Chronic Wounds Are Unique

Chronic wounds have always lived in the shadow of acute wounds. Scientific breakthroughs, therapeutic measures would generally first be developed or envisioned for wounds caused by trauma, scalpel, or other types of acute injury. The whole cascade of wound healing events for which we now have a seemingly endless number of diagrams is really an attempt to explain what happens after acute injury to the skin or, for that matter, to other organ systems. Inevitably, lessons learned about acute injury were extrapolated to the care of chronic wounds, which have often been seen as an aberration of the normal process of tissue repair. There are many examples of how this reliance on acute wounds worked out. For instance, stimulation of reepithelialization by dressings providing moist conditions was first observed experimentally in acute wounds. Later, this lesson was extrapolated to the care of chronic wounds. The acceleration of healing by peptide growth factors was first formally demonstrated in experimental acute wounds in animals. These observations provided proof of principle for the effectiveness of topically applied growth factors, and led to testing and commercialization of these agents in chronic wounds. There are many other examples, but the point is that knowledge accumulated about acute injury has been the anchor on which we have relied for developing a scientific and therapeutic strategy for chronic wounds. However, there are problems with this rather simplistic approach and, as I will explain, "wound bed preparation" is a vehicle for chronic wounds to regain their independence from models of acute injury.

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