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Key Points

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

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

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

  6. Antibiotics should be used only in the presence of infection; colonization and contamination does not mean there is infection.

  7. Dressing should facilitate the major changes taking place during healing to produce an optimally healed wound and take into consideration the comorbid conditions associated with chronic wounds.

  8. Cellular and tissue-based products are additional measures, and these products might accelerate the rate of healing but will not replace basic wound care.

  9. Chronic wounds have a decrease in oxygen supply to the wound, which contributes to delayed healing; oxygen therapy might aid in the healing of certain types of wounds.

  10. Biofilm is the term used for the bacterial growth on a chronic wound that is encapsulated by a protective layer made up of the host and bacterial proteins; this layer makes it difficult to heal chronic wounds and control infection.


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 following 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 ...

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