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Wound management and its history

History of Wound Management and related definitions.
In this presentation, we will talk about what is wound management, and the presenter is Finn Gottrup. Chronic wound, this term has been used for many years. But the terminology is not accepted or defined directly.
We are looking at it is a wound that fails to progress through an orderly and timely sequence of repair. What is the problem on non-healing wounds? There has been no definition during time of that. I made one myself which has been published in ‘99. And that is wound with a delay or no healing, which is a risk for the patient. The quality of life is reduced, but the patient lifetime may not be decreased. Actually, the term non-healing wound is today used by EWMA. The most used terminology for treating wound has been wound management or wound care. Wound management is normally related to that physician is taking care of the wounds.
While the wound care is primarily in focusing on that certified wound nurse or certified wound specialist who takes care of the wounds. This is which type of problem wound on non-healing wounds we actually have. Leg ulcers, pressure ulcers, diabetic foot ulcers, traumatic or surgical wounds, or other type of wounds, and that can be malignant or vasculitis or pyoderma gangrenosa.
Then we are going to say a few words about the history of wound management. Wounds has been known as long as man has been on Earth. We have found in some caves that there is paintings of the wounded men up to 30,000 years before Christ. And since then, the Egyptian actually this has described how to suture a wound. And 500 years before Christ, the Indians actually showed how you can use a type of staples because they are using the jaws of a soldier ant. And after they have put on the jaws here, they took off the body. And then you have actually staples like we have today.
400 years before Christ, Socrates described the use of wine as an antiseptic in wounds. And he also described how to use compression as a treatment for leg ulcers. In the Middle Age, there was made a lot of a different type of drawings of a man who was wounded and how to do with wounds. And as you can see, this is a classical man from 1500 after the Christ. And then in the Middle Age also, we show how you incise an abscess, how to clean the wound by burning, and how to amputate. It has not been very nice to be a wound patient at that age without any anaesthesia.
The modern development related to wound management started actually about 50 years ago by introducing the term moist wound healing. This slide show what we are meaning with dry and moist wound healing area surroundings. If you have a dressing you put on a wound, the inflammation phase will actually produce fluid. And that means that underneath the dressing, there will be a surrounding which is moist. This is opposite to no dressing where there will be a dry eschar. The moist wound healing area started actually with the experiment of Georg D. Winter in 1963, which was published in Nature. He took a very simple model. He took a split skin model, as you can see here.
And then he put on one group, he put on a small dressing, a film. And the other one was without any dressing or dry. And he found out, actually, that if you have the most wound healing surroundings, that the epithelialisation was about two to three times faster than if it’s totally dry. Since then, we have found a lot of different things which has been a benefit of the moist wound healing surroundings. I will not go through with this. You can see them yourself. As you can see from this slide is that modern dressing performance is very important that you have established moist wound healing. So that means that all modern dressings always is establishing this moist wound healing surroundings.
In this slide, you see how exudate is managing during the inflammatory phase. After one or two days, the exudation is very high. And then it go down again to about day four. This slide is used because I can actually relate that to how modern dressing actually is working. Because you actually related to exudation and wound healing phase. As you can see here is the same drawings how exudate is developing. And then you can put in foam dressing, silver dressing, hydrocolloid and thin hydrocolloid. And you can see where they can be used during the healing phase in this case.

In this video Professor Finn Gottrup discusses some terminology related to wound management and shares some of its interesting history.

Did you know?

  1. A clay tablet dating back to 2200 BC is one of the oldest medical manuscripts known to man. It describes washing wounds, making plasters, and bandaging wounds – the three “healing gestures”. Plasters were made from a number of materials – clay or mud, herbs, and plants.

  2. The Egyptians were the first people to use honey in treatment of wounds. They also used it along with grease and lint to make plasters. Lint, made from vegetable fiber, helped remove extra moisture from the wound, and the grease and honey helped in preventing infection. Going another step further, they painted wounds with green paint, to symbolise life. Green paint contains copper, which is toxic to bacteria.

  3. Beer was used in wound care by the Sumerians – they brewed at least 19 different types. An interesting prescription in Mesopotamian culture included these instructions: “Pound together fur-turpentine, pine-turpentine, tamarisk, daisy, flour of inninnu strain; mix in milk and beer in a small copper pan; spread on skin; bind on him, and he shall recover.”

  4. The Greeks were very mindful about cleanliness. They recommended the washing of wounds with boiled water, vinegar, and wine. Hippocrates was known to treat ulcers using wine and then covering them with fig leaves.

In the comments section below, please share any interesting facts about the history of wound management in your country, and don’t forget to have a look at what everyone else has shared as well!

We recommend all practitioners refer to IWII consensus document on identification, management and prevention of wound infection for principles of best practice.
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Antimicrobial Stewardship in Wound Management

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