A comprehensive review published on September 30, 2020, in Open Biology by The Royal Society synthesizes decades of research to provide a clearer picture of how wounds heal—and why some don’t. Instead of introducing new discoveries, this study connects the dots between existing findings, offering valuable insights for scientists and clinicians working to improve treatments for chronic wounds.
The Four Phases of Wound Healing
Wound repair is a meticulously coordinated process involving multiple cell types and molecular signals. It occurs in four primary stages:
- Haemostasis – When the skin is injured, platelets in the blood quickly form a clot to prevent excessive bleeding and create a temporary matrix for cell migration.
- Inflammation – The immune system sends neutrophils and macrophages to clear bacteria and debris while releasing signals to attract repair cells.
- Proliferation – Keratinocytes migrate across the wound, fibroblasts lay down new tissue, and blood vessels reform through angiogenesis.
- Remodeling – The wound tissue is strengthened as fibroblasts replace temporary structures with mature collagen, forming a scar.
Why Some Wounds Don’t Heal
While most wounds follow this natural progression, factors like ageing and diabetes can disrupt the process, leading to chronic wounds that remain open for more than 12 weeks. The review highlights key contributors to healing failure, including:
- Excessive inflammation: Chronic wounds are stuck in the inflammatory phase, with high levels of immune cells producing damaging molecules that prevent healing.
- Cellular senescence: Aged and diabetic cells lose their ability to divide and regenerate, leading to stalled repair processes.
- Poor re-epithelialization: The cells responsible for closing the wound fail to migrate properly, leaving the wound open.
- Infections and biofilms: Bacterial colonies create protective barriers that resist antibiotics, further delaying healing.
Future Directions: Where Science Is Headed
Rather than offering new treatments, this review points to areas where further research is needed. Scientists are particularly interested in:
- Senolytics: Drugs that target and remove senescent cells to reduce inflammation and promote tissue regeneration.
- Stem cell therapy: Using stem cells to replenish damaged tissue and accelerate repair.
- Bioengineered skin grafts: Lab-grown skin equivalents that mimic natural healing processes.
- Microbiome-targeted therapies: Modulating the wound’s bacterial environment to encourage beneficial microbes while eliminating harmful pathogens.
Why This Review Matters
This paper isn’t just a summary—it’s a roadmap for future research. By synthesizing existing studies, it helps guide scientists toward the most promising directions for improving chronic wound treatment. For clinicians and researchers alike, it provides an invaluable resource, highlighting gaps in knowledge and laying the groundwork for new discoveries in regenerative medicine.
Research Study Source
Wilkinson, H.N., & Hardman, M.J. (September 30, 2020). Wound healing: cellular mechanisms and pathological outcomes. Open Biology, The Royal Society, 200223. https://doi.org/10.1098/rsob.200223
