Have you heard or observed any wound, burn, or any injury which happens in the daytime and heals quicker in a daytime than the night time? Where did this thought come from? How does this phrase become a fact and what are the contributing factors? These all questions are answered in this article.
Wound healing means the replacement of destroyed or damaged or injured tissue by new tissue. The wound healing process precisely depends upon 4 stages, they are:
- Hemostasis phase: it is also referred to as blood clotting. It begins within the first few minutes of injury, in which platelets in the blood begin to aggregate to the injured site. Then aggregation of platelets change into an amorphous shape and release chemical signals to promote clotting. This results in the triggered off the fibrin, which forms a mesh-like network and acts as “glue” to bind platelets to each other. This clot serves to prevent further bleeding.
- Inflammatory phase: it is the first-ever response on the injury site, in which damaged and dead cells are removed, along with bacteria and other micro-pathogens or debris. In this phase phagocytosis, are the white blood cells (WBCs) “eat” debris by the process called engulfing. Platelet-derived growth factors are discharged into the wound that causes the migration and distribution of cells during the proliferative phase.
- Proliferation phase: proliferation means rapid growth or an increase in new cells or tissue. In this phase the following 4 steps occur:
- Angiogenesis: endothelial cells form new blood vessels.
- Granulation tissue formation: in which fibroblast grows new extracellular matrix (ECM) by ejecting collagen and fibronectin.
- Epithelialization: it is a process of migrating cells upwards to repair the wounded area.
- Wound contraction: in this step myofibroblast decreases the wound size by gripping the wound edges and the voluntary contracting mechanism occurs that matches like in smooth muscle.
- Maturation phase: it is also named as the remodeling phase, in which collagen is aligned again along with the tension lines, and extra cells that are no longer needed are eliminated by programmed cell death or apoptosis.
The wound heals actively in the daytime! Where did this thought come from?
This thought came from the Medical Research Council”s (MRC) Laboratory of Molecular Biology, Addenbrooke”s Hospital, and the University of Manchester, in the UK, where they focused on the healing of burn victims with a series of experiments and retrospective database study.
November 2017, BBC News published an article that claimed that injuries sustained at day time take just 17 days than the night time injuries which took 28 days on average to heal. And also explains how the inner body clock tick-tick affects wound healing.
Types of study used and their outcomes
Medical Research Council’s (MRC) Laboratory researchers used two types of study:
- Series of experimental study design on mouse skin cells, the live mouse, and also used human skin in laboratory settings to see the changes in biological processes during the 24-hour cycle.
- Database observational study design to see the contributing factors in the human body, in the wound healing process.
Experimental outcomes on skin cells
The surface of skin cells named as keratinocyte were cultured in the laboratory, which showed outcomes like:
- Protein cell production and action vary at different times of the day, with circadian rhythms.
- Changes in Circadian rhythms are also responsible for the protein actin cell movement, but genetically altered cells like actin remove their cellular clock and do not vary with circadian rhythm.
- Fibroblast, the connective tissue is the first responder who moved faster to the injured site and healed more quickly at peak activity time than the least activity time.
Experimental outcomes on mice
The live mice showed outcomes like
- Wounds actively heal in an active period than those mice who are injured in dawn time.
- High collagen deposition at the injury site in mice injured during their active time.
Database observational study outcomes
The time and day when an injury has happened, potential confounding factors, the severity of the wound, and time to treatment, all data are taken from the UK database of a burn injury which showed the following result;
- People who injured around 8 am to 8 pm, showed 95% recovery just after 17 days on average.
- People who injured around 8 pm to 8 am, showed 95% recovery after 28 days on average.
- The period around 8 am to 12 pm gives the quickest wound healing process.
- The injury around midnight to 4 am showed the slowest rate of healing.
This study could potentially have a huge impact on future medical treatments based on the science of circadian rhythm. like surgeons’ operation schedule and medication that can alter the circadian rhythm for healing.
Wound healing biological contributor factors
Let’s see the wound healing contributor factors like a circadian cycle, fibroblast, and cytoskeletal protein. What are they, and how do they work?
The circadian rhythm is the innate timing clock that regulates living creatures (plants, animals, fungi, and cynoblast) naturally. It is also called a sleep-wake cycle or biological clock that repeats after every 24 hours, and these 24 hours rhythm or ticks-ticks are driven by the circadian clock.
