Deconstructing the stalled wound.

The stalled wound refers to a wound that has entered a nonhealing or intransigent phase. This can occur as a progression of an acute wound to one of chronicity dictated by events within the wound milieu or following alterations in host immunity. The occurrence may be related by a number of variable factors that collectively or individually can halt the process of orderly healing. A number of biologic events occurring at the wound bed interface, outside the wound (exudate), and related to systemic chronic disease profiles have been identified. This assists clinicians and researchers in developing a systematic approach to managing and reversing this undesired event. First, host factors related to any background chronic disease are checked and controlled. Second, the focus turns to local wound factors adopting accepted principles of wound care to control the wound environment, adding systemic therapies where necessary. If this fails to change the healing milieu, more sophisticated, specialized local wound interventions are introduced. This systematic approach to the stalled wound in individual steps, or collectively, would be expected to re-advance the wound to a normal healing pattern. .