A healthy wound environment is essential for healing. The type of wound care treatment chosen can have either a positive or a negative effect on this process. Starting with the basics and adding on treatments as needed can make a big difference.

Treatment choices are based on the etiology of the wound, wound environment, and the patient’s underlying medical conditions. We’ll begin with the basics of wound care and then look at additional treatments and adjunct therapies.

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When teaching, I often get the question “What’s my role in the different stages of wound healing?”

To address this common question, I thought a review of basic wound physiology and the clinicians’ role during each of the stages of wound healing (aka phases of wound healing) would be helpful.

We know that the four phases of wound healing are driven by a mixture of chemical stimuli (growth factors and cytokines). Any diminished or excessive levels of these different chemicals can have a negative impact on the wound healing process. The phases are continuous and overlap each other to some extent. However, they must occur in a particular sequence to result in a healed wound.

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Living with necrotic tissue is challenging for patients and requires evidence-based treatments from skilled wound care clinicians to achieve improved patient outcomes. Let’s explore what it is, how to spot it, and where to go from there.

What Is Necrotic Tissue?

First, what is necrotic tissue and necrosis? The term necrosis stems from the Greek work nekros, which means death.

“Necrosis is a loose term, and it can appear in two ways – under a microscope and grossly viewed with the naked eye,” said Brian Gastman, MD, Surgical Director of Melanoma and High-Risk Skin Cancer Program at the Cleveland Clinic in Cleveland and Professor in the Department of Surgery at Case Western Reserve University School of Medicine in Cleveland.

When tissue is necrotic, there is a loss of tissue integrity, he said. “The tissue becomes discolored, there is fluid and exudative material present, and it becomes fodder for bacterial colonization.”

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Let’s say the wound you are working on is not healing. Why is the normal healing process not occurring?

You should approach healing not only by what you see, but also by what you can’t see happening at the cellular and molecular level.

To understand the factors that delay wound healing, you must first understand what normal healing is.

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