Editing Wound healing (section)

== Approach to a chronic/non-healing wound: ==

* Review all potential contributing factors from above
* Check for granulation tissue - most negative factors above will stagnate the wound in the inflammatory phase
* Remember that many rare causes of non-healing wounds can only be diagnosed with biopsy!
* Wagner classification system:
**
* Wound bed preparation:
** Debridement of non-viable tissue
*** Remove callus, eschar, fibrinous material, and slough. None of these have regenerative capacity, and they harbour bacteria, and prevent migration of healthy epithelium.
*** Chemical debridement is possible, mostly using collagenase, and this is most effective at removing a moderate amount of fibrinous slough from the wound base, but is ineffective against thick tissue or eschar
*** There are many methods of debridement, but none have ever been found to be superior to standard surgical debridement
** Identification and correction of bacterial involvement
*** Controversial as to whether wounds that are colonised but not clinically infected should be treated
*** Rutherford's says wounds with poor progress or any evidence of enlargement or infection should have quantitative cultures, and anything growing to >10^5 bacterial counts per cubic mm should be treated with systemic therapy, guided by sensitivities
*** It is advantageous to remove biofilms where possible
** Control of chronic inflammation
** Elimination of limb oedema
** Control of wound exudate