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Clinical Approach to Wounds: Débridement and Wound Bed Preparation Including the Use of Dressings and Wound-Healing Adjuvants

Attinger, Christopher E. M.D.; Janis, Jeffrey E. M.D.; Steinberg, John D.P.M.; Schwartz, Jaime M.D.; Al-Attar, Ali M.D.; Couch, Kara M.S., C.R.N.P., C.W.S.

Plastic & Reconstructive Surgery: June 2006 - Volume 117 - Issue 7S - pp 72S-109S
doi: 10.1097/01.prs.0000225470.42514.8f
Reconstructive Wound-Healing Supplement: Original Articles: Reconstructive

Summary: This is a clinical review of current techniques in wound bed preparation found to be effective in assisting the wound-healing process. The process begins with the identification of a correct diagnosis of the wound’s etiology and continues with optimizing the patient’s medical condition, including blood flow to the wound site. Débridement as the basis of most wound-healing strategies is then emphasized. Various débridement techniques, including surgery, topical agents, and biosurgery, are thoroughly discussed and illustrated. Wound dressings, including the use of negative pressure wound therapy, are then reviewed. To properly determine the timing of advance therapeutic intervention, the wound-healing progress needs to be monitored carefully with weekly measurements. A reduction in wound area of 10 to 15 percent per week represents normal healing and does not mandate a change in the current wound-healing strategy. However, if this level of wound area reduction is not met consistently on a weekly basis, then alternative healing interventions should be considered. There is a growing body of evidence that can provide guidance on the appropriate use of such adjuvants in the problem wound. Several adjuvants are discussed, including growth factor, bioengineered tissues, and hyperbaric medicine.

Washington, D.C.; and Dallas, Texas

From the Georgetown Limb Center, Georgetown University Medical Center, and the Department of Plastic Surgery, University of Texas.

Received for publication November 28, 2005; revised April 4, 2006.

Christopher Attinger, M.D., The Georgetown Limb Center, One Main, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, D.C. 20007, cattinger@aol.com

©2006American Society of Plastic Surgeons