Nonsurgical modalities to enhance healing and care of soft tissue wounds.

The rapidly aging population and patients with multiple concomitant pathologies present an increasing population of patients with nonhealing and problem wounds causing an unwelcome challenge for all health care providers. Many of these patients are not surgical candidates, or surgical procedures have failed to close their wounds. These wounds are particularly worrisome when an orthopaedic component is included, since bone and hardware must be covered as quickly as possible to prevent infection and even worse complications. We present a brief overview of several nonsurgical modalities that may be used to heal soft tissue wounds completely or to prepare the wound so a smaller surgical intervention may be done with greater chance for success. We include exogenous application of growth factors, cultured keratinocyte grafts, electrical stimulation, hyperbaric oxygen, and a vacuum-assisted closure system (V.A.C.).