Duration of wound healing

The duration of wound healing cannot necessarily be strictly determined, as it depends on many different factors. A well-perfused, low-germ wound, which can primarily heal, takes about 10 days to heal completely and is closed either by scar tissue or newly formed skin. During these 10 days, the classic primary wound healing process goes through various stages, which are divided into cleansing, granulation and differentiation phases.

In general, however, the duration of wound healing depends on a wide variety of influencing factors: for example, to ensure a good and rapid healing process: Wound healing is always negatively influenced when the wound edges are not in contact with each other or are even necrotic, when the wound is infected with bacteria, when excessive bruising or connective tissue proliferation occurs or when there are underlying diseases that can be associated with impaired wound healing (e.g. diabetes mellitus).

Well supplied with blood, low germ wound conditions
Smooth, tightly fitting wound edges
The presence of oxygen, zinc, heat and vitamins.

Wound healing is a complex mechanism. Besides the blood, the skin is the main organ involved.

Wound healing takes place in various stages until new skin has formed on the injured area. Wound-healing agents usually contain zinc. Zinc promotes healing and has an antibacterial effect.

Zinc is also a co-factor of the immune system. Besides zinc, the dermatologist can prescribe cortisone cream for complicated or inflammatory wound healing disorders. The cortisone suppresses the inflammatory reaction, which leads to faster wound healing.

If the wound is infected, wound healing is more difficult. In this case, treatment with antiseptic (germicidal) ointments is necessary. These are best selected after a smear test and the determination of the pathogen.

If the wound is infected, a dermatologist should be consulted. An infected wound can be recognized by a bad smell, discoloration of the wound base and the wound edges (usually greenish) and increased pain. In addition to zinc, the dermatologist may prescribe cortisone cream for complicated or inflammatory wound healing disorders.

The cortisone suppresses the inflammatory reaction, which leads to faster wound healing. If the wound is infected, wound healing is more difficult. In this case, treatment with antiseptic (germicidal) ointments is necessary.

These are best selected after a smear test and the determination of the pathogen. If the wound is infected, a dermatologist should be consulted. An infected wound can be recognized by a bad smell, discoloration of the wound base and the wound edges (usually greenish) and increased pain.

Fibrin coatings should be removed if they are firmly attached to the wound base and hinder healing. Various treatments are available here. Depending on where the fibrin deposits are located and how firm the fibrin deposits are, the treatment is selected.

The most gentle method is to rinse the wound. Here an antibacterial solution is used to clean the wound. If the fibrin layers are superficial and not very firm, fibrin layers can be removed.

If this method does not work, surgical debridement should be considered. This is a surgical procedure that is usually performed under short anaesthesia. The treating physician cleans the wound manually and removes the fibrin deposits.

Care is taken to ensure that the edges of the wound are smooth and free of irritation. This is important for good wound healing. If surgical debridement is not possible, other procedures can be used to remove the fibrin deposits.

Chemical methods are available here, for example in the form of enzymes. However, this type of wound treatment takes a long time and thus also the wound healing process. The scab is part of the natural wound healing process.

Eschar formation is caused by the accumulation of fibrin and closes the wound. The scab also protects the wound from the penetration of germs. The scab should not be removed unless it hinders the wound healing.

Since the scab is intended to protect the wound, it should be left in place until it has dissolved by itself. When the scab dissolves, you can see newly formed skin underneath. An exception where the scab should be removed is the formation of pus in the wound.

If pus forms under the scab, it is removed to remove the pus as well. If pus has formed under the scab, a doctor should be consulted to clean the wound and continue treatment.The Bepanthen ointment, for example, promotes wound healing. It is very rich and moisturizes the skin.

Bepanthene ointment is also available with an antiseptic effect, i.e. this cream also has a germicidal effect. Another ointment that works especially well on healed scars is the Linola Fat Ointment. However, this should only be applied to the scar once it has healed.

The linoleum grease ensures that the scar remains supple and does not form knots. Thus, the scar moves optically into the background. Ointments that promote wound healing are ointments that contain zinc.

The zinc promotes healing and also has a germicidal effect. Iodine ointment is recommended as a special cream for skin injuries. Iodine also has a germicidal effect and promotes healing.

With daily application infected wounds can be well treated. Note the strong staining of the cream on textiles. The plaster serves to protect against bacterial colonization.

In everyday life, a plaster should be worn where bacterial colonization of the wound is to be expected. This includes above all the hands and feet when wearing open shoes in summer. A plaster can also be used to stop bleeding from small wounds.

It is advantageous for wound healing if air and some UV light reach the wound. This is best achieved without a plaster. Therefore, if possible, care should be taken to ensure that the plaster is removed at night, for example, when the risk of contamination is not so high, so that air can reach the wound.

If the wound is subject to mechanical stress, for example in a shoe, a plaster should also be used for padding. This also helps the wound to heal. In addition to the typical secondary diseases of the kidneys and eyes, wound healing is also impaired in many patients with long-term diabetes.

The reason for this is that the vessels and nerves are affected by permanently elevated blood sugar levels. This leads to destruction of the small vessels (microangiopathy) and the large vessels (macroangiopathy). Microangiopathy in particular leads to circulatory disorders in the area to be treated.

