What are the skin’s particularities? The skin is the body’s largest organ (up to 15% of its weight approximatively) forming a flexible membrane which covers its entire surface. It is a stable but flexible outer covering that acts as a barrier, protecting the body from harmful things in the outside world such as moisture, the cold and sun rays, as well as germs and toxic substances.
The skin is made of three different layers: the outer layer (epidermis), the middle layer (dermis) and the deepest layer (subcutis) 1.
Regarding the depth, the origin, and the site, a wound can range from simple to life threatening. Wounds can be opened or closed, deep or superficial, clean or contaminated, acute or chronic, and each type of wound will need a specific management in order to heal correctly 2.
What is the wound healing process? Regeneration and tissue repair processes are based on a sequence of molecular and cellular events occurring right after the beginning of a tissue lesion.
This sequence of events, called wound healing, can be divided into 4 stages 3:
– Hemostasis phase: process of the wound being closed by clotting.
– Inflammatory phase: controls bleeding and prevents infection.
– Proliferative phase: the wound is rebuilt with new tissue made up of collagen and extracellular matrix.
– Maturation phase: also called the remodeling stage, consisting of fully closing the wound. It begins about 21 days after an injury and can continue for a year or more.
What are the challenges for wound healing? For injuries that require further management it is imperative to assess the wound and determine how best to treat it.
Multiple techniques can be used for wound closure. The three main techniques are sutures, staples and adhesive tapes/skin glues. In percutaneous wounds or simple pediatric cases, skin glues are particularly useful as they are quick, relatively painless and can be combined with deeper sutures too. They cause minimal wound inflammation, have a lower infection rate than sutures, and are removed easily 4-5.
Then, based on the wound type, suitable dressing material must be used. Indeed, even if closed, the wound is exposed to several exterior agents. Dressings, by providing protection against bacterial infection and maintaining a moist environment will promote the process of wound healing 6.
Chronic wound formation is also a challenging problem for both patients and caregiver, as it is estimated that 15% of the wounds cannot recover 1 year after appearance, and living with a wound can have a serious impact on quality of life 7. Therefore, it is essential to keep improving our understanding of wound repair and regeneration in order to bring innovative solutions and improve patient’s quality of life.