Approaches to wound management

Abstract

asically, all traumatic or surgical patients have one thing familiar, namely, the presence of a wound. The wound becomes a potential source of considerable morbidity and mortality as a result of subsequent tissue inflammation and infection. A non healed wound becomes quickly colonized with bacteria from the environment eliciting further inflammation and subsequent organ injury. The long term effects of the healing process, namely, contractures and scar formation, can also have an significant impact not only cosmetically but also on function, for example, the pulmonary fibrosis after acute lung injury or intra-abdominal adhesions after peritonitis (Dulmovits and Herman, 2012). New wound care technologies are being developed at an increasingly rapid pace in recent years. These innovations could significantly reduce the overall costs for treating complex and chronic wounds, while offering greater savings in preventing wounds and their recurrence. It is well documented that anaerobic bacteria constitute, one-third of the total number of microbial species in colonized wounds, and this number increases to approximately 50% in infected wounds. Therefore, antimicrobial treatment of clinically infected and/or non-healing polymicrobial wounds should cover a variety of potentially synergistic aerobic or facultative anaerobic microorganisms and should not simply target specific pathogens that are often perceived to be the causative agents (e.g., S. aureus and P. aeruginosa). Clinical studies have demonstrated that a measure of the tissue microbial load in a wound can predict delayed healing or infection (Percival et al., 2010). The quantitative tissue biopsy specimen technique is probably most useful in traumatic or surgical wounds to determine the correct time for wound closure or grafting. Antimicrobial agents (broad-spectrum antibiotics) are primarily used either prophylactically in the treatment of wounds that are likely to be heavily contaminated following surgery or in the treatment of clinically infected wounds. Wounds that are heavily contaminated (chronic or acute traumatic), failing to heal and possibly deteriorating, but have only local or no clinical signs of infection may benefit from topical antibiotic or antiseptic therapy. Surgical debridement of compromised (nonviable) tissue not only exposes the healthy, perfused tissue required to initiate wound healing but also effectively removes the majority of microbial contaminants, thus reducing the risk of infection. Biosurgical debridement,