A little more than two decades ago, the introduction of hydrocolloids initiated a change in the medical community’s awareness of and treatment approach to problematic wounds. Standard care had, until then, consisted primarily of gauze dressings in combination with sterile saline or water applied to the wound multiple times daily. Although a few polyurethane dressings and topical creams and ointments were already in use, wet-to-dry or wet-to-moist gauze dressings were universally viewed as adequate for wound treatment.

Newer dressings fostered the concept of moist wound healing as introduced by George Winter in 1962. Dressings, devices, and products were developed to address the wound environment and optimize the repair process while decreasing the risk of external contamination. The understanding that appropriate dressing selection could assist the wound in closing more rapidly and with fewer complications stimulated greater interest in the cellular activity within the wound environment.

Just as the 1980s was the decade of new dressings (e.g., hydrocolloids, alginates, foams, hydrogels, hybrid products), the 1990s was the decade of “interactive products.” New technology began to address cellular activity in the wound which resulted in the advent of “smart” dressings and drugs that either directly or indirectly affected the repair process. Further investigations into wound fluid, cellular activity, and biological interactions supported the use of devices and dressings designed to decrease the negative effects of prolonged inflammatory response, high levels and continued presence of matrix metalloproteinases, and decreased cellular activity. Types and levels of cytokines and other chemical mediators were and currently are being studied to determine effects on cell division, angiogenesis, and granulation tissue formation. The end of the decade witnessed the introduction of the first Food and Drug Administration-approved topical growth factor formulation. Dermal and skin substitutes were also introduced and approved for the treatment of diabetic and venous ulcers.

As we progress into the 21st century and begin to slowly unravel the complexities of wound repair, the medical and scientific community is developing a greater understanding of what may be preventing or delaying wound closure. While many dressings and devices may help maintain an optimal wound environment while acting as a protective or interactive covering, true progress will be made by directly manipulating and directing wound bed activity through the use of more advanced drugs, biologics, and genetically engineered products.

This issue of WOUNDS debuts the section Genomic, Cellular, and Recombinant Technologies and serves to highlight and emphasize a small portion of the more advanced technologies that have been developed or are in the developmental process, specifically growth factors, tissue equivalents, and genetically engineered products. During the next decade, clinicians can anticipate revolutionary changes in the approach to treating chronic and problematic wounds. In the not so distant future, we can expect to be able to determine and correct deficiencies in wounds that are not progressing to closure in the expected manner and time sequence. The articles in this section have been selected to provide an introduction for our readers to the current and progressing state of the art of wound healing.