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Wound Healing Overview

A wound is a break in the protective layer of the skin, it can be accidental or intentional as with surgery. All wounds, whether small or large, open or closed, go through the same basic stages. Closed surgical procedure wounds just go much faster because in a closed surgical wound the inside of the wound has only to heal back together. In an open healing wound that is healing from the bottom up, the process is to fill in the tissue that has been removed and leave the structure of the area similar to what it was before the removal of tissue.

The body is truly a miracle, and those people who go through open healing will have an unforgettable experience watching the healing process of a gaping cavity wound fill in and heal into a small patch of scar tissue over the course of about 8 weeks.

These two pages of learning about how wounds heal are mainly devoted to those with open healing so they can understand the process as it is happening, but they are also certainly relevant to those with sutured closed wounds. The best possible healing outcome is the goal in both cases.

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Pilonidal Surgical Wounds

A Pilonidal excision wound is also called a "Cavity Wound", meaning that a large chunk of tissue has been removed, leaving a cavity. Small cavity wounds can be closed with stitches (closed healing, healing by first intention) but larger cavities are in much greater danger of infection and will likely be smoother and less prone to splitting if the cavity is allowed to fill in with new tissue so that the area of the body retains its natural shape. The difference in technique can be imagined as digging a hole in your yard. In a closed surgery, you push the sides of the hole together and let them mend. In an open surgery, you allow the hole to refill itself from the bottom.

An "open" healing happens by letting the wound "fill in" from the bottom. Also called, "healing from the bottom up" or "healing from the inside out." To be more specific, the wound will fill itself in by building new tissue starting at the bottom of the wound. As the bottom begins to fill in, the sides of the wound also will get new tissue. The most important part of open healing is to keep the sides of the wound from touching until the bottom of the wound has filled in at least halfway. If the sides of the wound touch, then they can form bridges and heal together, trapping fluids and exudate deep in the wound bed. This is where the concept of packing comes in to play.

How long it takes for a wound to heal depends on many factors, not the least of which is the size and depth of the wound, location of the wound, age and health of body. 

The final result of wound healing is scar tissue. A scar is an area of fibrous tissue that replaces normal skin after injury. Scar tissue never regains the full ability to stretch that unbroken skin has, thus it will always be more fragile than the surrounding skin.  Scar tissue also has no pores or follicles and sunburns more easily. 

Now that we have covered the basics of wound healing, our next class is an in-depth look at the process.  Please take your seat in the auditorium for Wound Healing: In Depth

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This page last updated: 11/12/2010

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healing by first intention

Healing by fibrous adhesion, without suppuration or formation of granulation tissue. Also called primary adhesion, primary union.

closed healing

This specifically refers to a wound that has, by some means such as stitches, staples, etc. been closed from the outside.

Cavity Wound

See further discussion with Managing Cavity Wounds publication.