Granulation of wound: stages and features

Author: Surgeon Denisov M.М.

The wound is a violation of the integrity of the skin surface. Wounds are called complex if the process involves muscles, internal organs, bones.

The healing time for wounds is determined by the individual characteristics of the organism: regenerative abilities, the scale of damage. If the wound does not heal for a long time, then this indicates an urgent need to see a doctor. In general, the healing process consists of three interrelated and sequential phases: exudative, granulation and differentiation.

The exudative, or inflammatory, phase is intended for the purification of damaged tissues, accompanied by edema, which creates favorable conditions for the conversion of fibroblasts to fibroblasts. Due to the release of platelets of vasoactive substances, local acidosis develops, against which catabolic reactions are intensified.

Subsequently, leukocytes, T - lymphocytes and a number of other cells are isolated into the wound, the main function of which is phagocytosis of bacteria. A similar phenomenon is manifested in the release of pus. If the wound is festering , then this indicates a large accumulation of microorganisms in the wound.

Then follows the granulation, or proliferative stage. This stage was called similar because of the proliferation of cellular elements, revascularization (i.e., the formation of new vessels), filling the defect with new tissue. Granulation is a temporary tissue, in the performance of its functions is subjected to regression and replaced by scar tissue. The morphological basis of such a tissue is formed by the glomeruli of newly formed vessels. If the process occurs in full and necessary measure, then the growing tissue envelops these vessels, thereby increasing in its volume. Externally, the granulations have a gently pink color.

Granulation of the wound is a complex controlled process, in which the participation of cells such as leukocytes, histiocytes, mast cells, plasmacyttes, fibroblasts is mandatory. Particularly indispensable are fibroblasts, which ensure the insertion of collagen after the edges of the wound have been reached. Therefore, in the presence of hematomas, necrotic tissue, large accumulation of exudate, the process of movement of fibroblasts slows down significantly, as does capillary formation.

The formation of collagen fibroblasts occurs on the second day and the greatest activity is shown on the 6th day of wound healing. The granulation process itself lasts up to 3 weeks, during which time the granulation tissue (which is already represented by a connective tissue at this moment) ripens.

Especially important is the sufficient content in the wound defect of cytokines, oxygen, in the body - iron, vitamin C, zinc. When the maturation process is at an end, an epithelial lining is observed on top of the defect.

Very often, during this phase, so-called granulations are formed, which perform a sanitary function, delimiting non-viable, ischemic tissues. Such areas are removed independently by lysing. In case of care of a wound in a surgical hospital, it is possible to remove them mechanically. On how to properly conduct pho wounds (primary surgical treatment), click on the link.

The last stage is differentiation, characterized by scar formation. This process begins at the edges of the wound and moves to its central part. For minor lesions, epithelial movement occurs on average in 2 days.

Thus, granulation plays an important role in wound healing. To ensure the best effect of healing, it is necessary to follow all the doctor's recommendations.