This physiological wound healing cascade, which always wound healing impossible from the outset.
requires the cells involved in repair to appear in the
chronologically correct order, only occurs spontaneously The pathophysiological situation existing in venous leg
when certain basic requirements are fulfilled: ulcer, however, also indicates the kind of measures that
▪ The cell metabolism must be assured by an supply of need to be taken to achieve ulcer healing:
adequate blood and oxygen. ▪ As a causal measure, the hemodynamics in the leg vein
▪ A physiologically balanced, moist wound environment system and the microcirculation in the wound area are
with an adequate pH must be present in the wound to to be improved by the methods already described, such
promote the cellular activities. as compression therapy and, if necessary, invasive
▪ All inhibiting factors together, such as microbial colo- procedures such as surgery and / or sclerotherapy.
nization and toxic degradation products of bacteria and ▪ Locally, the chronic wound is to be transformed as far
tissue, must not exceed the autolytic capabilities of the as possible into the state of an acute wound by means
wound. of adequate treatment. This offers the opportunity for
the processes necessary for healing to be re-initiated in
If these conditions are not present due to the influence of the physiologically correct cellular and temporal
various deleterious factors (inadequate blood supply with sequence and to proceed in a regular manner.
tissue hypoxia, drying out of the wound floor, wound
infections etc.), more or less pronounced disorders of Which activities have proved beneficial in which phases
wound healing and, without timely intervention, a chron- of wound healing is described below. Moist wound treat-
ic wound will develop: Cells die, necrotic tissue forms to ment has proved particularly successful; its principles will
an extent that can no longer be compensated by endoge- therefore now be explained.
nous cleansing mechanisms. At the same time, toxic
degradation products of bacteria and tissue infiltrate the Moist wound treatment
peri-wound area, giving rise to further tissue necrosis and “A dry wound is a dead wound”. Based on this recogni-
maintaining the chronicity of the wound. tion, the principle of moist wound healing has become
the established approach to the management of second-
The problems associated with the chronic wound become ary healing wounds, i.e. wounds in which granulation tis-
more severe if the ulcer has developed due to microcircu- sue has to be formed, and for epithelial wounds. The
latory and metabolic disorders in the cutis and subcutis, benefits of this method of treatment, which is based on
as is the case with venous leg ulcer. In contrast to an studies by G. D. Winter (1962, first published in
acute wound, in which the preconditions for the wound “Nature”), the underlying scientific principles of which
healing cascade to proceed in the proper sequence are have been scientifically validated in general terms, are
created in the inflammatory-exudative phase, with ulcers well known, and have effects on all phases of wound
of ischemic origin the repair activities of the cells have to healing:
be initiated in an area of skin with highly compromised
metabolism, which makes a properly regulated process of
Phase-specific wound management [34.35]
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