ABSTRACT
Wounds heal best when the patient’s underlying medical conditions are optimized. Disorders which commonly impede wound healing include, but are not limited to, diabetes, chronic renal failure, cancer, immune-suppression, malnutrition, smoking history, and peripheral cardiovascular disease. In addition to the basic requirement of controlling these disorders, specifi c wound characteristics can impact adversely in wound healing. Local infection, presence of necrosis, biofi lm, local or regional ischemia, and a chronic wound interface must be managed either topically or surgically. In many instances, surgical debridement facilitates wound bed preparation. The goal of surgical debridement is to mechanically remove barriers to wound healing. The surgeon must determine whether a procedure is indicated and must then design an approach which will control infection, remove necrosis, exteriorize the wound, and refresh the wound surface. In most cases, it is best to preserve collateral tissue and to retain the healing edge of the wound. Once the wound is properly prepared, closure can be affected by application of an advanced therapy device, a skin graft or fl ap. Negative pressure wound therapy and a variety of topical devices are also available to manage the wound bed.
