1. What Does the Color of a Wound Bed Tell Us?
2. How to Identify Healthy Wound Beds
3. Conclusion
4. References

Wound bed appearance refers to the overall appearance of the tissue within a wound. This includes the type and colour of tissue, as well as the presence and amount of exudate (fluid produced by the wound). Assessing the wound bed is an important aspect of wound assessment and management, as it provides valuable information about the health of the wound and the progress of healing.

Different types of tissue and exudate can indicate different stages of healing or potential problems that may need to be addressed. For example, the presence of healthy granulation tissue may indicate that the wound is healing properly, while the presence of necrotic tissue or excess exudate may suggest that the wound is not getting enough blood flow or is at risk for infection.

In addition to providing important clues about the health of the wound, assessing the wound bed can also help to ensure that the wound is receiving the appropriate care and interventions to support the healing process. This may include using different types of wound dressings, debriding the wound to remove dead or damaged tissue and addressing any underlying medical conditions that may be impacting the healing process.

Normal wound bed appearance

A normal wound bed is one that is well-suited for the healing process and is making progress towards closure. There are several characteristics of a normal wound bed that can help to identify it as such:

Type of tissue: A normal wound bed typically contains healthy granulation tissue, which is a type of new connective tissue that forms during the healing process of a wound. It appears as a moist, spongy, red tissue on the surface of the wound bed. The surface of the granulation tissue may be smooth or rough, depending on the stage of healing. In the early stages of healing, granulation tissue may appear soft and fragile, with a velvety texture. As the wound progresses through the healing process, the granulation tissue becomes more robust and may develop a more bumpy or uneven surface. The presence of granulation tissue on a wound bed is a sign that the wound is healing properly and that new blood vessels and collagen fibres are being formed. It is important to keep the wound bed moist and clean in order to promote the growth of granulation tissue and support the healing process.

Epithelial tissue on a wound bed typically appears as a thin, pink layer that covers the surface of the wound. It may be smooth and shiny, or it may be rough and irregular depending on the type of epithelial tissue present. The appearance of epithelial tissue on a wound bed can also vary depending on the stage of healing. In the early stages of healing, the epithelial tissue may be thin and fragile, and may easily be damaged or disrupted. As the wound progresses through the healing process, the epithelial tissue becomes thicker and more robust, and is better able to withstand mechanical stress. Ultimately, the goal of wound healing is for the epithelial tissue to completely cover the wound, forming a barrier that protects the underlying tissues from infection and external damage.

Amount of exudate: A normal wound bed typically produces a moderate amount of exudate, which is the fluid produced by the wound. Exudate may be clear or cloudy and may be thin and watery or thick and pus-like. A normal wound bed should not produce excess exudate, as this can cause maceration of the tissues and interfere with the healing process by creating a moist environment that is conducive to bacterial growth.

Surrounding skin: The skin surrounding a normal wound bed should be healthy and free of inflammation or breakdown.

What Does the Color of a Wound Bed Tell Us?

There are several other tissue types that you may encounter when assessing a wound. Here is more information on these tissue types and what they can tell you:

Granulating: Granulating tissue is a type of healthy new tissue that is typically pink red in colour and has a moist, spongy appearance. It is a sign that the wound is healing properly and that new blood vessels are forming.

Necrotic/eschar: Necrotic tissue, also known as eschar, is dead tissue that has been killed by a lack of blood flow or other factors. It is typically black or brown in color and has a hard, dry appearance. The presence of necrotic tissue can indicate that the wound is not getting enough blood flow and may need additional interventions such as debridement to remove it and to promote healing.

Bulla/blister: A bulla is a large, fluid-filled blister that can form on the skin as a result of injury or other factors. Bullae can be a sign of infection or other problems and may need to be drained or treated with medications.

Fistula: A fistula is an abnormal connection between two organs or between an organ and the skin. Fistulas can occur in wounds and may need to be surgically repaired.

Epitheliating: Epitheliation refers to the process of new skin forming over a wound. A wound that is epitheliating is typically pink and is in the process of closing.

Hypergranulation: Hypergranulation tissue is a type of excess granulation tissue that grows beyond the edges of the wound. It is typically red and has a moist, bumpy appearance. Hypergranulation tissue can occur in response to certain types of wound dressings or as a result of excess moisture in the wound. It can interfere with the healing process and may need to be addressed with different dressings or other interventions.

Haematoma: A haematoma is a collection of blood that has escaped from a blood vessel and pooled in the surrounding tissue. Haematomas can occur in wounds and may need to be drained in order to promote healing.

Slough: Slough is a type of yellow or greenish-yellow tissue that is composed of dead cells and bacteria. It is often found in wounds that are not healing properly and can interfere with the healing process.

Dehisced suture line: A dehisced suture line is a wound that has opened along the line of a surgical incision. Dehiscence can occur as a result of infection, wound edges that are not properly aligned, or other factors.

Sinus: A sinus is a narrow, tunnel-like opening that leads from the surface of the skin to the underlying tissue. Sinuses can occur in wounds and may need to be surgically repaired.

