Andrew J. Rosenbaum, MD; Samik Banerjee, MBBS, MS(Orth), MRCS(Glasg); Kristen M. Rezak, MD; Richard L. Uhl, MD


J Am Acad Orthop Surg. 2018;26(23):833-843. 

In This Article

Abstract and Introduction


Wound management is a notable healthcare and financial burden, accounting for >$10 billion in annual healthcare spending in the United States. A multidisciplinary approach involving orthopaedic and plastic surgeons, wound care nursing, and medical and support staff is often necessary to improve outcomes. Orthopaedic surgeons must be familiar with the fundamental principles and evidenced-based concepts for the management of acute and chronic wounds. Knowledge of surgical dressings, negative pressure wound therapy, tissue expanders, dermal apposition, biologics, and extracellular matrices can aide practitioners in optimizing wound care.


The management of acute and chronic wounds is a substantial healthcare and socioeconomic burden, accounting for almost 3% of annual healthcare costs.[1] Chronic wounds affect patients' physical, mental, and social well-being to the same extent as heart and kidney diseases.[2] Acute wound healing typically progresses through four stages over approximately 8 to 12 weeks (Table 1). However, if healing stalls in one of these phases, the wound may become chronic.

Wound management principles are based on the causes of impaired healing, such as the presence of devitalized or necrotic tissue (T), excessive inflammation or infection (I), moisture imbalance (M), and nonadvancing wound edges (E).[3] Knowledge of this TIME acronym may facilitate an organized and conceptual approach to wound care.[4] Identifying systemic and local factors impeding healing, such as suboptimal nutrition, poor glycemic control, tobacco use, and inadequate blood supply, is also crucial. Maximizing protein, fat, calorie, and fluid intake is required to provide energy for healing, structural support, stimulating an effective immune response, and promoting sufficient tissue oxygenation.[5] Furthermore, several micronutrients including amino acids (eg, arginine, glutamate), vitamins (eg, A, C, D), and minerals (eg, selenium, zinc, copper, iron) are essential for wound healing.[6–9]

Advances in preclinical research have stimulated development of >3,000 types of dressings, biological materials, tissue-engineered substitutes, and mechanical devices for modulating wound environments and supporting the body's own regenerative capacities for wound closure. Despite this, there is paucity of articles in the orthopaedic literature devoted to wound management. Therefore, we present the fundamental concepts and advancements in wound care relevant to orthopaedic practitioners.