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When the first edition of Wound Healing: Alternatives in Management premiered in 1990, little did we know that we would find ourselves 20 years later bringing to market a fourth edition that far exceeded any of our expectations. The field of wound management has grown over the past two decades into a medical subspecialty with board-certified practitioners. The growth in subject matter content has been documented in the first three editions of our text and is readily evident in this edition, which we have renamed Wound Healing: Evidence-Based Management, 4th edition. Working on these editions over the years has been much like parents watching their first child being born, mature through adolescence, and head off to college. Here we find ourselves with a fully “grown up” edition that presents a broad overview of present-day wound management. Of course, just as we all aspire to be life-long learners, we know that this text will continue to change and improve, as will practice.

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In the preface to the third edition, we commented on the addition of a 50-picture color insert along with 13 new authors and topics divided into four sections. This seems to pale in comparison to the fourth edition, which offers fully integrated color and features 35 chapters by 45 nationally and internationally acclaimed authors. These chapters offer case studies and “pearls” that help the reader scan the chapter and locate major points of interest. Another unique addition to the text is an appendix with annotated multiple choice questions that summarize major content in each chapter and help readers see if they understand key concepts.

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The fourth edition is divided into six logically organized categories that take the reader from anatomy and physiology into patient assessment, general wound management principles, wound etiologies, and physical technologies, and concludes with practical information on managing a wound care practice.

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The first part, entitled “The Wound Healing Environment,” contains five chapters that integrate the basic science aspects of wound management. The section begins with an introduction to integumentary anatomy and follows with an overview of the wound healing process and how growth factors and the extracellular matrix influence repair. The section concludes with a discussion of the role of nutrition in wound healing and how other complications delay healing.

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Part II, “Assessing the Patient,” takes the reader through a general wound examination, addressing techniques applicable to a variety of patient types. This is followed by a chapter that focuses on tests and measures useful in assessing the circulatory and neurological systems. Several new chapters are included that provide information on assessing and controlling bioburden and identifying and managing atypical wounds. A new chapter on the role of imaging in wound care highlights some of the more commonly encountered radiographic assessments used to evaluate individuals with wounds.

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Part III, “General Management Principles in Patients with Wounds,” addresses wound bed preparation and how débridement, dressings, and skin substitutes facilitate repair. A new chapter in this section focuses on topical agents used for débridement, bacterial control, and facilitation of healing.

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Part IV examines etiological factors contributing to some of the more common wounds seen in clinical practice. New chapters in this section discuss causative factors leading to ulceration of the feet in individuals with diabetes. This is complemented by another new chapter addressing diabetes in general and how the disease process negatively impacts healing. Principles of venous ulcer development and treatment are discussed, then followed next by new chapters covering ischemic ulcers and lymphatic disease. The chapter on pressure ulcers and management has been completely revised and addresses both bedbound individuals as well as those who are functional users of wheelchairs. Additional new chapters have been included to address burn management from both the medical and rehabilitative perspectives. This is then followed by discussions on the management of wound pain, surgical considerations in wound management, and neonatal and pediatric issues.

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Part V looks at biophysical technologies. The change in name from physical modalities or agents to biophysical technologies demonstrates the broadened perspective addressed in this section. Included are discussions on electrical stimulation, ultrasound, and ultraviolet therapies, but distinctions are made between endogenous and exogenous electrical fields and the role of electromagnetic stimulation in wound repair. The section concludes with a review of compression therapies and two new chapters that address the rapidly expanding fields of negative-pressure wound therapy and oxygen therapy.

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Part VI concludes the text with an overview of issues pertinent to practice administration. The first chapter speaks to the proper means of documenting wound management and properly coding bills to meet third-party payment requirements. A new chapter provides information on developing an effective clinical wound care program. The text then concludes with helpful advice from the legal arena and discusses contemporary issues being addressed in the courts.

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All in all, we feel we have provided the wound care clinician with an evidenced-based text that should prove of great value in the daily management of patients who present with challenging wounds and increasingly complex medical problems.

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Joseph M. McCulloch
Luther C. Kloth

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