Overall, the appearance of the tissue within a wound can provide valuable information about the health of the wound and the progress of healing. By accurately identifying the tissue type and colour, you can ensure that the wound is receiving the appropriate care and interventions to support the healing process

How to Identify Healthy Wound Beds

Accurate assessment of the wound bed is essential in order to determine the most appropriate course of treatment and to monitor the progress of healing. There are several techniques that can be used to assess the wound bed, including visual inspection, measurement of the wound size and depth, and assessment of the type and amount of exudate present.

Visual inspection: One of the most important techniques for assessing the wound bed is visual inspection. This involves closely examining the wound bed to identify the type and colour of tissue present, as well as the presence and amount of exudate. It’s also important to pay attention to the surrounding skin, as this can provide clues about the overall health of the wound.

Measurement of wound size and depth: Measuring the size and depth of the wound can provide valuable information about the progress of healing. Wounds that are decreasing in size and depth are generally considered to be healing properly, while wounds that are not changing in size or are increasing in size may need additional interventions.

Assessment of exudate: Exudate, or the fluid produced by the wound, can provide valuable information about the healing process. It’s important to assess the amount and type of exudate present in the wound, as well as any changes in the exudate over time. Excess exudate can interfere with the healing process, while a lack of exudate can indicate that the wound is not getting enough moisture.

It’s also important to ensure that wound bed assessments are accurate and consistent in order to get an accurate picture of the wound’s progress. This may involve using standardized assessment tools or techniques.

It’s also important to document the results of wound bed assessments in order to track the progress of the wound over time. This can be done through the use of wound care documentation forms or electronic medical records.

Conclusion

In conclusion, the appearance of the wound bed can provide valuable information about the health of the wound and the progress of healing. Different types of tissue and exudate can indicate different stages of healing or potential problems that may need to be addressed. Accurate assessment of the wound bed is essential in order to determine the most appropriate course of treatment and to monitor the progress of healing. By regularly evaluating the wound bed and using appropriate interventions, you can help to ensure that the wound is on track to heal as quickly and effectively as possible.

References

Atiyeh, B. S., Costagliola, M., Hayek, S. N., Al-Amm, A. R., & Dibo, S. A. (2002). The role of moisture in wound healing. Advances in Skin & Wound Care, 15(6), 377-388.

National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance

 . (2014). Prevention and treatment of pressure ulcers: Quick reference guide. Cambridge, MA: Health Quality Press.

Palfreyman, S., & Cowman, S. (2014). The importance of wound bed preparation in the management of chronic wounds. British Journal of Nursing, 23(17), 962-968.

Schultz, G. S., & Sibbald, R. G. (1998). Understanding the principles of wound bed preparation: The foundation for wound management. Advances in Skin & Wound Care, 11(3), 144-149.

Thomas, D. R., & Goode, P. S. (2010). Wound bed preparation: A systematic approach to wound management. Wound Repair and Regeneration, 18(1), 75-83.

1. Local Factors
2. Systemic Factors
3. Barriers to Wound Healing
4. Local Barriers
5. Overcoming Barriers to Healing
6. Conclusion
7. References

Factors Affecting Wound Healing

Wound healing is central to the process of maintaining a healthy body. The healing process involves multiple phases that aim at restoring normal tissue architecture and function. These stages include hemostasis, inflammation, proliferation, and maturation. Factors that affect wound healing can be categorised into local and systemic factors. Local factors are related to conditions within the wound itself, while systemic factors relate to your overall health that affects the healing process.

Local Factors

Local factors contribute significantly to impaired wound healing. These factors include the presence of wound-bed infection, non-viable tissue, inadequate blood supply and wound dehiscence. Researches show that the incidence of wound infection increases the probability of wound failure by 70%. 

Chronic wounds are commonly found on the legs and feet, and these wounds (like diabetic foot ulcers, venous leg ulcers, and pressure injuries) result from different types of vascular disorders. For instance, blood flow is impaired if you are living with peripheral vascular disease, resulting in reduced perfusion to the skin and a high risk of ulceration. 

Furthermore, venous leg ulcers are the result of venous insufficiency and result from blood pooling in the veins, leading to the formation of fibrin and clot formation in the vessels. This then leads to skin damage in the lower extremities, which can ultimately lead to ulceration.

Systemic Factors

Systemic factors include a variety of cell types that impact overall health. These factors can be influenced by comorbidities, overall health status, age, sex and lifestyle choices that range from acute or chronic alcohol use to chronic obstructive pulmonary disease (COPD). 

People living with diabetes are more likely to develop a chronic wound due to poor circulation, neuropathy, and high blood sugar levels. 

Obesity also contributes to delayed wound healing, as it impairs blood circulation and causes inflammation.

Additionally, wound closure after surgical procedures can be complicated by systemic issues such as hypertension, anaemia, or poor clotting status.

