Dear Readers,

Over the last 15 years as Editor of WOUNDS, I have used the December letter to report highlights of the Journal over the preceding year. This year I would like to recount much of the progress in wound healing that has occurred during the existence of WOUNDS since 1989. These years have been marked by significant advances and changes in the understanding of wound healing, improved treatment modalities and procedures, and focus by clinicians and researchers. It has been an exciting time for all of us in wound care, and I feel privileged to have witnessed such progress in my chosen field. Fifteen years as an editor is certainly long enough, and perhaps, too long for any individual to remain. This will be my last letter to the Readership, as I am stepping down from this position at the end of this month. As a long-term participant in the field of wound healing, I would like to reminisce over many of the changes that have occurred during my time with WOUNDS.

Although the research leading to the concept of moist wound healing was first published in the early 1960s, it is only now that it has been broadly recognized as the appropriate approach for many clinical situations. The early belief that moist conditions would lead to an increased incidence of infection has been shown to be incorrect by work first published in WOUNDS. From the first film dressings, we now have many new treatment products available for providing moist wound healing.

With the increased aging population, there has been great interest in better treatments for chronic wounds, such as venous, diabetic, and pressure ulcers. Focus has been on the poorly healing or nonhealing ulcer. The nursing profession, especially ET nurses, were responsible for much early progress and have helped educate us on possible new approaches. Many other clinical and research specialists are now devoting efforts to the problems of chronic wounds.

Ever since epidermal growth factor (EGF) was characterized by Stanley Cohen in 1960, researchers have studied this and other growth factors for treating wounds. In 1997, platelet derived growth factor (PDGF) received FDA approval for treatment of diabetic foot ulcers. Today, work progresses on epidermal growth factor (EGF), fibroblast growth factor (FGF), keratinocyte growth factor (KGF), transforming growth factor beta (TGF-ß), vascular endothelial growth factor (VEGF), and others.

Cultured human epithelial cell sheets became available for treating burn wounds in 1988. In 1998, the first living skin substitute product was approved for use in treating chronic wounds and is now indicated for venous and diabetic ulcers. The mechanism of action for this class of products is thought to be the delivery of an array of growth factors that they produce.

From biochemistry and cell biology we have begun to understand gene function in healing and have a greater appreciation of the roles of growth factors, proteinases, extracellular matrix components, cell adhesion molecules, protease inhibitors, and inorganic molecules.

Recognizing the needs for treating the growing number of patients suffering from chronic wounds, stand-alone and hospital-affiliated wound care centers have been established. They have been successful throughout the US in bringing expert, multidisciplinary approaches to wound treatment.
Recognition of differences between acute and chronic wounds has led to a still evolving assessment of infection in chronic ulcers. Wound microbiology is addressing the concepts and importance of bacterial contamination, colonization, and “critical colonization” in the chronic wound. There is also attention to the challenges of treating sessile bacteria (biofilms) in the wound.

In the chronic wound it is recognized that there are barriers to healing. The concept of wound bed preparation has developed and is evolving to remove these barriers. Examples known to be important include the management of bacterial levels, controlling edema and exudation, removal of necrotic tissue, and management of the biological microenvironment. Simply put, good wound care is important to maximizing the potential to heal—it is also required for success with the more advanced products, such as PDGF and skin substitutes.

Over the last few years there has been a renaissance of interest in the use of antiseptics. Many of these agents were in disfavor because of toxicity shown in vitro. However, in vivo, many of these appear safe and effective. There are many silver dressings available which exploit the antibacterial properties of Ag+. This material is effective at very low concentrations (parts per billion) and has broad spectrum antibacterial activity. Bacterial resistance has been known to occur, however, it does not yet seem to be a problem with the use of these products. Examples of other agents include polyhexamethylenebiguanide (PHMB) and iodinated compounds (both are delivered by commercially available dressings).

One of the most important efforts we see in wound healing today relates to “evidenced-based approaches.” The conduct of randomized controlled trials (RCTs) documenting safety and efficacy of wound healing agents and devices presents a challenge, but will be increasingly of value in selecting the best procedures and treatments. To date, most of the large RCTs in wound healing have been mandated by regulatory requirements, namely, for drugs and class III devices.

Palliative wound care is a treatment approach to improve the quality of life for both the dying patient and their families. While it was first viewed as controversial, there is general consensus on the importance, value, and need for palliative care.

My listing of changes and advances over the last several years is impressive, but it probably represents an incomplete list.

WOUNDS has also evolved over its existence. We currently have a circulation to more than 15,000 readers. Almost 50% of the readership are surgeons—the remainder include podiatrists, dermatologists, internal medicine/family practice, geriatric medicine, researchers, infectious disease, RN/PA, and industry scientists. In addition to publications from US institutions, WOUNDS receive a large number of international manuscripts. Since our inception, WOUNDS has published 6 issues per year, expanded to 9 issues, and then to the first full year of monthly publication that started in 2003.

In leaving, I am especially pleased to relinquish the editorship of WOUNDS to Dr. Terry Treadwell. His background, experience, and dedication to our field make him an excellent choice and resource for the Journal. Dr. Treadwell becomes the new Editor of WOUNDS beginning January 2007. He has served on the Editorial Advisory Board since 2002. In 1998, he founded the Institute for Advanced Wound Care and serves as its Medical Director. He is also the Medical Director for Wound Care Services at Baptist Medical Center South in Montgomery, Alabama.

I appreciate the support received from the HMP staff, the editorial board members, and our readership over the years. You have all made my work a pleasure.

David T. Rovee, PhD
Editor (1992–2006)
WOUNDS