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The practice of wound healing dates back many millennia, with the earliest accounts from the Sumerians in 2000 B.C. Their practice consisted of both a spiritual component with incantations and a physical component with application of a poultice-like material to the wound. The Egyptians can be credited with differentiating infected and diseased wounds from noninfected wounds. In the Edwin Smith Surgical Papyrus, a copy of a document dated to 1650 B.C., there are descriptions of over 48 types of wounds. The Ebers Papyrus (1550 B.C.) describes concoctions containing honey for antibacterial purposes, lint for absorbance of moisture, and grease to provide a barrier in the treatment of wounds. The Egyptians recognized properties within these substances that are still fundamental in modern wound management. Building on this knowledge, the Greeks classified wounds as acute or chronic. Galen of Pergamum (120–201 A.D.), who was appointed as physician to the Roman gladiators, was one of most famous Greek physicians who emphasized the importance of maintaining moisture within the wound environment to ensure adequate healing.

A turning point in the history of wound healing was the discovery of antiseptics and their significance in reducing puerperal sepsis by washing hands with soap and hypochlorite by the Hungarian obstetrician Ignaz Philipp Semmelweis (1818–1895), the discovery of existence of microbes in the environment by Louis Pasteur (1822–1895), and the discovery by Joseph Lister (1827–1912) during a visit to Scotland that carbolic acid (phenol) in sewage reduces bacteria. Soaking surgical instruments in phenol and spraying it in the operating rooms resulted in reduction of postoperative mortality rates from 50% to 15%. After attending a lecture by Lister in 1872, Robert Wood Johnson began research and eventually went on to produce an antiseptic dressing in the form of cotton gauze impregnated with iodoform. Since this invention, multiple other materials have been utilized to achieve antiseptic dressing materials.1,2


The complex process of wound healing begins with an injury or wound. The normal process of wound healing can be divided into phases defined by cellular populations and biochemical events: hemostasis and inflammation, proliferation, and maturation and remodeling. This sequence of events spans the time from injury to resolution of acute wounds. It is necessary for all wounds to progress through this series of cellular and biochemical events that characterize the phases of healing in order to successfully reestablish tissue integrity (Figure 5-1 A and B).


Phases of wound healing. A. Different phases of wound healing. B. The phases of wound healing and key cells and events involved. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019.)

There are multiple factors, however, that can interfere with these phases and can lead ...

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