History of wound care
The history of wound care spans from prehistory to modern medicine. As wounds naturally heal by themselves, regardless of whether recovery from the scar or recovery from lost body tissue was a possibility, hunter-gatherers would have noticed several factors and certain herbal remedies would speed up or assist the process, especially if it was grievous. In ancient history, this was followed by the realisation of the necessity of hygiene and the halting of bleeding, where wound dressing techniques and surgery developed. Eventually the germ theory of disease also assisted in improving wound care. Many advances in wound treatment are now available in all forms of Health Care: from wet to dry dressings, Ag Alginate to the more technical Woundvac.
Ancient medical practice
The treatment of acute and chronic wounds is an ancient area of specialization in medical practice, with a long and eventful clinical history that traces its origins to ancient Egypt and Greece. The Ebers Papyrus, circa 1500 BC, details the use of lint, animal grease, and honey as topical treatments for wounds. The lint provided a fibrous base that promoted wound site closure, the animal grease provided a barrier to environmental pathogens, and the honey served as an antibiotic agent. The Egyptians believed that closing a wound preserved the soul and prevented the exposure of the spirit to "infernal beings," as was noted in the Berlin papyrus. The Greeks, who had a similar perspective on the importance of wound closure, were the first to differentiate between acute and chronic wounds, calling them "fresh" and "non-healing", respectively. Galen of Pergamum, a Greek surgeon who served Roman gladiators circa 120–201 A.D., made many contributions to the field of wound care. The most important was the acknowledgment of the importance of maintaining wound-site moisture to ensure successful closure of the wound. There were limited advances that continued throughout the Middle Ages and the Renaissance, but the most profound advances, both technological and clinical, came with the development of microbiology and cellular pathology in the 19th century.
Honey was utilized for its antibacterial properties that helped heal infected wounds. Moreover, honey was used as a topical ointment.
The first advances in wound care in this era began with the work of Ignaz Philipp Semmelweis, a Hungarian obstetrician who discovered how hand washing and cleanliness in general in medical procedures prevents maternal deaths. Semmelweis's work was furthered by an English surgeon, Joseph Lister, who in 1860s began treating his surgical gauze with carbolic acid, known today as phenol, and subsequently dropped his surgical team's mortality rate by 45%. Building on the success of Lister's pretreated surgical gauze, Robert Wood Johnson I, co-founder of Johnson & Johnson, began in the 1870s producing gauze and wound dressings treated with iodine. These innovations in wound-site dressings marked the first major steps forward in the field since the advances of the Egyptians and Greeks centuries earlier. In 1886, Ernst von Bergmann introduced heat sterilization of surgical instruments, which marked the beginning of aseptic surgery and significantly reduced the frequency of infections. In 1898, Paul Leopold Friedrich introduced wound excision and experimentally showed that excision of open wounds substantially reduced the risk of infection. The next advances would arise from the development of polymer synthetics for wound dressings and the "rediscovery" of moist wound-site care protocols in the mid 20th century.
The advent in the 1950s of fibrous synthetics such as nylon, polyethylene, polypropylene, and polyvinyls provided new materials from which researchers and doctors in the field of wound care could explore better protecting of healing wounds and even accelerating the natural wound healing process.
In the 1960s, research and articles by George Winter and Howard Maibach reported on the superior efficacy of moist wound dressings. The adoption of moist wound dressing technique as recommended best wound dressing practice reflected a large advance in approach producing markedly superior clinical outcomes. This dawn of modern wound care treatment initiated a process of improvement in the clinician's ability to bolster wound-site re-epithelialization and healing. The focus on evidence-based best practices and research continues.
In the 1990s, improvements in composite and hybrid polymers expanded the range of materials available for wound dressing. Grafting and biotechnology have produced usable and useful protective covering of actual human skin generated through cloning procedures. These improvements, coupled with the developments in tissue engineering, have given rise to a number of new classes of wound dressings. One of these, "living skin equivalents, " is often cited as a misnomer because they lack key components of whole living skin. "Living skin equivalents" may have the potential to serve as cellular platforms for the release of growth factors essential for proper wound healing.
Other recent developments has been the renewed focus on the prominent patient concern of pain. Burn patients and others affected by severe wounds often report pain as the dominant negative impact of the wounds on their lives. Clinical management of the pain associated with chronic wounds has been an emergent wound treatment priority and is now viewed as an integral part of treatment.
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