Pathophysiology
Clinical meaning
The clinician integrates molecular wound healing science with clinical decision-making to optimize irrigation strategies and comprehensive wound management. Normal wound healing progresses through four overlapping phases: hemostasis (platelet plug and fibrin clot, minutes to hours), inflammation (neutrophil and macrophage infiltration, days 1-6), proliferation (angiogenesis, fibroplasia, and epithelialization, days 4-21), and remodeling (collagen reorganization, 21 days to 2 years). Chronic wounds stall in the inflammatory phase due to excessive protease activity (MMP-2, MMP-9), bacterial biofilm formation, and growth factor deficiency. Biofilms—structured bacterial communities encased in a polymeric matrix—are present in >60% of chronic wounds and are 100-1000x more resistant to antibiotics than planktonic bacteria. The clinician must prescribe evidence-based irrigation protocols, order appropriate diagnostics, initiate systemic and topical antimicrobial therapy, address underlying etiologies (vascular disease, diabetes, pressure), and refer for advanced wound therapies.