What should a healthy healing wound look like?

A healing wound is slightly swollen, red or pink and tender with some clear fluid for about 2 to 5 days, then fills in with granulation tissue over about 3 weeks as the edges pull inward and it gets smaller. An open wound bed should be red or pink.

Healing is a sequence rather than a single look, which is more useful than one picture.

First days. The blood clots and dries to form a scab, which protects the tissue underneath from germs. Then your immune system begins protecting the wound: it becomes slightly swollen, red or pink, and tender, and some clear fluid oozes from it, which helps clean the area. That stage takes about 2 to 5 days.

Next few weeks. The body repairs broken blood vessels and new tissue grows over the next 3 weeks or so. The wound starts to fill in with new tissue, called granulation tissue. New skin begins to form over this tissue. As the wound heals, the edges pull inward and the wound gets smaller.

Afterwards. The area may itch. After the scab falls off it may look stretched, red, and shiny. A scar forms that is smaller than the original wound. It will be less strong and less flexible than the surrounding skin. It may fade and can take as long as 2 years to do so.

For an open wound, color is the clearest single marker. After cleaning or debridement, the area will be red or pink and look like fresh meat. Wounds that are pale, purple, or black are less likely to heal.

Two measures go with that, and they are both about direction rather than appearance. The wound getting smaller, which is part of the healing sequence. And for a packed wound, needing less packing: as the wound heals, you should not need as much gauze or packing gauze.

Against all that, the one thing that is not a measure of progress: how a wound looks at a single moment. A wound that looked worse after debridement may be doing better than one that looks tidy under a covering nobody can see through.

And here’s when the sequence is not happening. A wound is called non-healing if it has not started to heal in 2 weeks, or has not completely healed in 6 weeks.

What to watch for

A wound is called non-healing if it has not started to heal in 2 weeks, or has not completely healed in 6 weeks.

Wounds that are pale, purple, or black are less likely to heal. A wound bed should be red or pink.

Contact your provider right away for redness, increased pain, or yellow or green pus, or excessive clear fluid around the injury; black edges around the injury, which are a sign of dead tissue; bleeding that will not stop after 10 minutes of direct pressure; pain that will not go away even after pain medicine; and a wound that has come open.

For a packed wound, needing more gauze rather than less is a change worth reporting.

Wound Wizard is general education and can’t assess your wound. Your own clinician is the right person to ask.

What we look at

  • Examining and measuring the wound
  • Judging the colour and quality of the wound bed
  • Tracking the measurements between visits
  • Determining why it is not healing if it has stalled

Sources

  1. How wounds heal — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000741.htm
  2. Wound care centers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000739.htm
  3. Diabetes - foot ulcers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000077.htm
  4. Wet-to-dry dressing changes — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000315.htm