CURRENT CONCEPTS IN

WOUND CARE
 OUTLINE:
• Moist Wound Healing
• Acute vs. Chronic Wound
• Wound Bed Prep
• Pressure Ulcers
• Leg Ulcers
• Dressing Selection
• Cases
 Moist Wound Healing:
• George Winter 1960’s
Advantages:
-inc.rate reepithelialization
-inc. production collagen
-inc. angiogenesis
-allows autolytic debridement
-Decrease pain
-Dry dressings peel off healing layers
-accelerates healing 50% vs.air dry
Acute vs. Chronic wound
Healing:
 Acute Wound Healing:
• Orderly sequence Repair
• 4 Phases:
Hemostasis,Inflammation,Proliferation,
Maturation.
• Each Phase=Cell Type dominate
• Hemostasis=Plt.,Inflamm.=Neutrophil,
Prolif.=Fibroblast,Maturation
• All regulated by growth
factors,cytokines,&chemokines
 Chronic Wound:
• Stuck in the Inflammatory Phase,defective
remodeling of ECM,fail to reepithelialize.
 CHRONIC WOUND
• Usual Molecular & Cellular processes
disrupted
• Neutrophils dominate: release MMP’s in
excess-digest extracellular matrix
• Leaky capillaries- release excess
Fibronectin binds & inactivates growth
factors
 Chronic Wound:
• Fibroblasts become senescent fail to
respond to normal wound healing signals
• Neutrophils continue to stimulated (by
systemic or local factors) and wound is left
in a viscous circle of inflammation.
• Other Chronic wounds are stuck in the
proliferative phase again due to
unresponsive cells
Wound Bed Prep
 Wound Bed Prep.:
Goal: Convert the Chronic wound into an
Acute wound and allow normal healing to
take place.
 Wound Bed Prep.:
Three Pronged Attack
1. Debridement
2. Decrease Bacterial Burden
3. Manage wound Exudate
 Debridement:
Purpose: 1. To remove “Necrotic Burden”and
restore acute wound healing.
2. To allow proper wound
assessment.
 Surgical Debridement:

Advantages:
• Remove large amounts
necrotic tissue fast.
• Allows bone, tissue cultures
• Leaves healthy vasc. Bed
Disadvantages:
• Painful
• Can remove too much
 Enzymatic Debridement:
Collagenase selectively
digests collagen types
1 & 3 in necrotic
tissue
Advantages: Easy,Not
painful
Disadvantage: Slow
 Decrease Bacterial Load:
• All Chronic wounds sit somewhere along a
bacterial continuum.

Increased Infected
Contaminated Colonized
bacterial burden
 Infection:
Risk = Bacterial x Virulence
Infection Burden Microorganism
Host Resistance
 Infection Concepts:
• Host Resistance : Immunocompromised,
Malnutrition
• Bacterial Burden: >10 5th microbes/g
• Biofilm: Microcolonies of Bacteria secrete
protective glycocalyx
 Manage Wound Exudate:
Chronic Wound Exudate :
Inhibits: Proliferation
Fibroblasts,Keratinocytes,Endothelial cells
Contains MMP’s,Serine Proteases
Fibrinogen &Fibrin bind and inactivate
growth factors
Hospital Wounds:
Pressure Ulcers: