Acute Wounds vs. Chronic Wounds

Let us analyze how reliance on acute wounds, while helpful, has influenced the management of chronic wounds in ways that are not always realistic. For example, if one starts with the same perspective used for acute wounds, one common error is to view wound bed preparation as the same as wound debridement. In acute wounds, wound debridement is a good way to remove necrotic tissue and bacteria. After that is done, one should have a clean wound that can heal with relative ease. This is not the case for chronic wounds, where much more than debridement needs to be addressed for optimal results. For one, defining the necrotic material in chronic wounds is not so easy. Chronic wounds have what I call "necrotic burden", consisting of both necrotic tissue and exudate. Chronic wounds can be intensely inflammatory, i.e., venous ulcers, and thus produce substantial amounts of exudate that interfere with healing or with the effectiveness of therapeutic products, such as growth factors and bioengineered skin. So, in the context of wound bed preparation, not only do we need to concern ourselves with removal of actual eschars and frankly non-viable tissue, but also with the exudative component.

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