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Summary
There are major differences in the way acute and chronic wounds heal. An understanding of these differences enables practitioners to plan more appropriate care and management for patients. A simple framework such as wound bed preparation can be used to identify problems and plan realistic and appropriate outcomes of care.
Keywords
Dressings; Tissue viability; Wound bed preparation
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THERE ARE MANY classifications of wounds. These may be based on the depth of tissue injury, for example, grading in pressure ulcers; how wounds heal, for example, by primary or secondary intention; or the underlying pathology, for example, diabetic foot ulcers (Figure 1). A frequently used general description that crosses all of these typologies classifies wounds as either acute or chronic.
Acute wounds include:
* Surgical wounds (Figure 2).
* Traumatic wounds (Figure 3).
* Burns (Figure 4).
Chronic wounds include:
* Pressure ulcers.
* Leg ulcers.
* Diabetic foot ulcers (Figure 1).
* Fungating wounds (Figure 5).
This is, however, not straightforward because there are no accepted definitions of the terms acute and chronic.
Classification as acute or chronic can sometimes be unhelpful (Schultz et al 2004). It is often assumed that the difference between the two relates to the time taken for a wound to heal and therefore acute wounds heal quickly and chronic wounds take much longer to heal. In most cases even extensive surgical or traumatic wounds will heal in a timely and ordered way. Those deemed as chronic, however, seem to take extended periods to heal, for example, the standard definition of a leg ulcer is time-bound: 'a wound below the knee which fails to heal in four weeks' (Cullum et al 1997), and it is not unusual for patients to have chronic wounds for months or even years.
Troxler et al (2006) define chronic wounds as those that fail to heal with 'standard' therapy in an ordered and timely manner. The allocation of wound aetiologies to the time-bound definition, however, reveals only...