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Battling a Rolled Wound Edge (or Epibole)

Why is it important to evaluate the wound edge?

Evaluation of a wound edge is a key component of wound assessment. A healthy wound edge is attached to the wound bed and allows for epithelial migration across healthy granulation tissue, causing the wound to contract and finally close.

What is an epibole?

The migrating front of epithelial cells is unable to cover the cavity (often because of a hostile wound environment, or other issues) so they descend down and curl under at the edges. These rounded, rolled, wound edges (rolled down towards the wound bed) may indicate wound stagnation or wound chronicity and prevent this epidermal cell migration which results in impaired wound closure. This is also referred to as wound epibole. The rolled wound edge will ultimately cease in migration secondary to contact inhibition once epithelial cells of the leading edge come in contact with other epithelial cells.

What causes an epibole?

Rolled wound edges indicate an underlying condition that needs to be determined and addressed. Failure for the epidermal margin to migrate include many reasons, such as poor perfusion, infection, desiccation, trauma (pressure, friction or shear), and inadequate granulation tissue. Before treatment is initiated, determine the underlying factors impacting the wound edge and develop a plan to address them.

How do you treat an epibole?

When epithelialization has ceased and edges are rolled (epibole), treatment involves restimulating the edges and opening up the closed tissue, to renew the healing process. Debridement quickly and effectively manages a rolled edge, including surgical or mechanical means. Surgical edge revision is effective but not always available in every situation or site of service.

What are some alternatives to surgically removing the rolled edge?

Alternatives to surgical removal of the rolled edge may also include the use of a monofilament fiber and antimicrobial solution for wound edge hygiene, or hydromechanical debridement as an alternative to surgical edge revision. Historically silver nitrate has been used to revise rolled edges as well, but note that is has been found to reduce fibroblast proliferation and necrose healthy granulation tissue.

What is the role of debridement in treating an epibole?

Debridement of the rolled edge in conjunction with appropriate treatment of the wound environment and protection of healthy granulation tissue is necessary so the normal process of epithelialization can resume.

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Susan has 30+ years of clinical experience across the continuum of care. Her experience includes direct patient care in critical care and wound care. She has demonstrated clinical and sales leadership roles with wound management organizations such as Healogics, and industry experience with companies such as HealthPoint. Her broad experience from bedside to innovation and industry has provided a unique perspective that she has shared as a consultant and educator. She has been actively involved with the Wound, Ostomy, Continence Society and has many years of service on the board of directors for the Association for the Advancement of Wound Care, and the American Board of Wound Management of which she also served as President. She is currently vice-chair for the American Board of Wound Management Foundation.

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