Physiology of the chronic wound.

There is as yet no unified mechanism that explains the pathophysiology of every nonhealing wound. This is largely because many of the basic biological investigations in this area have only been undertaken seriously in the past few years and many phenomena remain unexplained. As new data become available, these theoretical models undoubtedly will continue to evolve. However, a clear understanding of the facts presently available should provide the clinician with a good scientific basis for rational clinical interventions. There is an urgent need to bridge the gap that often exists between laboratory research and clinical practice. A number of wound care practices, which have been shown to be ineffective or harmful, are still widely used. This includes the application of toxic wound cleansing agents, inappropriate use of topical antibiotics, and the practice of wet-to-dry dressings. The past 2 decades have witnessed an unprecedented proliferation of wound care products, few of which have be proven to be consistently superior to simpler and more cost-effective measures. For the foreseeable future, the search for the magic wound 'portions and lotions' probably will continue to revolve around topical growth factor and antiprotease therapy. However, such efforts will only come to fruition when we truly understand the pathophysiologic basis for abnormal wound healing.