The role of the pathologist in wound management

Skin wounds result from a wide variety of physical insults, traumas and idiopathic causes. All are prone to infection and vulnerable to dehydration, contamination and further damage from environmental insult. Appropriate therapy depends upon correct diagnosis of the lesion, wound bed preparation with antimicrobial measures as required, and selection and application of suitable dressings. Whereas tissue viability clinicians and nurses will routinely assess levels of tissue damage and infection through observation of the colour, depth and size of wounds, backed up by microbiological assessment, a range of laboratory pathological services are available to give a wider picture of clinical wounds and possible causes of indolence and non-healing. This review identifies the contribution that specialist pathologists can make to identifying immunological changes in patients and toxic events resulting from the use of xenobiotic materials in wound management, and unravelling the mechanistic action of wound care products. Emphasis is placed on the central role of research in furthering the study of wound healing and mechanisms of chronicity.