Unravelling the Mysteries of the Wound Healing System Editorial Summary Processes in wound healing are relatively well understood, but clinical practice is complex due to confounding variables. We fundamentally lack a proper definition of the wound healing system. The wound healing system is continually monitoring tissue to detect damage. The system is geared up to detect the key preceding events that disrupt homeostasis. This article discusses the Harm scale in detail.
Introduction
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o far it has been hard to produce data in wound care research. The main reason is that even though the processes in healing tissue are relatively well understood, the clinical practice is complex due to a considerable number of possible confounding variables. This makes practice rather difficult. We all know when a wound should heal, we seldom know when a wound will heal. This invited editorial is an attempt to increase our understanding of the problems; it contains ideas to encourage the exchange of thoughts, it results from many discussions and contains assumptions. It is not a scientific paper, though comments are welcome.
gradations and will develop in time. The second factor is failing to monitor factors which influence the outcome. Patient-related factors such as compliance and general fitness of the patient, influence the course of events in healing tissue to a large extent. The third factor is the population heterogeneity, where specific genetic factors come into play. Fundamentally, we actually lack a proper definition of the wound healing system, which I will aim to address in the next section. There are terms which require some explanation; the Harm scale, a definition of the wound healing system, expanding the current view towards structure, function and regulation and finally a model for mapping out events in damaged tissue. Essential Wound Healing
The confounding factors may be categorized as: • • • • •
Mr Harm Jaap Smit Wound Biologist, Erasmus MC Academy Rotterdam, Netherlands
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Comorbidities Generic fitness issues Wound related problems Underlying pathology Genetic issues
For these the 5 level model may be useful. Keep in mind that in general practice, identifying and resolving the cause of the wound will heal at least 9 out of 10 wounds. The wound healing system is remarkably robust and will, if the source of damage is identified and removed, heal all wounds. The vast number of confounding factors give rise to some of the most obvious data issues. First of all, we have qualitative and quantitative diagnostic issues, where not only may the diagnosis be missing but also the severity of the problem is not monitored. For example, peripheral arterial disease has many
Wound Masterclass - Vol 1 - June 2022
In essence, wound healing is a response to tissue damage.
DAMAGE
RESPONSE
So, we have two events occurring simultaneously, damage and response. I will call the according processes respectively β and α, where the α-processes represent the responsive processes and the β-processes represent the damage causing processes.