الفهرس 
Anatomy of the skinOnly 14 pages are availabe for public view
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Abstract
As the populations of developed countries age and become more sedentary, the incidence of diabetes and obesity increases, along with a dramatic increase in the incidence of chronic nonhealing wounds. In most medical communities, surgeons are considered the local experts in the care of wounds and are expected to manage cases that do not respond to typical treatments recommended by primary care clinicians.
A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic. chronic wounds seem to be detained in one or more of the phases of wound healing. For example, chronic wounds often remain in the inflammatory stage for too long. In acute wounds, there is a precise balance between production and degradation of molecules such as collagen; in chronic wounds this balance is lost and degradation plays too large a role.
In addition to poor circulation, neuropathy, and difficulty moving, factors that contribute to chronic wounds include systemic illnesses, age, and repeated trauma. Comorbid ailments that may contribute to the formation of chronic wounds include vasculitis, immune suppression, and diseases that cause ischemia. Emotional stress can also negatively affect the healing of a wound, possibly by raising blood pressure and levels of cortisol, which lowers immunity.
Treatment of the different chronic wound types varies slightly, appropriate treatment seeks to address the problems at the root of chronic wounds, including ischemia, bacterial load, and imbalance of proteases. Various methods exist to ameliorate these problems, including antibiotic and antibacterial use, debridement, irrigation, vacuum-assisted closure, warming, oxygenation, moist wound healing, removing mechanical stress, and adding cells or other materials to secrete or enhance levels of healing factors
A wide variety of advanced treatment for nonhealing wound, such as Topical growth factors, Bioengineered skin grafts(BATs), VAC(Vacuum Assisted Closure) Therapy, and hyperbaric oxygen therapy(HBOT), have shown some evidence of improved wound healing compared to standard wound care.