How a wound heals — and what scar it leaves — is significantly influenced by how it is managed from the moment of injury through to scar maturation. Modern wound care has moved a long way from “leave it to dry out” — the evidence clearly favours moist healing environments, appropriate dressings, and specific scar-reduction interventions.
The Phases of Wound Healing
Haemostasis (0–several hours): vasoconstriction, platelet aggregation and fibrin clot formation stop bleeding. Inflammation (days 1–4): vasodilation, neutrophils and macrophages clear bacteria and debris. The wound appears red, warm and swollen — normal and necessary. Proliferation (days 4–21): fibroblasts produce collagen; new blood vessels grow (angiogenesis); epithelial cells migrate across the wound surface. The wound becomes pink, slightly raised and may itch. Remodelling (3 weeks – 2 years): collagen fibres reorganise, the scar flattens and lightens. Final scar appearance is not reached until 12–24 months post-injury.
Moist Wound Healing: The Most Important Principle
The most significant advance in wound care in the past 50 years is understanding that wounds heal faster, with less pain and better scar outcomes in a moist environment. Dry wounds form a scab (eschar) — a hard crust that epithelial cells must burrow around to re-cover the wound. Moist wounds allow epithelial cells to migrate directly across the wound surface. The result: healing approximately 50% faster, less scarring, less pain. Dressing choices: hydrocolloid dressings (Compeed, Granuflex, Duoderm) maintain ideal moisture for shallow to moderate wounds. Non-adherent dressings (Mepore, Melolin) prevent the dressing from sticking to new tissue. Foam dressings for wounds with significant exudate. Leave hydrocolloid dressings in place until fully saturated or lifting — changing unnecessarily disrupts new tissue.
Optimising Healing Through Nutrition
Wound healing is an energetically and nutritionally demanding process. Protein — collagen is a structural protein; adequate protein intake (1.2–1.5g/kg/day) is essential for wound repair. Vitamin C — a cofactor for the enzymes that cross-link collagen. Deficiency directly impairs healing and is the cause of scurvy’s characteristic wound-healing failure. Zinc — required for epithelial cell migration and immune function. Deficiency significantly impairs healing. Vitamin A — promotes epithelial cell division and inflammatory response. After significant injury or surgery, considering a brief supplementation course is clinically reasonable.
Scar Management: What Actually Works
Silicone gel and sheets (Kelo-Cote, Mepiform, Scar Away): the most evidence-based OTC scar treatment. Multiple RCTs confirm that topical silicone reduces scar height, redness, pain and itching in hypertrophic and keloid scars. Mechanism: the occlusive effect improves hydration of the stratum corneum, which reduces fibroblast and collagen over-activity. Must be used consistently for 2–3 months minimum (ideally 6 months) on fully closed wounds only. SPF over scars: new scar tissue is hypersensitive to UV and will permanently hyperpigment with sun exposure. SPF 50 over any scar for the first 12 months post-injury. Massage: gentle scar massage (2 minutes, twice daily, once fully healed and closed) improves scar softness and reduces fibrosis — helps break down excessive collagen cross-linking.
Frequently Asked Questions About Wound Healing and Scars
Should I let a wound air to help it heal?
No — this is one of the most persistent and damaging wound care myths. Exposing wounds to air causes scab formation that impairs epithelial migration and increases scarring. Keep wounds covered with an appropriate moist dressing until fully re-epithelialised. The wound “needs to breathe” claim has no scientific basis.
Does Vitamin E oil help scars?
Despite widespread use, multiple RCTs have failed to show benefit of Vitamin E oil over petroleum jelly alone for scar outcomes. Approximately 30% of people develop contact dermatitis to topical Vitamin E. Silicone gel has considerably stronger evidence and should be preferred for hypertrophic scar management.
What is a keloid scar and how does it differ from a hypertrophic scar?
Hypertrophic scars are raised, firm and red but remain within the original wound boundaries. They often improve over 12–18 months with silicone. Keloid scars extend beyond the original wound margins, are firm, raised, often pink or purple, and may continue growing for months to years. More common in people with darker skin tones and in specific body areas (earlobes, sternum). Keloids require medical treatment — intralesional steroid injection (first-line), cryotherapy, laser, or surgical excision (combined with steroids to prevent recurrence).
When should a wound be seen by a doctor?
Seek medical assessment for: wounds that don’t stop bleeding after 15 minutes of firm pressure, gaping wounds needing closure, bite wounds (very high infection risk), deep puncture wounds, any wound showing infection (increasing redness/swelling/warmth after day 2, pus, fever), wounds involving tendons or joints, and facial wounds (cosmetic closure matters). Don’t attempt to close gaping wounds with DIY sticking plaster — a hospital or urgent care closure by a professional produces far better cosmetic and functional results.
Browse wound care products and antiseptics at Huncoat Pharmacy. Related: First Aid Guide, Wound Care.
At Huncoat Pharmacy: Browse wound care & scar products.