JCMS Header

Contents, JCMS, Vol. 3(1), Supplement

Wound Healing and Chronic Wounds
Vincent Falanga

Management of Venous Ulcers
Ysabel M. Bello and Tania J. Phillips

Management of Diabetic Foot Ulcers
O. Fred Miller, III

Tissue Engineering
Michael V. Sefton and Kimberly A. Woodhouse

ApligrafTM Living Skin Equivalent for Healing Venous and Chronic Wounds
R. Gary Sibbald

Dermagraft in the Treatment of Diabetic Foot Ulcers
C. Keith Bowering


Rosacea—A Condition That Needs Special Care

There is a new excitement these days in the way we view and treat chronic wounds. In the past, the management of chronic wounds was viewed as nonrewarding. It was thought that ulcers either healed by themselves or did not heal and that there was little one could do to alter the situation. Treatment was based largely on traditional therapies with only marginal links to science or, at best, on simple anecdotal experience. There were myths about wound healing and wounds. The myth that wounds heal better if left dry was hard to overcome and still has a surprisingly large following. The myth that wounds should be debrided with wet to dry dressings was another obstacle to proper and thoughtful wound care. The breakthroughs in science and in our understanding of the wound healing process were many, but their translation to useful treatment modalities was slow. There was also little realization of the social, financial, and psychological impact of chronic wounds. Clinicians often underestimated the adverse effect of wounds on patients' quality of life, and even their pain and suffering.
     Enter the last 10 years. Moist wound healing is increasingly accepted as standard treatment, and there are about 200 types of biosynthetic wound dressings. We have much better ways of debriding wounds and of achieving leg compression and edema removal. Laboratory observations and advances are leading to technological breakthroughs more quickly and efficiently. Doctors and nurses have become more interested in wound healing in general and, particularly, in chronic wounds. Increasingly, wound management is based on evidence and clinical trials. In the last 2 years alone, we have seen regulatory approval for a topically applied growth factor and for bioengineered skin.
     In this issue dedicated to chronic wounds, we present a small but significant view of what is happening today with venous and diabetic ulcers. These are two important types of chronic wounds that are associated with considerable consequences for patients and for the health care system. We discuss the advances in our understanding of their pathogenesis, in diagnosis and evaluation, in better dressings and compression bandages, and in overall management. The use of bioengineered skin is discussed at some length because it is a new and exciting therapy that may result in fundamental changes in the way we manage chronic wounds. Ultimately, we hope that readers will take away with them some of the excitement we have about these new therapies and for the field in general. No longer is management of chronic wounds nonrewarding.

Vincent Falanga
Guest Editor
Boston University

JCMS Homepage