Medical History and Evolution of Wound Care

UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)

Iriga City
HEALTH CARE EDUCATION DEPARTMENT
Medical history and evolution of wound care

Since the caveman, man has been tending to his wounds. Wound care evolved from magical
incantations, potions, and ointments, to a systematic text of wound care and surgery from
Hippocrates and Celsus. These advances were lost after the fall of the Roman Empire. In Europe,
the Middle Ages were a regression of wound care back to potions and charms. It was'nt until the
time of large armies using muskets and cannons that surgical wound care emerged again.
Wound care has evolved from treatments based on superstition to systematic, evidence-based
care. The history of wound healing dates back to 2000 BCE. Various civilizations over the
centuries had differing approaches to wound care:
1500 B.C Ancient Egyptians used lint, animal grease, and papyrus as remedies for
open wounds. They believed that making sure a person’s wound stayed
closed would help their own spirit not be invaded by evil spirits. The
Egyptian practice and art of wrapping mummies also had an influence on
their understanding of bandaging wounds.
200 A.D. Ancient Greeks were the first to differentiate between acute and chronic
wounds. Galen of Pergamum, a Greek surgeon who served Roman
gladiators, was the first to acknowledge the importance of wound closer for
faster healing.18th Century – Surgery was not a widely-accepted practice at
this point in history, but the demands of war pushed surgeons to test many
types of antiseptics, such as hydrogen peroxide, phenol, and Iodine, to help
fight wound infection.
19th Century Robert Wood Johnson, co-founder of Johnson & Johnson, began producing
gauze and wound dressings sterilized with dry heat, steam, and pressure.
These innovations marked the first major advances in the field since the
time of the Egyptians and Greeks.
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20th Century Fibrous synthetic materials such as nylon, polyethylene, polypropylene,

and polyvinyls were introduced, providing new materials for dressing and
protecting wounds. These materials were found to help accelerate the
natural wound healing process.
21st Century Wound Care innovation has evolved to encompass more advanced wound
treatments that promote healing, prevent infections, and heal existing
infections. More than 5,000 wound care products exist today, and there are
over 1,000 clinical wound healing facilities in the U.S. alone that specialize
in this area of medicine.
The history of wound care spans from prehistory to modern medicine. Wounds naturally heal by

themselves, but hunter-gatherers would have noticed several factors and certain herbal
remedies would speed up or assist the process, especially if it was grievous. In ancient history,
this was followed by the realization of the necessity of hygiene and the halting of bleeding,
where wound dressing techniques and surgery developed. Eventually the germ theory of
disease also assisted in improving wound care.
Ancient Greece
 The Greeks also acknowledged the importance of wound closure, and were the
first to differentiate between acute and chronic wounds, calling them "fresh"
and "non-healing", respectively. Galen of Pergamum, a Greek surgeon who
served Roman gladiators circa 120–201 A.D., made many contributions to the
field of wound care. The most important was the acknowledgment of the
importance of maintaining wound-site moisture to ensure successful closure of the
wound.
Ancient Egypt
 The clinical history of the treatment of acute and chronic wounds can also trace its
origins to ancient Egypt, and many Egyptian medical papyri have survived which
document herbal, surgical and magical remedies for wounds. The Edwin Smith
Papyrus, c. 1600 BCE, describes closing wounds with sutures (for wounds of the
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lip, throat, and shoulder),[5] bandaging, splints, poultices,[6] preventing and curing

infection with honey, and stopping bleeding with raw meat. The Ebers
Papyrus, c. 1500 BCE, details the use of lint, animal grease,
and honey as topical treatments for wounds. The lint provided its natural
absorbency, the animal grease provided a barrier to environmental pathogens, and
the honey served as an antibiotic agent. The Brugsch Papyrus, c. 1200 BCE,
stated that the Egyptians believed that making sure a person's wound stayed
closed would help their own spirit not be invaded by external evil spirits.
MIDDLE AGES
 There were limited advances that continued throughout the Middle Ages and the
Renaissance, but the most profound advances—both technological and clinical—
came with the development of microbiology and cellular pathology in the 19th
century.
19TH CENTURY
 The first advances in wound care in this era began with the work of Ignaz Philipp
Semmelweis, a Hungarian obstetrician who discovered how hand washing and
cleanliness in general in medical procedures prevents maternal deaths.
Semmelweis's work was furthered by an English surgeon, Joseph Lister, who in
1860s began treating his surgical gauze with carbolic acid, known today
as phenol, and subsequently dropped his surgical team's mortality rate by 45%.
Building on the success of Lister's pretreated surgical gauze, Robert Wood
Johnson I, co-founder of Johnson & Johnson, began in the 1890s producing gauze
and wound dressings sterilized with dry heat, steam, and pressure.These
innovations in wound-site dressings marked the first major steps forward in the
field since the advances of the Egyptians and Greeks centuries earlier.
1950s onward
 The advent in the 1950s of fibrous synthetics such
as nylon, polyethylene, polypropylene, and polyvinyls provided new materials
from which researchers and doctors in the field of wound care could explore
better protecting of healing wounds and even accelerating the natural wound
healing process. In the 1960s, research and articles by George Winter and Howard
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Maibach reported on the superior efficacy of moist wound dressings. The