Barriers to Wound Healing

Chronic wound care is complex because it addresses a variety of factors that contribute to the wound’s progression, including local, systemic, physical, and psychological barriers. These barriers prevent or delay the healing process, leading to chronicity, infection, and complications. Understanding the challenges that lie in managing chronic wounds is crucial in developing successful wound care strategies that promote healing outcomes.

Local Barriers

Local barriers refer to any factor that impedes the healing of wounds within the wound bed. These barriers include: wound bed infection, non-viable tissue, inadequate blood supply, and wound dehiscence. Delayed wound healing arises as a result of the presence of these barriers, and therefore, interventions must be implemented to overcome these challenges. Among the major local barriers to healing are exudate, infection and biofilm.

Exudate

Wound exudate is the fluid that is produced by the wound. It contains growth factors, cytokines, and enzymes necessary for the wound healing process. However, excess exudate in the wound bed can delay healing by causing maceration of surrounding skin, reducing the circulation of nutrients and inhibiting wound closure. 

Addressing this issue involves choosing the right optimal dressing that can manage exudate effectively; some dressing options include the use of foam or alginate dressings. When managing exudate, it is essential to balance moisture correctly to prevent peri-wound maceration. Wound care clinicians should observe for maceration and wetness at the peri-wound area and dressings that adhere to the dry wound bed during reassessment to facilitate a moist wound environment.

Infection

The presence of infection in the wound is one of the most common local barriers to wound healing. Infection is a critical factor that contributes to delayed wound healing or, in some cases, leads to chronic wound development. Infection delays wound healing by releasing various enzymes and toxins that impair wound repair and the growth of granulation tissue. Consequently, it is essential to maintain a sterile environment and use appropriate wound care dressings, such as silver dressings or compression bandaging, to reduce bacterial load and protect the wound from further infection.

Biofilm

Biofilm formation is a critical factor that contributes to local barriers to wound healing. Biofilm is a bacterial community embedded within an extracellular polymeric matrix that protects the bacteria from antibiotics and immune system defenses. Chronic wounds often exhibit biofilm formation and prevent healing by impeding the growth of granulation tissue and impairing collagen synthesis. 

The presence of biofilm in the wound bed requires special attention and treatment requires identification and removal of the biofilm. Dressings play a significant role in the management of biofilm in the wound bed, and the use of an antimicrobial dressing such as Aquacel Ag Plus Extra Dressing has been shown to be effective in preventing reformation of biofilm.

Sleep disturbances, depression and anxiety

Sleep disturbances can lead to metabolic changes and immune system stimulation that impair wound healing. Additionally, psychological issues such as depression and anxiety can impair wound healing as these conditions generate stress hormones such as cortisol and catecholamines that lead to vasoconstriction and overall impaired healing. It is therefore essential to address these psychological and environmental factors when managing chronic wounds.

Overcoming Barriers to Healing

Overcoming barriers to healing requires an understanding of the principles of wound bed preparation. Wound bed preparation involves the management of local and systemic factors that contribute to the wound’s progression. These principles include adequate exudate management, management of wound bed infection, maintaining a moist wound environment and attending to social factors. 

Principles of wound bed preparation should be implemented alongside the right wound dressing to create a favourable environment for wound healing. Dressings should be chosen based on their fluid handling capability and ability to hold exudate, ensuring an equilibrium between the right amount of moisture at the wound bed and protecting the peri-wound skin. 

Effective wound bed preparation requires a holistic assessment of the wound and the patient to identify the factors that contribute to delayed healing. Identifying the barriers to healing is the first step in developing relevant interventions to overcome those obstacles and promote improved healing outcomes.

Conclusion

Chronic wounds are a significant health problem that requires the implementation of successful wound care strategies to reduce healthcare costs and improve patient outcomes. A holistic approach to wound care management that addresses patient-related factors and identifies local and systemic barriers to healing is crucial in reducing delayed wound healing and persistent chronic wound development. Understanding how exudate, wound infection, and biofilm can impede the healing process is key to promoting rapid wound repair. Evidence-based approaches and the right wound dressing choice are necessary to address the factors that affect wound healing, promote perfusion, and aid in wound bed healing. Finally, effective wound bed preparation should be paired with psychological and environmental factors that affect the overall healing process to facilitate rapid wound healing and improved patient outcomes.

References

Australia Medical Association. (2022). Solution to the Chronic Wound Problem in Australia. Retrieved from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ama.com.au/sites/default/files/2022-08/research-report-solutions-to-the-chronic-wound-problem-in-australia.pdf

Boateng, J., & Catanzano, O. (2015). Advanced therapeutic dressings for effective wound healing—a review. Journal of pharmaceutical sciences, 104(11), 3653-3680.

Frykberg, R. G., & Banks, J. (2015). Challenges in the Treatment of Chronic Wounds. Advances in wound care, 4(9), 560–582. https://doi.org/10.1089/wound.2015.0635

Team, V., Bugeja, L., & Weller, C. D. (2018). Barriers and facilitators to participant recruitment to randomised controlled trials: a qualitative perspective. International wound journal, 15(6), 929-942.