Pathophysiology
Clinical meaning
Wound classification and healing assessment require systematic evaluation of wound type, depth, phase of healing, and factors influencing repair. Wounds are classified by mechanism (surgical/intentional vs. traumatic), depth (superficial/epidermal, partial-thickness involving dermis, full-thickness extending through dermis into subcutaneous tissue, or extending into muscle, tendon, or bone), cleanliness (clean, clean-contaminated, contaminated, dirty/infected), and chronicity (acute wounds healing in expected timeframe vs. chronic wounds stalled in the inflammatory phase for greater than 30 days). Wound healing progresses through hemostasis (immediate platelet plug and fibrin clot), inflammation (neutrophil and macrophage debridement of devitalized tissue and bacteria, days 1-6), proliferation (fibroblast collagen deposition, angiogenesis, granulation tissue formation, and re-epithelialization, days 4-21), and remodeling (collagen cross-linking and maturation, months to 2 years). Primary intention healing occurs in clean surgical wounds with approximated edges, healing with minimal scar. Secondary intention healing occurs in open wounds that fill with granulation tissue from the base, contracting and epithelializing from the edges. Tertiary intention (delayed primary closure) involves initial open wound management followed by surgical closure after contamination is cleared. The nurse assesses wound dimensions (length, width, depth, undermining,...