Acute Wound Guidelines for Healing: A Must Read

I am not a big fan of hunting, but as one who grew up in the 1950s with heroes such as Roy Rogers and the Lone Ranger, I certainly learned how to be comfortable and fairly accurate with a rifle. Last week my eldest son asked me to go hunting with him. I assure you that I am not a fan of getting up in the middle of the night to go sit in a deer stand and freeze. I told him I would go, but only in the afternoon. If you know anything about deer hunters, they must get to their deer stands 2 to 3 hours before sunset so the deer will not see them coming. As a dutiful father, I climbed into the stand in the middle of the afternoon waiting for sunset when some poor deer was expected to come by so I could help him commit hunter-assisted suicide. Since I can’t sit for long without doing something, I took a pile of my wound care journals to read. I wonder how many times WOUNDS and Wound Repair and Regeneration have been read in a deer stand!

An article that caught my attention in Wound Repair and Regeneration (2008;16(6):723–748) was “Guidelines to Aid Healing of Acute Wounds by Decreasing Impediments of Healing.” One would wonder: Why do we need guidelines for the treatment of acute wounds? Won’t the wound heal if you remove all the necrotic tissue and close the wound appropriately? Dr. Martin Robson said, “…healing in the acute wound is taken for granted.”¹ As I reflected on my surgical career, I realized that while most surgeons agree with that adage, it is far from the truth. Acute wounds can fail to heal in a timely manner and can even heal abnormally with a hypertrophic scar or keloid. Ramos et al and Zhang et al provide more information on hypertrophic scarring and keloids in this issue of WOUNDS.

The guidelines are divided into 11 sections, and each deals with an impediment to acute wound healing. The impediments reviewed include: inadequate perfusion, nonviable tissue, wound hematoma and seroma, infection or increased bioburden, mechanical factors, systemic immune deficiencies, cancer and its treatment, systemic conditions, burn injuries, external agents, and excessive scar formation. Each section presents levels of evidence regarding the recommendations and the references pertaining to each, making each section easy to read and evaluate.

I would encourage all wound care providers to read these acute wound healing guidelines. Improved care for patients with acute wounds will undoubtedly result if one follows these recommendations.

The numerous authors and editors, headed by Dr. William Lindblad and Dr. Patricia Hebda of the Wound Healing Society, are to be congratulated for this monumental work. These guidelines will be available at www.woundheal.org if you do not have access to the journal. By the way, I was so busy reading that I forgot to look for deer!

Terry Treadwell, MD, FACS
Senior Clinical Editor, Wounds
woundseditor@hmpglobal.com