The 4 Stages of Wound Healing: A Clinical Timeline Guide
What are the 4 stages of wound healing?
The Quick Answer
The four sequential stages are: **1) Hemostasis** (immediate clotting), **2) Inflammation** (days 1–4: immune cell cleanup), **3) Proliferation** (days 4–21: granulation, contraction, epithelialization), and **4) Remodeling** (weeks to months: collagen maturation). Slough indicates pathological prolongation of stage 2, preventing transition to proliferation without intervention.
Why We Ask This
Patients expect linear, uninterrupted progression through stages, not realizing chronic wounds become 'stuck' in inflammation due to factors like biofilm or ischemia—requiring targeted interventions to restart the cascade.
The Practical Science
Each stage has molecular hallmarks: hemostasis (platelet aggregation), inflammation (neutrophil/macrophage influx), proliferation (fibroblast collagen deposition), remodeling (collagen cross-linking). Slough forms when macrophage dysfunction prevents transition to proliferation.
In Clinical Practice
A healing surgical incision shows scab formation (hemostasis) by hour 6, redness/swelling (inflammation) days 1–3, pink granulation (proliferation) days 5–10, and scar maturation (remodeling) over months—while a slough-covered pressure injury remains visibly 'stuck' in inflammation beyond day 7.
References & Context
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