The Stages of Wound Healing- How Oxygen Free Radicals Influence the Inflammatory Phase
James Gleaves, MD,FACS: Kim Eldridge, RNFA,CNOR,CFCN,WCC: Richard M. Millis, PhD
The wound healing process is a complex process in which all phases play an important role. There are four phases in the wound healing cascade of events: 1. Hemostasis, 2. Inflammation, 3. Proliferation and 4.Maturation.
All of the phases are important but sometimes rarely occur in the strict order. At times, the phases overlap making it difficult to identify where a particular wound is in the process of healing. The inflammatory phase is important for preventing infection. Some wounds stall in the inflammatory phase, thereby, creating a chronic wound.
The purpose of this presentation it to demonstrate how a novel hydrophilic gel with oxygen free radical binding capacity aids in preventing the overgrowth of bacteria in a wound during the inflammatory phase. An excessive amount of oxygen free radicals cause harm by degradation tissue and delaying wound healing. This presentation shows how the binding of oxygen free radicals promotes wound healing by decreasing inflammation, eliminating bacterial overgrowth and creating an environment to promote the development of healthy granulation tissue, thereby, resulting in wound healing and closure with minimal scarring.
In normal inflammation, polymorphonuclear leukocytes (neutrophils) fill the site of the wound within one hour of the initial wounding. These neutrophils are present in high numbers during the first and second days and produce a bactericidal effect by releasing oxygen free radicals and proteolytic enzymes (proteases). Then, macrophages are activated by T-lymphocytes to phagocytose the neutrophils, thereby, activating fibroblasts, the main indicator of the granulation phase.
In wound healing, oxygen free radicals are both helpful and destructive. When a wound occurs, oxygen free radicals, also called reactive oxygen species (ROS), are created. These ROS molecules are unstable, containing unpaired electrons which are highly reactive, seeking to steal and bond with electrons from other molecules, thus, creating more ROS. This cycle continues, and can, in some cases, end up destroying living cells in and around the wound, slowing the healing time, and in some cases, putting a complete halt to healing. In severe cases, this healing can be delayed to such an extent that the wound becomes susceptible to contamination and infection.
Medical researchers have been working on products to help remove the oxygen free radicals from open wounds for many decades. Wound-Be-Gone, has an active ingredient that removes these radicals by binding them while also forming a hydrophilic barrier over the wound to protect it from the environment, thereby, keeping the wound clean and accelerating healing. The active ingredient in Wound-Be-Gone (sterically hindered amines)that supplies ROS in the wound with the electrons that are missing, completing their molecular structure and stopping the destructive chain of events. This gel also provides a protective layer over the wound, maintains constant moisture and temperature, thereby, permitting the gel to penetrate the open wound and create the perfect conditions for would healing.
In summary, oxygen free radicals are ROS which produce oxidative stress during the inflammatory phase of wound healing. ROS result from the respiratory burst associated with revascularization, reperfusion and restructuring epithelial and connective tissues. ROS likely play several complex roles in wound healing, some are unknown. An example of this is the interactions between ROS and the enzyme ribosomal S6 kinase (RSK), the production of which is stimulated by a small amount of ROS. However, overactivity of RSK from excessive production of ROS has been implicated in poor wound healing because RSK overactivity also inhibits synthesis of the collagen required for wound maturation and closure with minimal scarring. In our experience, the topical administration of a hydrophilic polymer with an oxygen free radical (ROS) binding technology results in rapid healing of wounds that have, prior to the use of Wound-Be-Gone, been characterized by stalled healing. Therefore, the observation of rapid healing of a chronic wound following the administration of Wound-Be-Gone suggests proof that healing of the wound may have been stalled in the inflammatory phase by overactivity of ROS.