Stages of Wound Healing

Stage 1: Haemostasis

• Timeline: Immediately after injury, lasting minutes to 2 days

• Body reacts to prevent wound from bleeding

  • Blood vessels constrict

  • Blood clotting occurs

Stage 2: Inflammatory Stage

• Timeline: After haemostasis (minutes to a couple of days) to 4-5 days

• Increase in white blood cells, blood flow, and swelling

• Body responds to heal area but often "overdoes" it, resulting in excess scar tissue to eventually form in later stages

Therapy during this stage focuses on:

• Immobilizing affected joints to protect the area and prevent/minimize contractures

  • After an injury our body tends to want to be in a comfortable position, which is often in flexion

  • However, this can often lead to a contracture so it is important to keep affected joints in a position that allows the affected tissues to be lengthened

  • This can be done through an orthosis 

Stage 3: Fibroplasia and Proliferation Stage

• Timeline: 4-5 days after injury to 2-6 weeks

• Proper wound healing begins

• Granulation tissue appears

  • This is a form of tissue that is a part of the healing process

  • Is new connective tissue that grows

  • It protects the wound from infection and further injury, helps blood flow to the injured area, and temporary fills the wound until scar tissue forms

• Body produces lots of collagen

  • Helps new cells grow in the area

  • Essentially acts as a biological glue

  • However, the collagen is formed in a disorganized fashion

Therapy during this stage focuses on: 

• Focus on regaining any lost range of motion that occurred

  • Can be done through passive range of motion, active range of motion exercises, or static progressive orthosis/serial static progressive orthosis

Stage 4: Maturation and Remodeling

• Timeline: 2-6 weeks after injury to 1 year or more

• Scar tissue begins to form but it is still early enough for the scar tissue to be remodeled

• The collagen fibers are reorganized to be stronger

  • They cross-link

  • They align along tension lines

  • The scar tissue becomes strong (up to 80% stronger than normal, uninjured skin)

  • The scar tissue becomes less flexibile

    •  Stretches about 15% of its original length, whereas normal skin can stretch up to 50% of its original length

  • The scar tissue becoming stronger and less flexible can cause scar tissue to restrict movement, especially if the scar is over a joint

Therapy during this stage focuses on:

• Scar mobilization to promote a more smooth and flexible scar

• Continue progressing with passive and active range of motion to help the collagen fibers and scar tissue align more correctly along lines of natural stress

• Progressive orthotics can be performed if needed

References

Leonard, C. (2020). Four stages of wound healing | Vohra Wound Physicians. Vohra Wound Care. https://cert.vohrawoundcare.com/the-four-stages-of-wound-healing-an-updated-overview-for-clinicians/

Sharp, P. (2021). Stages of Wound Healing. PhysicalTherapy.Com. https://www.physicaltherapy.com/ask-the-experts/stages-of-wound-healing-4790