I would like to add that the expended healing surges repersent the original cut, brakes and nicks that are still there but not bothering you that much.It's an issue if you assume that a decrease in hit points of X, followed by an increase in hit points of X, returns the character to the identical cinematic state he was in prior to the two events.
In Doom, your health is expressed as a percentage... and there's a little picture of your face at the bottom of the screen. At 100%, you look fine. At 50%, you show some a bloodied nose. At 20%, there's more blood, and one eye is blackened and swollen. (Numbers are vague and approximate!)
If you pick up a health pack and go from 20% to 50%, some blood disappears, and your eye unblackens and unswells. When you go from 50%, to 20%, to 50% again, your cinematic representation is identical before and after the -30, +30 sequence. If 30% damage meant "More blood, black eye", then 30% healing means "Heal the eye, wipe some blood".
If you treat 4E hit points the same way - "I said that when he lost 6 hit points, that was a shallow slice along his ribs, and when he lost 12 hit points, it was a club to his face that broke his nose" - then healing must reverse the cinematic effects of damage. When you heal him 12 hit points, his nose becomes unbroken. When you heal him another six, the gash along his ribs disappears.
And this is where Quantum Wounding appears.
But if you don't require an increase in hit points to cinematically reverse exactly the effects of the decrease in hit points, Quantum Wounding doesn't occur. If 6 damage can be a slice in the ribs, but then 6 points of healing can represent a reinvigoration of fighting effort? Then after the cycle, you are not returned to an identical cinematic state (you still have a slice in your ribs, but it's not impairing you); thus it's not necessary for you to know the form of the healing before cementing the form of the damage.
It's only when you assume that healing reverses not only the hit point loss, but exactly reverses the cinematic description of the effect of the hit point loss, that Quantum Wounding rears up.
So I don't make that assumption, and it's not a problem.
-Hyp.
Would it help to consider healing surges returning at a rate per day that all returned after a nights rest.