Moist

Objective: This article reviews the current recommendations for the classification and treatment of chronic wounds. With a rational approach and a thorough understanding of available treatment options, plastic surgeons can provide better-quality and more cost-effective wound care. Methods: The authors reviewed the literature on the history of wound care and on recent advancements in wound care and also summarized the current clinical practices of the Johns Hopkins Wound Center. Results: n/a. Conclusions: Optimized wound dressings decrease pain, diminish morbidity, and improve healing times. Wound care is often performed in a manner that is anecdotal, inconsistent, and lacking in evidence base. In 2004, the direct costs of wound care in the United States exceeded 15 billion dollars.1 Wet-to-dry and gauze dressings remain the most widely used primary dressing material in the United States.2 While the newer-generation wound dressings are more costly than gauze, they decrease overall costs since they are more effective.3,4 EVOLUTION OF WOUND CARE While Sumerian cuneiform tablets depicted poultices being applied to wounds 4000 years ago, the ancient Egyptians advanced this practice by creating dressings composed of veg-etable fibers, grease, and honey to provide absorbency, barrier protection, and antimicro-bial activity, respectively. Around 150 AD, the Greek physician Galen published the ob-servation that wounds from gladiatorial combat healed optimally in a continuously moist environment.5,6 Recent advancements in technology and in the understanding of human physiology have led to the commercial development of dressings that offer material improvements on these same ancient fundamental principles. Even so, gauze still remains the mainstay of wound care. We now know that patients with chronic wounds often have multiple under-lying medical comorbidities, and the rate of wound healing is affected by multiple factors (Table 1). A chronic wound is defined as a break in the skin of more than 6 weeks ’ duratio