Episode 6. The Wound Guy: How Wounds Heal

Hello, my name is Gary Bang from the Woongai and the Lindsay Leg Club Foundation. In this podcast, I will provide you with a simple overview as to how wounds heal. From our first childhood memory of an injury, and then throughout our adult lives, we accept that we get wounds, but we also expect that they will heal, most of the time uneventfully. We see healing as being normal, for the majority of us repairing our skin is something that will continue even into old age however for around 1% of the population this will not be the case and their wounds become stalled chronic or hard to heal why is this so the skin is our most visible organ on average the skin is responsible for 15% of our weight making it our heaviest organ in surface area it is one of our largest organs. So all of this is impressive, but there's more. The skin is more than just an organ. The layers we refer to as the adipose, dermis and epidermis work together to function as the integumentary system. This incredible system contains a vast array of cells, nerves, blood vessels, lymphatics, glands, fibers and hair. This system helps us do many things like manage our external microbial environment, regulate our body temperature, sense pressure, vibration, hot and cold, but also to instigate and and regulate the repair of injury. The key moment here is understanding that the integumentary system, our skin, interfaces with all other systems. Normal skin health and function is reliant on the integumentary system working alongside the cardiovascular system, system, the gastrointestinal system, the respiratory system, the immune system and so on. If one or more of these systems is offline, or not working as it should, then the integumentary system will be negatively impacted, even to the point that the integumentary system may not have sufficient capacity to heal itself. a wound on the skin is actually a whole-of-body exercise. It is a multi-system collaboration whose goal is wound closure and restoration of function. When a wound repairs itself, there are steps it goes through to achieve this. These steps are the same for every person and for every wound. The outer skin cells located in the epidermis are the first to send a message that they have been breached. Their messages and the subsequent bleeding that takes place activates the platelets to produce a blood clot which stops the blood loss. The platelets do more than produce a clot. Whilst they are doing this they are sending off their very own messages which go throughout the integumentary system to say that a wound is now present. These messages will trigger an immune system response by our white blood cells. They will fight off microbes and clear away dead or broken tissue. When this is happening you will notice that the skin around the wound is red, swollen, painful and oozing. This is inflammation, an essential early first step in getting our wound building site cleared of debris so that we can make a new wound building in its place. As the inflammation subsides we often notice that a Ferrari red colored base emerges within the wound. This is called granulation tissue and its purpose is to fill in the volume of the wound and to assist contraction bringing the wound edges closer together. Pink purple cells start to build up at the wound edges and they then move over the granulation tissue aiming to meet somewhere near the wound center. When the pink-purple cells have completed their journey, the wound is what we call closed. It is covered or sealed. But it is structurally weak, which is why after closure a scar must progressively form so that in time the wound site will be strong enough to cope with the robust strains and forces of everyday life. For those wounds that heal, the steps of repair do follow something of a time sequence. Forming a blood clot usually takes a few minutes. Inflammation and the immune system response lasts from hours to a few days. Making granulation tissue and closing the wound can take days to weeks. The formation of a scar is actually months in the making. Wound healing can be interrupted at any of these stages of repair. Should this happen then the integumentary system and those systems that support it have been challenged. The priority then is to understand why and to determine how best to respond. Fixing the hole in you is actually very much about treating all of you. This may mean dealing with medications, having procedures, dressings, ensuring you have adequate nutrition and a number of other things. Whilst importantly not overlooking your social, emotional and spiritual needs. This is the Lindsay Leg club way, because wound care is really the care of our entire being. Bye for now.