For a wound to heal there must be proliferation of cells to fill the wounded area. In order for cells to proliferate they must undergo mitosis (cell division). During mitosis, cells have to make copies of the DNA inside of the nucleus so that when the cell divides there is an identical cell. ATP is required to make copies of the DNA, and for the process of dividing the DNA into identical cells. Once the cell divides and begin to grow, proteins, lipids, and carbohydrates are required and each requires ATP in order to be assembled.

As cells proliferate to fill the wound, they require proteins to be made and secreted so that the cells can attach to each other. These proteins form what is called the extracellular matrix. In order to produce the extracellular matrix cells must produce these proteins and this requires large amounts of ATP. In wounds that have decreased blood flow, the cells have decreased ATP production, which leads to decreased extracellular matrix production, leading to wounds that do not heal.

Skin cells and other cells that reside within the skin produce trophic factors (growth factors, mitotic factors, cytokines, chemokines) that are responsible for controlling cell proliferation. ATP plays a role in growth factor production, and in addition, ATP acts as a hormone to stimulate cells to produce growth factors. ATP also increases cytokine (substances that control immune responses) and chemokine (substances that attract other cells) levels that help signal to the skin and rest of the body what is occurring in the skin.

When a wound forms cells are broken open releasing ATP. ATP when released by damaged cells binds to receptors on neighboring blood vessel cells. These cells respond by making the diameter of the blood vessel larger, and hence increasing blood flow to the wound. Blood flow is important in wound healing as it brings nutrients (amino acids, lipids, sugars, ions) and oxygen, as well as removing cell by-products like carbon dioxide and urea.