the wound with a hydrogel can facilitate surgical debridement and prevent the formation of new layers. Necrosis requires differentiated or extended treatment, depending on the type and severity of the contributing factors, e.g., known peripheral arterial occlusive disease (PAOD) or DFS. This is a matter to be decided by the attending physician.

Fibrinous membranes

Fibrinous membranes are avital tissue which has not yet been separated from the wound. Their size and depth are not always immediately apparent. Fibrinous membranes and necrotic tissue block the supply of blood and nutrients. Treatment with a hydrogel or TRIGOpad aqua can accelerate the loosening of the fibrinous membranes and prevent the formation of new layers. Since there is usually heavy exudation from wounds with fibrinous membranes, it is important that the dressings used in this phase absorb a large amount of exudate while still ensuring an ideal moist wound environment (e.g.TRIGOfoam).

Granulation

The wound is increasingly filled by the formation of new granulation tissue. In this phase it is important to ensure that the wound does not dry out and that no slough forms, as this can inhibit wound healing. Water vapour and oxygen exchange must be guaranteed. Polyurethane foams, hydrocolloids and combined products are particularly suitable for this purpose.

Epithelialisation

In this phase, the wound is sealed at the surface by the formation of epithelial tissue. At this stage the wound dressing serves to protect the sensitive, newly formed tissue. Dressings can be left on the wound for up to a week.
Thin hydrocolloid dressings and thin polyurethane dressings are highly suitable in this phase.

IMPORTANT
Infection


Infection in the wound is a commonly occurring impediment to healing. Typical signs of infection are redness, heat, odour, pain, formation of oedemas and/or increased exudation. The attending physician should be consulted as soon as any of these signs of an infection is observed.
Wound cleansing /Wound disinfection:
A wound should be cleansed with a suitable irrigation solution each time the dressing is changed. It is important only to dab the wound clean, and not to use a wiping action. Disinfection with a suitable antiseptic is only necessary if the wound is infected. On no account should disinfection be carried out as a preventive measure.
Skin care:
• Oil-in-water emulsions (O/W preparations) should not be used because the high water content leads to the skin drying out
• Water-in-oil emulsions (W/O preparations) should be used because they pose no risk of drying out
• Do not use pure fat products because they prevent air from reaching the skin
• Emulsions should be used sparingly and be quickly absorbed into the skin
• With extremely dry skin, it is a good idea to use moisture-retaining additives such as urea, allantoin and panthenol

Exudation phase
or cleaning phase


Heavy exudation from the wound occurs during this phase, indicating that the natural process of wound cleansing is taking place. Damaged, necrotic tissue and bacteria are flushed out. Necrotic tissue and fibrinous membranes must be removed before the wound can properly heal.

Granulation phase
or proliferative phase


In this phase, granulation tissue is formed, which can be seen as well perfused, reddish tissue. In addition to new tissue, new blood vessels are also formed, which penetrate into the closing wound. Granulation tissue grows upwards from the base of the wound and is essential for permanent healing.

Epithelialisation phase
or regeneration phase


This phase marks a further progression of the wound healing process. The epithelial layer grows over the newly-formed granulation tissue. This is a new skin layer which covers the wound from the edges to the centre.