Prevention vs. cure

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“An ounce of prevention is worth a pound of cure.” This is one of the most famously recognized axioms of the astute American philosopher and pragmatist, Benjamin Franklin, first expressed over 2 centuries ago. Yet, how very applicable it is today for a broad range of situations; but quite specifically, it is very well suited to the practice of medicine and, in particular, to the care of chronic wounds. How much better to recognize a patient at risk for the development of this disabling condition and to aggressively intervene before there is tissue breakdown and fulminate ulceration, with all of the associated risks and complications. Yet, what is the most effective and efficient way to exert efforts toward ulcer prevention? Who are the health care providers most able to employ interventions before tissue disruption and ulceration? How well documented is the cost–benefit of preventive measures in the spectrum of treatments for chronic wounds? The prevention guidelines for chronic wounds published in this issue of Wound Repair and Regeneration provide the best documentation currently available for an effective means to recognize patients at risk and to exercise early intervention strategies aimed toward avoiding tissue breakdown and ulcer formation. Such information is vitally important for optimal care of patients, especially in the geriatric and bed-confined populations, for whom the development of a chronic wound is often accompanied by a prolonged and challenging course of treatment. Although not possible in every case, clearly it would be much preferred to avoid this scenario through vigilant efforts toward prevention. Evidence exists documenting the value of such prophylaxis, but there is certainly the need for more such supportive evidence and the even greater need to widely communicate and disseminate this information with the goal of universal implementation. To quote another old axiom, this time from Sir Francis Bacon—“Knowledge is power”; and the knowledge of effective preventive strategies represents a powerful tool for the care and management of patients at risk for developing chronic wounds. To be most effective, this information must reach beyond the wound care specialists to primary care providers, so that they can recognize patients at risk and take appropriate preventive measures as part of the best standards of care. Medical and nursing students and other trainees should receive this information as part of their basic education so that effective preventive measures become incorporated into generalized standard practice. It is incumbent upon the readers of this journal to help share and distribute this knowledge so that the practice of these evidence-based wound prevention guidelines become a standard part of patient evaluation and treatment.