Due to the reduced blood circulation, the supply of oxygen and nutrients deteriorates, so that the healing process is impaired due to a lack of energy and nutrients. A classic example is the “diabetic foot“. Although this late complication is very much feared, one in four will develop it in the course of their illness.

Due to the circulatory problems in the legs, there are open spots that can no longer be healed or only with great difficulty. These can even increase drastically, so that amputation may be necessary in extreme cases. Chronic wounds with poor blood sugar control are one of the most common consequential damages caused by diabetes.

One speaks of a chronic wound if a wound has not healed within four weeks under professional care. It can even happen that wounds become even larger. The causes of chronic wounds are manifold.

It starts with the skin, which loses water content, becomes brittle, flaky and more vulnerable due to diabetes. In the case of a wound, the skin itself is therefore already weakened and cannot do the work of building up new tissue effectively enough, thus delaying the healing of the wound. Moreover, even the smallest injuries and scratches can develop into full-blown chronic wounds.

The wounds are a serious risk to be taken, because they are entry points for an enormous amount of germs which in extreme cases can cause blood poisoning in the whole body, which often ends deadly. These wounds are so dangerous that from a certain size and a certain risk of infection, only leg amputation can protect. Every year there are almost 60,000 leg amputations due to chronic wounds in diabetics.

The longer the diabetes persists, the more frequent is the development of a diabetic foot and a chronic wound due to a wound healing disorder. In addition, high blood sugar levels attack the nerves. This leads to a neuropathy.

Due to the neuropathy, the wounds caused, for example, by shoes that are too tight are not noticed. As a result, these wounds become bigger and bigger and do not heal. This phenomenon can also slow down the healing of wounds.

The immune system is also impaired by diabetes. The immune system can no longer properly protect the wound from invading bacteria and the wound becomes infected more easily. In addition, even small wounds become infected, which are no challenge for a healthy immune system.Theoretically, any skin injury, no matter how inconspicuous, such as scratches, can become the entry point for germs and a wound develops.

Diabetes also damages nerve cells, including those responsible for the perception of pain. As a result, patients do not take wounds seriously or do not even discover them in inaccessible parts of the body such as the sole of the foot and the heel. In order to avoid enlargement of the wound, diabetics are advised to check their legs and feet every day so that they do not overlook small wounds that will be difficult to get a grip on later.

Optimal blood sugar control can significantly reduce this risk and allows the body to heal wounds better and faster, while also being able to fight germs effectively. The long-term glucose level (HBA1c) should be controlled and antidiabetic therapy should be discontinued accordingly. Like diabetes, smoking causes damage to the blood vessels.

The cause is arteriosclerosis (= hardening of the arteries). Over the years, the calcification leads to a narrowing of the blood vessels and a decrease in their elasticity. All people experience this process in the course of their lives.

Smoking, however, accelerates this process enormously. In addition, substances in cigarette smoke cause the vascular muscles to contract, so that the vessels become even more constricted. These vasoconstrictions lead to an increasing lack of blood circulation in various organs such as the heart, brain, skin and even the arms and legs.

This process is particularly noticeable in the often cold hands of smokers. This process of vascular constriction alone makes one understand why smokers’ wounds heal more poorly, because the lack of blood circulation simply means that the essential supply of oxygen to the cells, as well as important blood components and nutrients that are necessary for the healing of a wound, is missing and the healing of the wound is delayed. But that is not enough.

With each cigarette smokers also breathe in carbon monoxide. Carbon monoxide is absorbed by the oxygen carriers in the blood just like oxygen. Strictly speaking, it is actually much better absorbed by the oxygen carriers.

In the blood of smokers, the important oxygen carriers, the erythrocytes (= red blood cells) are therefore saturated with carbon monoxide to a not inconsiderable extent, namely up to 15%, and thus cannot transport vital oxygen. For non-smokers, the proportion is approximately only 0.5% of red blood cells. The blood vessels, which are already constricted due to arteriosclerosis, therefore also supply blood enriched with less oxygen, which makes the supply of tissue even worse.

Both processes together make the critical situation of smokers clear and show why the vast majority of smokers have to deal with wound healing disorders in the course of their lives. With progressive deficiency of blood supply, more drastic situations can occur in addition to wound healing disorders. The best-known example is the smoker’s leg, which, like the diabetic foot, often leads to amputation.

Since the problem of smokers also affects surgical wounds, smokers are advised to stop smoking before surgery and to refrain from smoking after surgery. It is particularly important to refrain from smoking after abdominal surgery. This can lead to wound healing disorders of the intestines, which can have serious consequences.

For example, after a bowel operation, the two ends of the bowel cannot grow together properly and the suture may open. In this case, the leakage of stool into the abdominal cavity can lead to a life-threatening peritonitis. An emergency operation must be performed immediately.

With moderate alcohol consumption, alcohol does not interfere with the wound healing. However, long-term alcohol consumption should be avoided, especially after surgery. Chronic alcohol consumption weakens the immune system and wounds can become infected more easily.

This impairs the healing of wounds. However, alcohol has no direct influence on wound healing. Under no circumstances should alcohol be applied directly to an open wound. The alcohol is toxic for the tissue. Alcohol causes necrosis in the wound area, which can spread to the entire extremity and is very dangerous.