The saying goes “time heals all wounds,” but what happens when a wound does not heal? Wounds go through many stages while healing and complications at any step can prolong the process.
The first step is stopping the bleeding. For people who are taking blood thinners like aspirin or warfarin, it may take longer for the bleeding to stop or clot.
The next step after the blood starts to clot is forming a scab. This happens when blood vessels around the wound narrow and platelets in the blood clump together to create the scab. A protein called fibrin helps hold the clot in place. After someone has had a stroke or heart attack caused by a clot, they may be placed on medications to make the platelets more slippery and less likely to clump together. Medications like Plavix and Aggrenox make platelets slide past each other rather than clumping to make a clot which can delay the scabbing process.
At this point, the body cleans the wound. Blood vessels will dilate and increase blood flow to the area. White blood cells called macrophages arrive on the scene to clear out infection and release chemicals called growth factors and cytokines that help tell the body to form new skin cells. If the infection is not cleared by the body, the wound will not heal properly.
The body also creates new blood cells to bring in nutrients and supplies to help heal the wound. Conditions like diabetes, atherosclerosis, known as hardening of the arteries, and high blood pressure, cause poor blood flow and can slow down wound healing. Smoking slows healing in many ways. Nicotine causes blood vessels to narrow and reduces the number of macrophages and fibrin in circulation. Carbon monoxide in cigarette smoke decreases the oxygen transport needed to help repair and rebuild the skin cells.
The final step of wound healing is strengthening or maturation. At this stage the wound looks closed and repaired, but the tissues below are still being strengthened. The wound may feel itchy or tight and the skin may look slightly pink and stretched. After about three months the wound should be about 80 percent healed. It can take up to two years for the scar to remodel and achieve its final appearance.
Yes, it takes time to heal all wounds, but if you have concerns don’t bide your time. Talk to your doctor to learn about options that can assist you through the healing process. We want to help your wound heal, all in good time.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.organd follow Prairie Doc on Facebook. Jill Kruse, D.O., is part of The Prairie Doc team of physicians and currently practices as a hospitalist in Brookings, S.D.
