Pathophysiology
Clinical meaning
Advanced wound management requires understanding the molecular environment of chronic wounds and evidence-based interventions that target specific healing impediments. Negative pressure wound therapy (NPWT) promotes healing through macro-deformation (wound contraction), micro-deformation (cellular stretch activating mechanotransduction pathways), and removal of excess exudate and bacteria. Growth factor therapy, including platelet-derived growth factor (PDGF/becaplermin), stimulates chemotaxis and proliferation of cells essential for tissue repair. Hyperbaric oxygen therapy increases dissolved oxygen in plasma, enhancing oxygen delivery to hypoxic wound beds, stimulating angiogenesis through vascular endothelial growth factor (VEGF) upregulation, and augmenting neutrophil oxidative killing. The clinician must also address systemic factors affecting wound healing: glycemic control (HbA1c < 7%), nutritional optimization (adequate protein, vitamin C, zinc), vascular assessment (ABI for arterial perfusion), and infection management using wound culture-guided antibiotic therapy.