What are the characteristics of a wound that is healing well?

From the Guidelines

A well-healing wound can be described by observing several key characteristics, including well-approximated wound edges, surrounding skin that appears pink rather than red, and a clean wound bed with no purulent drainage, as noted in the most recent guidelines 1. To describe a wound that is healing well, several factors should be considered.

• The wound edges should be well-approximated with minimal gapping,
• The surrounding skin should appear pink rather than red, indicating appropriate inflammation without infection,
• The wound should be clean with no purulent drainage, though small amounts of clear or slightly yellow serous fluid may be present in early healing stages,
• As healing progresses, the wound should become progressively drier with decreasing drainage,
• The skin around the wound should feel warm but not hot to touch,
• The patient should report decreasing pain and tenderness over time,
• A properly healing wound will develop a scab or thin layer of granulation tissue that eventually contracts and is replaced by new epithelial cells,
• The wound should not have significant swelling, and any initial edema should decrease over time,
• There should be no foul odor, which would suggest infection,
• For surgical wounds, sutures or staples should remain intact until removal, and the incision line should become increasingly stable,
• As the wound matures over weeks to months, the scar will transition from red to pink to white, becoming flatter and less noticeable, as supported by recent studies on wound care 1. These observations help distinguish normal healing from complications like infection, dehiscence, or poor granulation. It is also important to note that the use of antimicrobial dressings does not improve wound healing or decrease infection rates in clean wounds, as stated in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Additionally, the optimal protocol for wound care, including debridement and wound exudate control, is yet to be elucidated, but it is agreed that surgical debridement can be helpful in converting a biologically chronic wound to an acute wound to promote healing 1.

From the Research

Describing a Well-Healing Wound

To describe a well-healing wound, consider the following characteristics:

• A moist wound environment, which facilitates autolytic debridement, reduces pain, and promotes keratinocyte migration over the wound surface 2
• The presence of a suitable wound dressing that maintains a moist environment, has an optimal water vapor transmission rate (WVTR), and absorptive capacity 2
• A wound that is protected against trauma and contamination, and has an optimal level of hydration throughout the treatment 2
• The progression of the wound through the classical wound healing phases, including inflammation, proliferation, and remodeling 3

Factors that Promote Wound Healing

Several factors can promote wound healing, including:

• Optimization of the wound environment through the use of different topical therapies and wound dressings 4
• The use of antimicrobial dressings to control bioburden and promote wound healing 5
• Appropriate wound cleaning and debridement to remove necrotic tissue and reduce wound bioburden 6
• The selection of a suitable wound dressing based on the type of wound, local microbial burden, and location and condition of the wound 5

Characteristics of an Optimal Wound Dressing

An optimal wound dressing should have the following characteristics:

• Provide a moist environment for healing 2
• Have an optimal water vapor transmission rate (WVTR) and absorptive capacity 2
• Protect the wound against trauma and contamination 2
• Be easy to apply, painless to remove, and esthetically acceptable 2
• Have the ability to adjust the WVTRs to the exudate level of the wound, or have a large absorptive capacity without changing the WVTR 2