Invited commentary on 'modern wound care for the poor: a randomized clinical trial comparing the vacuum system with conventional saline-soaked gauze dressings' by Perez et al.

摘要

There are abundant data documenting the morbidity and reduced quality of life associated with acute and chronic wounds. Mainstays of management for difficult wounds have been, for several centuries, debridement and wound dressings. Ambrose Pare is credited with stimulating the change from cauterization of acute and chronic wounds to the use of protective dressings. The ideal dressing serves as a complement to surgical debridement. The dressing should protect the wound, keep the wound surface warm and moist, contribute to maintaining the wound surface free of dead tissue, and manage wound drainage. Under ideal circumstances, the wound dressing should promote the process of healing. At the very least, the dressing should not retard healing. There are several wound dressing approaches that, to varying degrees, offer all of these desirable qualities. The dressings vary and include artificial membranes, foams, tissue substitutes, and living tissue. Recently, the value of negative wound surface pressure has been documented, and shortened wound healing times for various types of wounds have been observed. The 2 areas in which the vacuum device clearly contributes are wound protection and drainage management. There is also circumstantial evidence that the process of wound healing is enhanced by negative wound surface pressure. One limitation common to all commercially available wound dressings is the high, often prohibitive, cost of the devices and the single-use accoutrements that are needed to make the dressings and devices usable. The feature of high cost means that some patients who could benefit from the dressing approach will not be able to acquire it.