Wound healing
The science of wound healing occupies a central role in surgical history and continues to represent a common theme for all surgical subspecialties. As early as 1550 B. C., the Ebers Papyrus of ancient Egypt documents the use of a multitude of natural reme
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University of Washington, Department of Surgery, USA University of Washington, Regional Burn Center, USA
History of wound care The science of wound healing occupies a central role in surgical history and continues to represent a common theme for all surgical subspecialties. As early as 1550 B. C., the Ebers Papyrus of ancient Egypt documents the use of a multitude of natural remedies in wound healing. The Egyptians observed that honey, now known to have hygroscopic and antibacterial properties, proved an effective wound dressing. Mild antiseptics such as frankincense, date-wine, turpentine, and acacia gum also found a place in the Egyptian pharmacopeia. The Egyptians are also credited with the first use of sutures for primary wound closure. In a strikingly early use of 20th century medicine, there is documentation of the application of sour or moldy bread to wounds, now understood to harbor antibiotic-producing fungus [1]. Galen of Pergamon, the celebrated surgeon and anatomist, undoubtedly derived a wealth of wound care experience from serving as a surgeon to the Roman gladiators. It was he who first emphasized the importance of maintaining a moist environment for wound healing, although not until recent times has it been understood that wound epithelialization is greatly enhanced in sufficiently hydrated wound beds [2]. The next major breakthroughs in wound care arrived almost two millennia later with the development of the germ theory of disease. Ignaz Phillip
Semmelweis, a Hungarian obstetrician, noted that the incidence of puerperal infections was significantly lower when medical students on the ward washed their hands with soap and hypochlorite after attending cadaver dissection. Louis Pasteur stands among the first to apply the microbial theory of disease to healthcare applications. In addition to relating natural phenomena such as the souring of milk the fermentation of sugar to microorganisms, he developed a heat treatment (pasteurization) of milk that prevented the transmission of tuberculosis or typhoid. Robert Koch remains another giant of the era, having formulated a generalized set of criteria for microbial infections, now known as Koch’s postulates [3]. Finally, the English surgeon Joseph Lister is widely credited as the father of antiseptic surgery. Lister’s use of carbolic acid for surgical sterilization is said to derive from his observation that sewage treated with the chemical was less murky than without. He began treating surgical instruments and instituted hand-washing protocols with carbolic acid, which initially led to his suspension from practice, but eventually paved the way for institution of sterile technique in surgery [3].
Types of wounds The nature of the wound and the manner in which it may heal are fundamentally linked to the mech-
325 Marc G. Jeschke et al. (eds.), Handbook of Burns © Springer-Verlag/Wien 2012
D. A. Brown, N. S. Gibran
anism of insult. Injuries by physical agents may be broadly classified into four groups: mechanical trauma, thermal injury, chemical injury,
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