Debridement: go big
Although debridement represents the standard of care for chronic wounds, Dr. Kirsner said, wound-healing specialists have long debated how extensively one should debride. Based on a series of 312,774 chronic wounds, "It turns out, the more you debride, the better."9
Biopsies have shown that debridement removes key factors – including c-Myc and nuclear expression of beta-catenin – that prevent keratinocytes from migrating outward from the edges of chronic wounds.10
"Therefore, you want to not only debride the base of the wound, but also the edge," to reach healthier skin.11 In fact, "If you had a sort of molecular scalpel, you could debride right to that edge and get to the tissue that's capable of healing. So we propose envisioning debridement almost like Mohs surgery," wherein one examines successive layers of excised tissues not for cancer, but for c-Myc and beta-catenin.