Débridement. The key initial first step in wound healing.

Before addressing a wound, whether it is chronic or acute, clinicians must thoroughly assess the wound and the patient. An acute wound in a patient with normal blood flow and good medical and nutritional condition should go on to heal if appropriate care is given. This means that the wound has to be débrided adequately, dressed, and closed when appropriate. Getting back to healthy tissue is the key. In chronic wounds, healing is more difficult because the etiology of the wound is harder to determine, and the measures to reverse the medical abnormalities are often complex. When these have been sorted out and addressed, however, débridement again plays the key role. It converts the chronic wound into an acute wound so that it can then progress through the normal stages of healing. The key is for clinicians to be aggressive and not let concerns about the residual defect limit débridement. Subsequent healing then can be achieved by use of wound-healing adjuncts such as the V.A.C. device, hyperbaric oxygen, skin substitutes, growth factor, or plastic surgical techniques.