The circadian rhythm regulates by sleeping and feeding patterns but is also responsible for other biological processes like body temperature, brain wave activity, hormonal activity, and cell generation. All these processes are highly active in the daytime because it is primarily inspired by the light (sleepy in the night and awake or active in a whole day is the best example of the light-related circadian rhythm.)
A fibroblast is a type of biological cell that provides the structural framework for animal tissues and plays an important role in wound healing. Fibroblasts are one of the types of connective tissue in animals, which has a speckled shaped nucleus and two or more nucleoli. Fibroblasts are an active form of fibrocytes that can be recognized by their abundant rough endoplasmic reticulum.
Fibroblasts play a significant role in an immune response to tissue injury, in which they initiate inflammation in the presence of invading microorganisms and influence chemokine synthesis through the receptors on their surface. Then immune cells respond and launch a cascade of events to clear the invasive microorganisms. Receptors of fibroblasts also regulate the hematopoietic cells to provide a pathway for immune cells to regulate fibroblasts.
According to the research, the Cytoskeleton protein is a vital contributing factor of wound healing at the cellular level and necessary to eukaryotic cell biology, being crucial to cell division, signal transduction, and pathogenesis. Failure to properly repair injuries at the cellular level can result in the death of a part of the body. wound repair is powered by the actin, myosin, and microtubule networks like assembling of a contractile actomyosin to the formation of protrusions from the cells at the leading edge of wounds, and the cell cytoskeleton is needed to precisely organize the dynamic process of wound repair.
Small GTPases from the Rho family are popular regulators of the cytoskeleton and particularly of transient contractile arrays such as observed in cytokinesis.
Factors which can alter the wound healing process
There are some of the pathological, physiological, and physical factors which alter the wound healing process. These include:
- Oxygenation: role of oxygen in wound healing is not completely understood but, according to research adequate oxygen supply to the tissue is significant to the healing process and the avoidance of wound infection.
- Infection: infection can obstruct the path of healing
- Age: aging affects everything in the body that includes the structure and function of the body. Mostly in old age, everything is slow due to decreased immune system and skin gets thinner, reduced vascularity, and weak muscle toon, which highly affect the wound healing process.
- Sex hormones: estrogen insufficiency contributes to cutaneous aging and delayed wound repair or impaired wound healing.
- Diabetes: diabetes is one of the chronic conditions which directly affects the body’s natural abilities.
- Obesity: obesity is one of the major dead leading causes, which can also alter the wound healing process. Because the accumulation of white fats can diminish the vascularity of the skin and decrease oxygen and nutrition suppletion.
- Medications: American Academy of Orthopaedic Surgeons, stated that prescription medication can have adverse effects on wound healing like ibuprofen and aspirin can interfere with the inflammatory process, anticoagulant can obstruct the blood clotting process, and immunosuppressant may impair the immune system which can increase infection risk and delay wound healing.
- Alcoholism: excessive use of alcohol may be detrimental to wound healing and increase the risk of infection.
- Smoking: Smoking causes tissue hypoxia means a low level of oxygen supply in tissues. smoking constricts the blood vessels and diminishes the oxygenation, which causes coughing and puts pressure on the wound, and leads to delayed healing.
- Nutrition: having a good nutrient diet can give you optimal healing. Any type of wound is incapable to heal well if an individual is lacking the essential nutrient for cell repair and growth.
Q. What are the other things which can support wound healing?
Some other things which support wound healing are; rest, having a good nutrient diet, stay active and devoted to the daily routine, don’t smoke, and keep the wound clean and dressed with suitable dressing.
Q. Is there any medicine, ointments that can cure wounds by fooling injury sites and heals the wounds more quickly?
Ointments include Bacitracin and NEOSPORIN® + Pain, Itch, Scar,* which provides 24-hour infection protection and helps heal minor wounds four days faster than average and may help minimize the appearance of scars. But these ointments don’t cure wounds by fooling the injury site, they just keep the wound moisturized and clean from germs.
Before you leave!
This research “wounds heal actively in day-time” explains that wound healing is more efficient during the active phase and could appraise future clinical practice and has clear translational potential. And provide clear evidence as to whether or not human wound healing is determined by the circadian clock. considering maximal healing supported by pharmacological resetting of restricted cellular clocks before an operation, such as through the topical application of chronoactiv drugs
A student of Surgical Technology from Dow University of Health Sciences. She brings her expertise on surgical procedures, knowledge on Human Anatomy and Modern Day Surgeries to help students understand and learn easier ways and help patients understand hospital procedures before their surgeries.