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Journal of the American Academy of Dermatology

Journal of the American Academy of Dermatology.

Chronic wounds are a major medical problem in the United States each year. The American Society of Dermatology emphasizes the practical significance of skin wound care. All physicians understand the essential elements of diagnosis and treatment. We highlight the main aspects of the diagnosis and propose a simple classification of guidelines for the use of wound dressings and relative cost data.

Study purpose.

Upon completion of this learning activity, participants should be able to diagnose common types of chronic wounds, develop treatment plans, and describe the major categories of local treatment and dressings for chronic wounds.


Ankle, ankle brachial index; carboxymethyl cellulose, carboxymethyl cellulose, ESR, CRP; C- reactive protein; erythrocyte sedimentation rate; MRI, magnetic resonance imaging; MRSA methicillin resistant Staphylococcus aureus; PG, pyoderma gangrenosum; cells, recombinant human platelet-derived growth factor; brain injury and toe brachial index; TNP, partial negative pressure; vacuum, vacuum assisted closure; vascular endothelial growth factor, vascular endothelial growth factor; vancomycin resistant Enterococcus, VRE

Chronic wounds are defined as long (6 weeks) or recurrent skin lesions. 1 and 2 in today's society, chronic wounds are a major medical burden. Approximately 1% to 2% of people suffer from leg ulcers during their lifetime, and this figure may increase the age of the population. 3, 4 and 5 related costs are staggering. A recent article shows that the cost of treating a single ulcer is close to $3 billion, accounting for a large proportion of the total budget for health care, with a total of $13 to $6 a year for global trauma care Numerous factors can delay wound healing. Chronic disease, vascular insufficiency, diabetes, neurological defects, nutritional deficiencies, advanced age, and local factors such as stress, infection, and edema are associated with impaired healing.

Physiological wound healing

Normal wound healing requires proper circulation, nutrition, immune status, and avoidance of negative mechanical forces. This process usually takes 3 to 14 days to complete, there are three stages: inflammation, proliferation and remodeling of wound contraction8, 9 and 10 (Figure 1). During the inflammatory phase, neutrophils and macrophages appear in the injured area, engulfing bacteria and debris. At this stage of wound healing, a functional immune system and adequate supply of growth factors are needed. In the proliferative phase, fibroblasts produce collagen matrix, new blood vessels invade the formation of granulation tissue, epidermal cells in the wound surface migration, to close the gap. Protein and vitamin deficiency can affect the production of collagen, and in the wound necrotic tissue will hinder the re epithelialization.