Epibole 101: From Causes to Care

When wound edges roll inward and fail to connect, it’s not just an aesthetic concern — it’s a major roadblock to wound healing.

Epibole is an unfortunate part of wound treatment and management. It is when the edges of an open, unhealed wound roll over and thicken. When this happens, the wound-healing process halts, leaving the wound unhealed with no further advancement toward healing.

When treating epibole, it’s essential to know what a healthy wound edge looks like so you can spot signs of trouble early on. Let’s discuss epibole, including causes, prevention, treatment, and complications.

What is epibole?

In many chronic wounds, the clinical condition known as epibole causes a problem with slow or absent epithelial edge advancement. This refers to rolled or curled-under and closed wound edges.

These rolled edges may be dry, callused, or hyperkeratotic (a thickening of the epidermis, the outermost layer of the skin). Epibole edges typically have a raised and rounded appearance, may feel hard and rigid, and may be lighter in color than surrounding tissue.

The process of epibole

Epibole occurs when the upper epidermal cells roll down over the lower ones and migrate down the sides of the wound instead of across.

Edges that roll over ultimately cease to migrate once epithelial cells of the leading edge come in contact with other epithelial cells on the sides of the wound. In other words, the body thinks the wound is healed, and epithelial migration across the top of the wound ceases, leaving the wound open and healing stalled.

Epibole vs. the ideal wound edge

What happens when full-thickness wounds heal effectively? Following the initial hemostasis and inflammatory phases, wounds begin to fill in with granulation tissue.

Wounds typically heal from the bottom of the wound bed and move upward. Granulation tissue forms during the proliferation stage of wound healing and requires a myriad of intricate and complex mechanisms at the cellular level. As the proliferation stage continues, the wound edges contract and pull together.

When a wound moves through the proliferation stage, the ideal edge will have these characteristics:

• Attachment to the wound bed
• Moist with an open, thin, soft rim
• Pale pink tissue

During the final stages of proliferation, epithelial tissue migrates toward the center of the wound. Horizontal movement of new epithelial tissue stops when epithelial cells meet. This is called contact inhibition.

Once this process is complete, the wound is now healed by the formation of scar tissue and by coverage with new epithelial tissue. This newly healed wound will require more time for the new tissue to mature and become stronger.

What causes this condition?

Understanding the underlying factors that contribute to the development of epibole is necessary for effective wound management and prevention. There are several possible reasons why the epidermal margin fails to migrate, including:

• Hypoxia and poor perfusion to the wound
• Infection
• Desiccation (extreme drying out) of the wound bed
• Chronic, prolonged, open wound
• Pressure, friction, or shearing forces
• Poor wound treatment and/or dressing choice

Preventing epibole

To prevent the occurrence of epibole in wounds, you can implement a series of strategic interventions to promote healing and avoid complications. Consider the following tips to help you achieve this:

• Loosely pack dead or empty space in the wound bed. Packing promotes healing from the bottom up and helps prevent abscess formation at the wound depth.
• Fill the depth of the wound to the surface. Do not pack tightly, as this will cause pressure and impair circulation. Loosely place wound fillers, hydrogel impregnated gauze, alginates, or fluffed plain, woven, moistened gauze can be into the space.
• Protect periwound skin with a skin sealant, moisture barrier ointment, barrier wafer, or appropriate secondary dressing.
• Use silicone adhesives and silicone tape to prevent epidermal stripping. Consider tape-free strategies for securing dressings. Educate those providing dressing changes to remove adhesive dressings using the “low-and-slow” approach to prevent skin trauma.
• Protect the wound from pressure, friction, and shearing forces.

Epibole treatment

Treatment for epibole involves reinjuring the wound edges and opening the prematurely closed tissue. This renews the healing process by helping the body identify the wound as an acute wound instead of a closed, healed wound.

Treatment options can include:

• Surgical, sharp debridement using sterile blades or curettes
• Use of topical chemical cauterizing agents, such as silver nitrate, to wound edges
• Scrubbing closed wound edges using monofilament fiber dressings or gauze

Potential complications

Complications of epibole can impact both clinicians and patients, as it significantly impacts the healing process and overall patient well-being. Some of the most common complications from untreated epibole include:

• Delayed healing is the most common complication and can be very frustrating. A stalled wound is time-consuming and expensive. As patients and medical caregivers continue to care for an unresponsive wound, patients may become disheartened.
• Risk of infection due to a chronic, open wound: When a wound remains open and untreated, it becomes a perfect breeding ground for bacteria and other pathogens. This can lead to infections that further complicate the healing process and may require additional medical interventions.
• Significant scarring: When wound edges fail to heal properly and the wound remains open for an extended period, the body may produce excess fibrous tissue. This can lead to pronounced scarring, which can create aesthetic and functional challenges. Scarring can restrict movement, cause discomfort, and may have a negative psychological impact, affecting the patient’s overall quality of life.

Effective wound management can prevent epibole. Education for patients and caregivers is crucial. Allocate sufficient time to ensure patients and caregivers understand how to care for this condition effectively.

Epibole can keep a chronic wound open indefinitely. By facing this challenge head-on with immediate correction, you’ll improve not only wound healing but also the quality of life for your patients.