Wound management encompasses a number of disciplines. As new concepts and innovative technologies develop within this exciting field, it is important to share them in spite of the divergence of clinical perspectives between the expert disciplines. One such divergence exists between surgeons and nonsurgical wound specialists. As a result, there is a need to develop a common language between these two groups. How can we develop a common language that unites surgical expertise within medical wound management? One route may be through the principles of wound bed preparation, which we believe have great potential for the communication of effective surgical techniques. Another is through sharing our concepts of surgical debridement as it is applied to different wounds by a variety of surgical disciplines. In this monograph, we try to bring these two themes together. We discuss how wound bed preparation has added to our understanding of the pathophysiology of the nonhealing wound and has provided us with some general clinical concepts. We discuss what role debridement, and then specifically surgical debridement, has to play within wound bed preparation, before analyzing the importance of surgical debridement in tissue preservation and the control of infection. We finally look at ongoing work that examines the cost of various surgical debridement techniques. We will also review a new hydrosurgery system (VERSAJET, Smith and Nephew, Hull, UK), which we believe has an important role to play in the surgical preparation of the wound. We also expect that this paper will remind our medical colleagues about the critical role played by surgery in wound management.

Objective-The objective of this preliminary study was to document general somatic and wound nitric oxide (NO) levels during and after hyperbaric oxygen therapy (HBOT).Design-The study evaluated 6 chronic wound patients that responded favorably to HBOT treatment (20 treatments; 2.0 atmosphere absolute [ATA] × 90 minutes). Successful HBOT was associated with increased wound granulation tissue formation and significantly improved wound closure. Wound fluid and fasting plasma samples were obtained for measurement of nitrate and nitrite (NOx), the stable oxidation products of NO; plasma L-arginine (L-Arg); and asymmetric dimethylarginine (ADMA). NOx measurements were obtained before treatment (baseline), after 10 and 20 treatments, and at 1 and 4 weeks after therapy.Results-Wound fluid NOx levels tended to increase during treatments, were significantly elevated at 1 and 4 weeks after therapy, and correlated with reductions in wound area. Plasma L-Arg and ADMA were unchanged during and after HBOT.Conclusion-This preliminary study documents a significant increase in local wound NO levels (by NOx measurements) after successful HBOT and suggests that this mechanism may be an important factor in promoting enhanced wound healing and wound closure associated with this therapy.Hyperbaric oxygen therapy (HBOT) accelerates the healing of chronic wounds and is now primarily used as an adjunctive therapy in managing selected problem wound healing. [1][2][3][4] Hyperoxia during HBOT is an important mediating factor for wound collagen deposition and cross-linking, 5 neutrophil-dependent microbial killing, 6 and neovascularization. 7 Other HBOT-mediated processes in wound healing include the inhibition of integrin-mediated intravascular leukocyte adhesions and platelet aggregation, 8 enhancement of cutaneous microvascular homeostasis after ischemia-reperfusion syndrome, 9 increased oxygen capacitance and survival of ischemic flaps, 10 and upregulation of platelet-derived growth factor (PDGF) receptor mRNA. 11Experimental normobaric oxygen activates gene expression in human dermal fibroblasts, supporting the concept of oxygen as a possible signal transducer. 12 An additional signaling system modulated by oxygen availability is provided by the naturally occurring oxygen-free radicals (oxidants), or reactive oxygen species (ROS), found in the wound environment. ROS have been observed to increase cellular vascular endothelial growth factor (VEGF) expression and signal transduction that is considered to promote an overall enhancement of the wound healing process. 13 Further, accelerated wound healing during HBOT may be mediated by the combined effects of hyperoxia and the increased local (wound) production of nitric oxide (NO), an important cellular signal for tissue repair. 14,15 Ongoing experimental and clinical wound healing studies have established NO as a critical mediator of normal tissue repair. 16 Angiogenesis, granulation tissue formation, epidermal migration, collagen deposition, and microvascular homeostasis are signi...