Deconstructing the chronic wound

Abstract

Chronic wounds have traditionally been defined as those that fail to progress through an orderly and timely sequence of repair, such that healing does not take place in a predictable time frame. More objective definitions of chronic wounds are �those that have failed to heal within three months�; �a wound that has not decreased by 30% of its size within four weeks�; �if a wound is not 30% smaller by week four, it will not heal by week twelve�; and so on. The crux of the matter is that these wounds reach an impasse in their healing progression which is not easily explained and has remained a mystery for decades. On �deconstructing� the chronic wound phenomenon in recent years, two factors appear to play an increasingly important role in the evolution of chronicity � exaggerated inflammation and allied to that, infection, particularly involving biofilm.