adoption of moist wound dressing technique as recommended best wound
dressing practice reflected a large advance in approach producing markedly
superior clinical outcomes. This dawn of modern wound care treatment initiated a
process of improvement in the clinician's ability to bolster wound-site re-
epithelialization and healing. The focus on evidence-based best practices and
research continues.
Modern wound care

 In modern-day 21st century, medicine has evolved to involve past treatments such
as leech therapy, as well as advancing wound prevention and the treatment. A
large part of wound care is wound treatment. This involves promoting healing,
preventing infections, and getting rid of an already existent infection. Deciding on
a treatment depends on the type of wound that a person has sustained. Varying
from infections to burns, wound care is a priority in saving the limb, extremity, or
life of a person. In a hospital or medical care setting, more severe wounds like
diabetic ulcers, decubitus ulcers, and burns require sterile or clean (depending on
the severity of the wound) dressings and wound care. The types of wound
dressing include: dry dressings, wet-to-dry dressings, chemical-impregnated
dressings, foam dressings, alginate dressings, hydrofiber dressings, transparent
film dressings, hydrogel dressings, and hydrocolloid dressings. All of the listed
dressing types require different materials to complete the dressing.
 Dry dressings: these dressings are typically composed of a gauze material and used for
wounds with a small amount of drainage. These dressings are good for keeping the wound
covered after cleaning and to promote healing as well as taking out small amounts of
infection.
 Wet-to-dry dressings: Although some medical facilities are stepping away from these types
of dressings, they are used mostly for post-surgical wound care as well as debridement of
wounds. These dressings take out necrotic areas as well as infections. In this type of wound
dressing, gauze is soaked in saline, placed lightly inside of the wound, and covered with a
dry dressing. Once the gauze dries, it can be removed. It dries onto the infection or necrotic
areas to remove them. These dressings are being replaced by Wound-Vacs, which are
attached to a dressing directly onto the wound, and lightly but continuously, pull and suck
exudate and fluids from the wound.
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 Chemical-impregnated dressings: these are provided by manufacturers and they contain

chemicals and agents that promote the healing process. Some of these dressings come in
sheets and require secondary dressings.
 Foam dressings: dressings that require additional padding utilize foam pads to help absorb
and provide a moist healing environment. They also act as a shield to the wound and prevent
any damage from friction or pressure. They can be tricky when applying and removing due
to the surrounding skin.
 Alginate dressings: these dressings are composed of calcium, sodium salts and also provide a
moist environment for the healing process. They are better used with a larger wound such as
ulcers or donor sites.
 Hydro-fiber dressings: these dressings are similar to alginate dressings when it comes to
absorbing characteristics, but they do not affect hemostasis. They are composed in sheets
which contain polymer carboxymethylcellulose and can be cut according to wound size and
severity. However, when using these dressings, a secondary dressing is almost always
required.
 Transparent film dressings: this specific type of dressing is more like a plastic covering for
the wound. It allows oxygen to reach it and help heal but does not absorb any fluids.
Transparent film dressings are used primarily on dry wounds.
 Hydrogel dressings: this type of dressing is more directed towards infected areas and those in
need of a moist environment to heal properly. It helps promote the body's own natural
functions of removing necrotic tissue. It is advised not to be used on dry wounds.
 Hydrocolloid dressings: unlike transparent film dressings, hydrocolloid dressings do not
allow oxygen to reach the wound. It is a wet-to-dry technique but is not recommended for
infected areas. This type of dressing can last up to 7 days with a close eye and must be
removed with care.[21]
 Biologically based dressings: Integra LifeSciences’ artificial skin is placed on a wound
where burned or scarred skin has been removed. The two-layer membrane provides
scaffolding to regrow a new layer of dermis.

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UNIVERSITY OF SAINT ANTHONY

(Dr. Santiago G. Ortega Memorial)

HEALTH CARE EDUCATION DEPARTMENT