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Received Feb 9, 2018; Accepted May 9, 2018
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1. Introduction
An open wound is a loss of continuity of the epidermis, caused by mechanical, chemical, biological, or thermal injuries. Open wounds can be superficial involving the epidermis and varying degrees of dermis, or full thickness extending to the subcutaneous layer. Cutaneous wound healing is a highly organized physiological process that restores the integrity of the skin following injury. It involves the interplay between various populations of cells and is typically categorized into three overlapping phases: inflammation, proliferation, and maturation [1–3].
The highly coordinated wound repair process is susceptible to interruption or failure by multiple factors which can result in nonhealing wounds. Chronic wounds are defined as those which persist for at least three months and are generally classified as vascular, diabetic, or pressure ulcers. They usually occur due to characteristics of the wound or patient physiology or as a complication of a disease process, all of which prolong or exacerbate the inflammatory process and prevent dermal or epidermal cells responding to regenerative stimuli [4]. Cutaneous injury that penetrates beyond the epidermis in adult human skin is repaired by a highly evolved fibroproliferative response that quickly restores the skin barrier but results in the formation of a scar. Scarred skin lacks dermal appendages, such as sebaceous glands, hair follicles, and sensory nerve receptors [1], and has a reduced tensile strength [5], which alter its visual appearance and impact its normal functions.
Wound healing represents a significant challenge in plastic surgery. Chronic wounds cause substantial patient morbidity, with detrimental effects on patient quality of life, increasing pain, stress, depression, and social isolation [6]. More than six million people suffer with chronic skin wounds every year in the United States alone [7], and with the aging population and increased incidence of diabetes and obesity, this disease burden is increasing [8]. Current standards of wound care focus on identifying and removing precipitating or aggravating factors with the hope of reducing inflammation and allowing the healing cascade to proceed [1, 9]. These treatments are often expensive, time-consuming, and inefficient, and...