scope:

Preface

Surgical wound management is largely neglected in medical textbooks. This book is an attempt by 14 senior international clinicians and scientists who represent the major surgical specialties to address this deficiency by focusing on a procedure that most surgeons had to learn for themselves during the course of their careers, namely surgical debridement. Once the wound has been appropriately debrided, it can then follow a pathway to closure that employs topical treatments or surgical reconstruction.

Surgical debridement was described by Jean Laray in 1840 to be one of the most important and significant discoveries in all of surgery, yet in the wound management community its significance is underestimated. More importantly, it is only now that we are beginning to understand the precise impact that effective surgical debridement has in minimizing wound infection and in encouraging the development of growth factors that ultimately facilitate wound healing. Furthermore, there are exciting improvements in surgical technology that facilitate wound debridement. Surgical wound debridement creates the conditions necessary for wound healing, whether reconstructive surgery or topical treatments are used to complete wound closure.

So, what is in surgical wound management? Greg Schultz, a scientist in the obstetrics/gynecology department from the University of Florida, begins by introducing the scientific and practical context behind debridement and surgical wound bed preparation. In acute wounds, an appropriately prepared surgical wound bed is required in order to successfully accomplish wound closure. In chronic wounds, surgical wound bed preparation rapidly recreates an acute wound, which can then proceed more effectively through the healing cascade. Mellick Chehade, an academic orthopedist from Adelaide, Australia and I describe the history of wound management and how the surgical community diverged from the nonsurgical wound community hundreds of years ago. We introduce a new concept in this field-a classification system of tissue type, wound personality, and debridement-that we hope will foster a new protocol on surgical debridement that all surgeons can use. Mayer Tenenhaus and Dhaval Bhavsar, plastic/burn surgeons from San Diego, California and Hans Oliver Rennekampff, a burn surgeon from Tübingen, Germany describe the nature of micro-organisms in the wound, and the role that surgical debridement plays in the control of bacteria. Richard L. Gamelli, a surgeon from Chicago, Illinois and my co-editor, describes the management of fasciitis and related wounds. Roy M. Kimble, an Australian pediatric burn surgeon, and S. L. A. Jeffery, a burn and military surgeon from the U.K., examine surgical treatment of burns. Peter V. Giannoudis and Michael Suk, orthopedic traumatologists from Leeds, U.K. and Jacksonville, Florida, respectively, describe how surgical debridement and wound management can minimize the ill-effects of traumatic wounds. Luc Téot, an internationally recognized wound expert from France, discusses debridement of surgical wounds. Giovanni Mosti, an Italian vascular surgeon, Joseph V. Boykin, a plastic surgeon from Richmond, Virginia, and Lucca Dalla Paola, an Italian endocrinologist, look at a range of chronic and otherwise infected wounds, and the contribution that surgical debridement and wound management can make to their treatment. John S. Davidson, an experienced orthopedic surgeon from the U.K., investigates debridement of infected orthopedic prostheses.

Surgical wound management, beginning with wound debridement, is the cornerstone of treatment for patients with both acute and chronic wounds. In spite of the critical role of surgery in wound management, historical events have led to a separation between surgical and medical wound specialists, with the medical perspective widely published. This textbook seeks to overcome these differences by highlighting the role of surgery. It is time for the wound communities to integrate their practices and unite for the benefit of our patients.