Chapter 9

1. Wound healing is a complex cellular and biochemical cascade that leads to restitution of integrity and function.

2. Although individual tissues may have unique healing characteristics, all tissues heal by similar mechanisms, and the process undergoes phases of inflammation, cellular migration, proliferation, matrix deposition, and remodeling.

3. Factors that impede normal healing include local, systemic, and technical conditions that the surgeon must take into account.

4. Optimal outcome of acute wounds relies on complete evaluation of the patient and of the wound, and application of best practices and techniques.

5. Clinically, excess healing can be as significant a problem as impaired healing; genetic, technical, and local factors play a major role.

6. Future advances in growth factor understanding, tissue engineering, and dressing design are expected to increase the armamentarium in improving wound outcomes.

The earliest accounts of wound healing date back to about 2000 b.c., when the Sumerians employed two modes of treatment: a spiritual method consisting of incantations and a physical method of applying poultice-like materials to the wound. The Egyptians were the first to differentiate between infected and diseased wounds compared to noninfected wounds. The 1650 b.c. Edwin Smith Surgical Papyrus, a copy of a much older document, describes at least 48 different types of wounds. A later document (Ebers Papyrus, 1550 b.c.) relates the use of concoctions containing honey (antibacterial properties), lint (absorbent properties), and grease (barrier) for treating wounds. These same properties are still considered essential in contemporary daily wound management.

The Greeks, equipped with the knowledge bequeathed by the Egyptians, went even further and classified wounds as acute or chronic in nature. Galen of Pergamum (120–201 a.d.), appointed as the doctor to the Roman gladiators, had an enormous number of wounds to deal with after gladiatorial combats. He emphasized the importance of maintaining a moist environment to ensure adequate healing. It took almost 19 centuries for this important concept to be proven scientifically, when it was shown that the epithelialization rate increases by 50% in a moist wound environment when compared to a dry wound environment.1

The next major stride in the history of wound healing was the discovery of antiseptics and their importance in reducing wound infections. Ignaz Philipp Semmelweis, a Hungarian obstetrician (1818–1865), noted that the incidence of puerperal fever was much lower if medical students, after cadaver-dissection class and before attending childbirth, washed their hands with soap and hypochlorite. Louis Pasteur (1822–1895) was instrumental in dispelling the theory of spontaneous generation of germs and proving that germs were always introduced into the wound from the environment. Joseph Lister probably made one of the most significant contributions to wound healing. On a visit to Glasgow, Scotland, Lister noted that some areas of the city’s sewer system were less murky than the rest. He discovered ...

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