A PARADIGM THAT FULFILLS THE ADAGE
“PRIMUM NON NOCERE”
with autologous epidermis and
dermis. 2 (See Figure 1, this page.)
Several new products that
remove deterrents to wound
healing without adding agents
that inhibit healing have been
introduced. Antimicrobials that
mimic the leukocyte’s oxidative
burst to eradicate pathogens,
and dressings and devices that
can draw debris, bacteria, and
harmful cytokines from the
wound are replacing agents
that are placed into the wound
and have harmful side effects.
Closure with autologous skin
is supplanting skin substitutes.
Despite these advances, many
aspects of wound healing
and wound care have failed
to address the directive of
primum non nocere.
During a recently held
symposium titled Scientific
Advances in Wound Care: An
Update, which was hosted by
the department of surgery at the
Uniformed Services University
of the Health Sciences and the
Walter Reed National Military
Medical Center, Bethesda, MD,
participants discussed the need
for tools to be developed in the
areas of inflammation, infection,
biomarkers, wound strength,
and scarring that could improve
outcomes without the addition
of injurious agents. 6 In each
area, novel approaches could
be developed that would do no
harm to the wound and allow
the healing trajectory to shift
from its present compromised
position toward a more ideal
trajectory as represented by
fetal wound healing. 3 It was
the opinion of those present,
including the panelists, that
such approaches should become
a therapeutic imperative.
Products used in wound care
can be synergistic and designed
to aid various acute and chronic
wounds to heal without outside
interference and without doing
any undue harm to healing
tissues. The paradigm of “do no
harm,” particularly when it comes
to wound care, allows surgeons to
follow their inherent drive to do
what is best for their patients. ♦
1. Tobin GR. Closure of contaminated
wounds: Biologic and technical
considerations. Surg Clin N Amer.
1984; 64( 4):639.
2. Winkler M, Steadman ME. Removing
deterrents without adding potentially
harmful agents: A new paradigm
for effective wound healing. Today’s
Wound Clinic. April 2014. Available
Accessed July 25, 2016.
3. Robson MC, Steed DL, Franz MG.
Wound healing: Biologic features
and approaches to maximize
healing trajectories. Curr Prob Surg.
200l; 38( 2):61-140.
4. Smith CM. Origin and uses of
primum non nocere—above all, do no
harm! J Clin Pharmacol. 2005; 45( 4):371-
5. Schultz GS, Sibbald RG, Falanga
V, et al. Wound bed preparation:
A systematic approach to wound
management. Wound Rep Regen.
2003; 11(Suppl 1):S1-S28.
6. Scientific Advances in Wound Care:
An Update. Symposium held at
USU Walter Reed Surgery, USUHS,
Bethesda, MD. June 25, 2015.