Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. The development of new and effective interventions in wound care remains an area of intense research. Negative pressure wound therapy has undoubtedly changed wound care from this point forward and has proven beneficial for a variety of wounds. Hydroconductive dressings are another category that is emerging with studies underway. Other modalities such as hyperbaric oxygen, growth factors, biologic dressings, skin substitutes, and regenerative materials have also proven efficacious in advancing the wound-healing process through a variety of mechanisms. There is an overwhelming amount of wound dressings available in the market. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to "ideal" as possible. It is only after properly assessing the wound characteristics and obtaining knowledge about available products that the "ideal" dressing may be chosen. The future of wound healing at this point remains unknown. Few high-quality, randomized controlled trials evaluating wound dressings exist and do not clearly demonstrate superiority of many materials or categories. Comparative effectiveness research can be used as a tool to evaluate topical therapy for wound care moving into the future. Until further data emerge, education on the available products and logical clinical thought must prevail.

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Since ancient times, it has been known that silver reduces inflammation of wounds and promotes healing. Partially owing to concerns over bacterial resistance and a growing awareness of the deleterious effects of bacteria and their toxins on wound healing, a wide variety of silver products are now commercially available. This article reviews the effects of silver on wound bioburden and its role in the management of complex wounds.

WOCN) has been a leader in the development of clinical practice guidelines for the care of patients with wounds, fecal and urinary diversions, and continence disorders since the late 1980s. In 2000, the WOCN established a process to develop evidence-based guidelines for preventing and managing wounds due to pressure, venous, arterial, and diabetes/neuropathy. A level-of-evidence rating was established for the recommendations in each guideline. Four guidelines were developed and accepted by the National Guideline Clearinghouse (http://www.guideline.gov/) and have been widely used by healthcare professionals.The WOCN Guideline for Prevention and Management of Pressure Ulcers was originally published in 2003 and is intended for use by physicians, nurses, therapists, and other healthcare professionals. The goal of the guideline is to assist healthcare professionals to provide evidence-based care for prevention and management of pressure ulcers, serve as a guide for continued education, and provide direction for future research. To that end, the WOCN has recently updated the guideline to keep it current.The guidelines' task force developed the following questions to guide the evidence-based review of the literature: