Discipline Construction and Talent Cultivation of Tissue Restoration and Regenerative Medicine

Abstract

With the development of social economy and the aging of the population, the human disease spectrum has undergone significant changes. The epidemiological data of Fu Xiaobing’s team showed that as prevailing in 1998 [1], the 2008 survey showed that burn wounds accounted for only 18% of wound diseases, and the remaining 82% were chronic wounds. The survey data also estimated that nearly 100 million people in China need wound treatment every year [2]. The survey also found that wound disease brings a lot of burden to social medical resources. The first is the burden of manpower; the second is the average length of stay (ALOS). The third is the cost of hospitalization. These data show that we are not only faced with the major medical needs of wound disease treatment, but also the wound disease has brought us a major social medical burden. It can be seen that all kinds of chronic wounds have become one of the important diseases affecting people’s life and health, and one of the important issues that modern clinicians and researchers must face.

With the development of social economy and the aging of the population, the human disease spectrum has undergone significant changes. The epidemiological data of Xiaobing’s Fu team showed that as prevailing in 1998 [1], the 2008 survey showed that burn wounds accounted for only 18% of wound diseases, and the remaining 82% were chronic wounds. The survey data also estimated that nearly 100 million people in China need wound treatment every year [2]. The survey also found that wound disease brings a lot of burden to social medical resources. The first is the burden of manpower; the second is the average length of stay (ALOS). The third is the cost of hospitalization. These data show that we are not only faced with the major medical needs of wound disease treatment, but also the wound disease has brought us a major social medical burden. It can be seen that all kinds of chronic wounds have become one of the important diseases affecting people’s life and health, and one of the important issues that modern clinicians and researchers must face.

Now that all kinds of chronic wounds have become a major component of wound diseases, it is necessary to establish a wound repair specialist and popularize wound treatment to meet such a huge demand for wound treatment. The current problems mainly include the following aspects:

• A. There is no professional department for all kinds of wound treatment in the setting of the current clinical departments in our country, which makes the patients with wound diseases unable to find a place to seek medical treatment.

• B. Wound repair specialists involve multidisciplinary intersections. Therefore, no professional has taken this business for granted, so that patients can be transferred to various subjects in disorder, without systematic treatment.

• C. There is currently no uniform clinical guidelines and norms for chronic wounds.

• D. The knowledge of chronic wound diagnosis and treatment in medical undergraduate teaching in China has not been extensive.

• E. There is still a lack of innovative theories and techniques in the field of wound healing. Therefore, it often seems to be inadequate in specialist treatment.

• F. Wound diseases have the characteristics of “small wards and large outpatients,” that is, a considerable number of patients only need to change medicines in the outpatient department, and only need hospitalization when deep treatment or surgery is needed. In the current situation that there are not many wound repair specialists, it is difficult to meet the needs of patients living in different regions when the general practitioners in the primary hospital are unfamiliar with the methods of chronic wound healing.

To this end, many hospitals across the country have set up specialists in wound repair to meet the needs of the medical market. However, we realize that the establishment of the wound repair specialist is by no means a gorgeous turn of disciplines such as burns or reduction surgery. There is a need for new understanding of the theoretical mechanisms of wound repair, new methods for wound treatment techniques, new norms in clinical guidelines and diagnosis and treatment, new breakthroughs in medical treatment models and clinical pathways, so that wound repair specialty has rich connotation.

13.1 Guiding Clinical Practice with Wound Repair and Innovation Theory

In addition to the huge demand in the medical market, the upsurge in the construction of wound repair specialists in China has also accumulated a certain theoretical accumulation in the past 20 years. Its landmark events were the major projects of the National Natural Science Foundation in 1992 and the three “973” projects in 1999, 2005 and 2011.Through the investment of these major projects, not only a team has been trained, but also a series of theoretical understandings of wound repair have been formed, which has played a supporting role in the construction of wound repair specialists in China [3].

13.1.1 Understand the Significance of Wound Repair Procedures for Wound Treatment

Wound healing is a complex and orderly biological process that involves several stages of inflammation, cell proliferation/connective tissue formation, wound contraction, and wound remodeling. The various stages of the healing process are not independent but intersect and overlap each other and involve the participation of a variety of inflammatory cells, repair cells, inflammatory mediators, growth factors, and extracellular matrices [4]. The wound healing mechanism has three characteristics, namely the regionality, time-bound, and sequential inertia of wound healing:

13.1.1.1 Regional Characteristics of Wound Healing

The so-called regionality means that after the wound is formed, except for large-area wounds, a series of biological events related to repairs that occur in the body usually accumulate in the local part of the wound. It is a regional biological event, not a systemic one. Therefore, wound treatment should focus on local treatment. Wound debridement, wound dressing and adequate drainage, providing a relatively moist and suitable environment for wounds are important means of wound treatment. If the local treatment of the wound is neglected, attempts to promote wound repair by means of systemic therapy often fail to achieve the desired effect. A common clinical phenomenon is the infection of the wound and the hope to control the infection through systemic application of antibiotics, while neglecting the local treatment and drainage of the wound.

13.1.1.2 Time-Bound Characteristics of Wound Healing

The so-called time-bound means that the wound repair is mainly divided into three stages, namely, the inflammation stage, the tissue cell proliferation stage, and the tissue remodeling stage. These three stages have different characteristics of cell behavior and tissue biological environment, respectively. Although the stages overlap partially, they all have their own behavioral “time window.” It is necessary to take appropriate measures in the effective “time window” according to the characteristics of the phase. Taking deep burn wounds as an example, it is an important link to promote the shedding of necrotic tissue in the early stage of wound formation. There are many ways to promote the shedding of necrotic tissue, both medicated and surgical. In the medium term, it is mainly to provide suitable means for tissue cell growth and repair, such as giving the wound a relatively moist environment and drugs for promoting growth. Therefore, how to grasp the time-bound characteristics of the wound healing process in the process of wound healing, and take appropriate measures in the effective “time window” to facilitate wound repair, this is not only a technology, but also an “art”, which requires long-term clinical accumulation.

13.1.1.3 Network Sequential Characteristics of Wound Repair

The so-called network sequence of wound repair refers to the participation of many different cells, factors and matrix components in the process of wound repair. At different stages of wound healing, various cells, factors and matrix components increase and decrease and regulate each other, thus forming the network and sequential nature of the healing process. There are many factors affecting the sequential advancement of wound healing, including exogenous or endogenous. A variety of reasons lead to abnormal immune system in the inflammatory reaction of wound repair, affecting the repair of wounds; malnourished people can inhibit the proliferation of wound repair, affect the formation of granulation and the synthesis of related components. Therefore, in the treatment of wounds, we must give a good healing environment. At the same time, the network and sequential features of wound repair also suggest that we have different biological events at different stages of wound repair. Therefore, wound treatment is not a drug or a means to “catch the world”.

13.1.2 The New Theory to Explain the Common Problems of Clinical Treatment of Diabetic Refractory Wounds

Diabetes mellitus combined with wound difficult to heal accounts for a considerable proportion of chronic wounds and is one of the important targets for clinical treatment. The traditional view is that the formation of refractory ulcers in diabetic foot can be divided into vascular, neurological or mixed vascular and nerve. However, we also clearly recognize that the main pathophysiological feature of diabetes is elevated blood glucose. This has led us to a series of thinking: Why is the main pathological mechanism of diabetic refractory wounds is neuropathy and vasculopathy, not elevated blood glucose? Is it possible to consider neuropathy and vasculopathy as a pathological result of hyperglycemia rather than an initial cause? Does hyperglycemia directly affect the healing process of diabetic wounds? Or does the skin tissue itself be damaged in the high glucose environment of diabetes mellitus? In response to these problems, our research group carried out a series of studies that lasted for 15 years, and through analysis and induction has formed some theoretical understanding of diabetes complicated with wound surface difficult to heal, which has reference significance for clinical practice.

13.1.2.1 The Nature of Difficult Healing of Diabetes Wounds

Diabetes combined with wound healing is a pathological evolution process based on metabolic disorders of diabetes mellitus and mediated by subsequent events of metabolic abnormalities. Compared with diabetic skin vasculopathy and neuropathy, the accumulation of metabolites in local tissues is an upstream event in the development of this disease. The microenvironmental changes caused by the increase of glucose content and accumulation of metabolites in skin tissue caused by diabetic metabolic disorders, namely “cutaneous environmental disorders,” are one of the initiating factors leading to the difficult healing of diabetic wounds. “Cutaneous environmental disorders” cause a series of “recessive damage” characterized by histological and cellular functional changes in noninvasive diabetic skin and continues to affect all aspects of wound healing after trauma, ultimately leading to delayed wound healing or not healed [5]. Therefore, for the prevention and treatment of diabetes mellitus complicated with wounds, it is undoubtedly the focus should be placed on the initial stage of “cutaneous environmental disorders,” that is, through the intervention of the upstream element related to wound healing, to stop the occurrence or development of its follow-up effects. Therefore, it provides a means for effective and feasible prevention and treatment strategies and achieves an ideal preventive and therapeutic effect on diabetic complicated refractory wounds.

13.1.3 Focus on the Key Issues of Wound Repair, Explore New Entry Points for Wound Treatment

Wound repair is an old and modern medical problem. It is old, because the wound repair behavior is the body’s instinct, even before humans, gorillas licking their wounds with their tongues is a proof; it is modern because human understanding of wound healing has been from the late 1980s to the early 1990s. Only from the rise of histology and cytofunctionology to the understanding of growth factors, it is gradually recognized that the wound healing process is regulated by a complex network. With the development of various related technologies, human understanding of wound repair mechanisms has made great progress: growth factors accelerate the regulation of wound repair; the role and status of inflammatory cells, especially macrophages in wound healing; role of various repair cells in wound repair; the role of extracellular matrix components and structures; and even the effects of stem cells and wound microenvironment on wound repair are gradually being recognized. The mystery of wound healing mechanisms is gradually being unveiled.

13.1.3.1 The Wound Repair Process Can Be Converted from Passive to Active

Before the 1980s, the traditional view was that wound repair is a natural means of protection for the body. It has an inherent spontaneous regulation mechanism. There is a sequence of self-regulation of the network. We cannot control or accelerate the healing process of the wound. What Clinicians can do is to protect the wound environment and prevent the wound from developing in a direction that is not conducive to healing. At that time, doctors can only passively wait for the natural healing of the wound. However, since the 1980s, with the deepening of people’s understanding of growth factors, it has been theoretically realized that growth factors can accelerate the healing process of wounds. In the early 1990s, a study at the Third National Burn Conference reported that the application of lymph fluid from the thoracic catheter in asthma patients to burn wounds significantly accelerated wound healing. At that time, we realized that lymph fluid may be rich in growth factors, and the effect of lymph fluid on wound healing may be related to growth factors. However, at that time, there was a lack of routine detection methods for growth factors, and the ELISA method for growth factor detection became popular in a few years. Different concentrations of cytokines and growth factors were detected in the lymph fluid, and the relationship between these growth factors and the accelerated repair of wounds was clarified. Later, a variety of commercial growth factors such as EGF, FGF, etc. were introduced one after another, widely used in clinical, and the role of growth factors in promoting wound repair was generally accepted. Since then, clinicians have no longer been passively awaiting the healing of wounds but can actively promote wound repair through the intervention of growth factors. With the gradual deepening of research on wound repair mechanism, we conclude that the wound repair process has regional, time-bound, and network sequential inertia characteristics. The three characteristics of wound healing tell us that the active repair and acceleration of the perfect restoration of the wound is not based on a means to protect the world. The perfect state of wound healing treatment should be the application of various cellular components, factors or extracellular matrix in a phased, selective or combined manner to protect the wound environment and promote wound repair. However, at present, our understanding of the wound repair mechanism and the means of promoting it are still far from perfection. There are still many scientific problems to be explored.

13.1.3.2 Strive to Explore Macrophage as an Important “Regulatory” Cell Behavior Mechanism for Wound Repair

Research and understanding of the role of macrophages in wound repair has gone through three stages.

Stage 1: In the mid-1970s, Leibovich et al. [6] used systemic hydrocortisone and subcutaneous local antimacrophage serum to remove macrophages from blood circulation and cutting wound and found that the degree of fibrosis was increased in the wound, fibrin, and neutrophil and red blood cell debris clearance time prolonged; the wound fibroblasts in control group appeared on the third day after injury, peaked on the fifth day, and fibroblasts appeared on the fifth day of the experimental group, and the proliferation ability was weaker than control group. For the first time, this classic experiment confirmed that macrophages are not only an immune cell that removes pathogenic microorganisms in wound healing, but also participate in wound repair.

Stage 2: In the 1980s and early 1990s, scholars confirmed the role of macrophages in promoting fibroblast proliferation, collagen deposition, and vascularization, and in situ hybridization and cell separation techniques were used to confirm that macrophages secrete various cytokines and inflammatory mediators during wound healing. It was confirmed that the wound could not heal smoothly without macrophages.

Stage 3: Since the late 1990s, the researchers have noticed significant differences between IL-4-treated macrophages and IFN-γ-treated macrophages. Macrophages treated with IL-4 did not show strong resistance to pathogenic microorganisms, but the expression of inflammatory factors such as IL-1, IL-8, and TNF-α decreased, and the expression of mannose receptors, which mediate endocytosis and pinocytosis, was significantly enhanced. Gordon et al. referred to the high inflammatory state of macrophages against pathogenic microorganisms as classical activated macrophage (caM or M1), and the macrophages with low inflammatory state after IL-4 and IL-13 treatment are called alternative activated macrophages (aaM or M2), and for the first time define macrophage activation patterns that are quite different from the past. Since then, the differential effects of caM and aaM macrophage activation in wound repair have been paid more and more attention. Scholars have already confirmed in vitro that classical macrophages and alternative activated macrophages may have different roles of wound repair. This suggests that macrophages of different activation types may have an important impact on the outcome of wound repair.

In recent years, in vivo experiments on macrophage activation have also been carried out, confirming that different activation modes of macrophages have a certain degree of growth and decline during normal wound healing, showing that both M1 and M2 activation markers are elevated in the early stage of wound formation, but the M1 is the main one, while the M2 mark is dominant in the later stage, and the growth and decline of activated M1 and M2 suggest that they dominate the different stages of the healing process.

In clinical research, Israeli scholars have isolated mononuclear/macrophage suspensions from whole blood through ABO and Rh blood group matching, and local injection or external application for treatment of refractory wounds after stimulation with hypotonic fluid. Since 1995, More than 1000 patients have been cured by this method, 90% of which are effective only with a single use of macrophage suspension. It is further suggested that macrophages are the key cells for wound healing. Studies have shown that macrophage-activated lipopeptide (MALP-2) can be used in the full-thickness model of the back of mice, which can increase the number of wound macrophages and promote wound healing. Studies suggest that the infiltration of wound macrophages can be intervened by external means. Recently, Miao’s research found that the infiltration of macrophages in the wounds of diabetic rats showed a phenomenon of “slow-in and slow-out,” which was not synchronized with the inflammatory phase and the proliferative phase. At the same time, it was found that the expression of M1 was insufficient and the number of M2 was overexpressed, showing the abnormal phase of macrophage infiltration and the abnormal expression rate of M1 and M2. These abnormalities may be related to changes in the microenvironment of diabetic wounds. From the above studies, it can be found that macrophages do play an important role in wound repair and play the role of “commander.” However, from the latter two studies, we can also see the infiltration of macrophages and the increase and decrease of M1 and M2 expression can be regulated by external intervention or changes in internal environment. The so-called “commander” of wound repair may be an important “executor” of wound repairs at best, not the “originator” of wound repair behavior. However, research on how to improve the wound environment, explore and create conditions conducive to the infiltration of macrophages and the orderly expression of M1 and M2 is still an important entry point to promote wound healing.

13.1.3.3 Pay Attention to the Role of Dermal Template in Wound Repair

In the literature on wound repair research, a considerable part of the research focuses on cells, factors or extracellular matrix components, and these components are involved in the network regulation of wound repair, which is an important direction of research. However, some phenomena in clinical practice have led us to think more deeply about this issue. If the same incision is made, the plastic surgery technique is used to suture, and the scar formation is not obvious, but if the general triangular needle is used for suturing, a clear scar will be formed. Why the same wound is supposed to stimulate the same “strength” wound healing response, but because of the different suture skills that lead to different healing results? Then, whether we have previously described the wound repair network sequential inertia response is only a possibility “domino array”? What is the original driving force to push down this “domino array”? Similarly, deep wounds with razor graft have scars, while full-thickness skin graft has no scars, giving composite transplantation of acellular dermal matrix and razor graft also has no scar. Why does the same depth of wound and the same wound healing reaction give different thicknesses of dermal matrix for replantation, and the healing outcome is very different? Liu Yingkai and other studies have found that the degree of dermal tissue defect can affect the wound healing process [7]. The three-dimensional structure of dermal tissue has a “template-like” guiding effect on the function of repairing cells, which not only induces the growth of repaired cells, but also improves the mechanical state of wound skin tissue, regulates the function of repairing cells, and promotes tissue remodeling; and the structure of the dermal tissue has a “permissive effect” on the component. Under the nonphysiological structure, the extracellular matrix component can have an abnormal effect on the function of the fibroblast. Once the structural and mechanical properties of the extracellular matrix return to the physiological state, then the abnormal effects of extracellular matrix components on cell function will disappear. The tissue structure is a “template” that guides the cell function. The appropriate three-dimensional structure can promote the completion of the cell physiological cycle and facilitate the recovery of cell biological behavior. However, the integrity and continuity of the dermal tissue are the necessary prerequisites for the tissue structure to fully play its “template effect.” The destruction of dermal tissue integrity and continuity caused by trauma may lead to the loss of dermal “template effect,” which may be one of the important mechanisms affecting the function of repairing cells and leading to scar formation. Therefore, the “template defect theory” of scar formation is proposed. Jiang Yuzhi et al. constructed a cell culture system with cell adhesion points at different angles through molecular self-assembly and microprinting techniques. It was found through experiments that the same cells exhibited different cell functions under the culture conditions of cell adhesion points at different angles. It is also calculated by geometry and calculus: any unregulated shape can be fitted with a plurality of arcs of different diameters, and the surface of the substrate adhered to different arcs forms a different angle from the horizontal plane. It is inferred that the adhesion of cells at different angles is equivalent to adhesion on matrix of different morphological three-dimensional structures. Therefore, Jiang Yuzhi et al. [8] concluded that the same cells exhibited different cellular functions under the culture conditions of cell adhesion points at different angles, which indirectly proved that the morphology of the three-dimensional structure of extracellular matrix can affect the function of repairing cells and affect the outcome of wound healing. The results of this series of studies suggest that the process of wound healing is not a mere biochemical event of cell-to-cell, cell-to-factor, and the role and status of the physical factor of the three-dimensional structure of the extracellular matrix of wound tissue in wound repair cannot be ignored.

13.1.3.4 The Impact of Wound Microenvironment on Stem Cells Is Worth Considering

Early studies have suggested that no matter what kind of wounds, as long as there are hair follicles remaining, the cells will have fulminant growth after injury. The reason why hair follicles can become the source of proliferation and differentiation of wound repair cells is mainly in hair follicles. At the same time, similar stem cells were also found in the basal part of epidermis. These cells differentiate into corresponding tissue cells according to their different anatomical levels, repairing defects and regenerating the skin. In recent years, the characteristics of stem cells with high self-renewal ability and multidirectional differentiation potential have been highly valued. The use of stem cells to treat various types of wounds, especially refractory wounds, has become a hot topic, and relevant basic and clinical research is continually deepening. However, in the in-depth study, many researchers have found that in addition to improving the local environment of the wound and promoting wound repair, stem cells are also susceptible to the microenvironment of the skin tissue. Various factors such as cytokines, inflammatory mediators, matrix active components, spatial structure, biochemical signals, biomechanics, etc. in this microenvironment can directly affect the differentiation direction of stem cells and their proliferative activity, this is the biological effect of so-called “stem cell niches.”

Taking diabetes mellitus and refractory wounds as an example, the accumulation of advanced glycation end products (AGEs) in skin tissue is one of the main causes of diabetic wounds. Diabetic skin with severe accumulation of AGEs may appear thin; the epidermis is not clear, the collagen in the dermal tissue is slender and loose; the collagen synthesis and decomposition are dynamically unbalanced. AGEs can also affect the local cell apoptosis of wound surface to increase and proliferation to be inhibited by affecting apoptosis- related factors Bcl-2, Bax, p53, and cell cycle related factors CDK4, Ki67, and mitogenic factors. At the same time, it also glycosylates growth factors in local tissues, impaired inflammatory cell function, local abnormal inflammatory infiltration, formed a “cutaneous environmental disorders” of diabetic skin. It can be seen that the local accumulation of AGEs creates a bad tissue environment that is not conducive to wound healing. So, can stem cells also be affected by this local environment? Through the specific markers of epidermal stem cells in diabetic wounds, keratin 19 and integrin β1 immunohistochemical staining showed that the positive expression was significantly lower than normal. In the wound skin of diabetic patients, the number of epidermal stem cells is smaller than that of normal human skin, and the ability to proliferate and differentiate is lagging. It can be seen that the microenvironment of the diabetic wound makes the main force stem cells of the wound repair in a “low state,” which inhibits the main driving force of wound repair and is worthy of attention. In recent years, enrichment of bone marrow mesenchymal stem cells or adipose derived stem cells has become a trend in the treatment of refractory wounds. However, whether stem cells enriched in bone marrow or adipose tissue of diabetic patients will also affect the healing of wounds due to the microenvironment of diabetes, it is worth further research and related experiments are underway. The study found that substance P acts as a stem cell synergist to increase the proliferation rate and mobilization rate of stem cells, and enhance the function of stem cells themselves to overcome adverse environmental factors; Shen et al. used degradable materials and bone marrow mesenchymal stem cells, fat marrow mesenchymal stem cells are prepared together with the biological scaffold, and the shape of the material itself changes the cell environment of the transplant, which can guide the stem cell to be repaired. It can be seen that external factors or environmental factors can effectively improve the “low state” of stem cells in the diabetic environment, which has found a breakthrough point for improving the effectiveness of the treatment of diabetic and refractory wounds, and it is worth exploring.

13.2 Interdisciplinary Technology to Improve the Level of Wound Healing Treatment

13.2.1 Improve the Accuracy of the Record of Wound History by APP

Chronic wounds belong to the category of surgery, and the history of surgical specialties requires the description of the characteristics of the wound. However, the judgment of any wound is characterized by morphology. Whether it is the existing evaluation system or classification criteria, or the description of the surgical specialty history is written, usually when the patient returns to the clinic, the doctor cannot imagine or restore the detailed characteristics of the wound surface at the time of the first visit or the previous visit according to the medical history description at the time of the first visit or the previous visit. Therefore, it is difficult to accurately determine the effectiveness of treatment or systematically review the progress of wound evolution. To this end, Shanghai Ruijin Hospital created a “mobile phone based wound information collection system” through software writing. The system photographs the wound surface through a mobile phone to record the morphological features of the wound surface, and then clicks on the drop-down menu to input the basic condition of the patient and the diagnosis and treatment plan of the wound, that is, the text can be uploaded to the database, and the information can be sent to electronic medical records and resident health records through the database. When the patient returns to the doctor, the doctor can use the mobile phone to recall the previous images and texts of the database, and visually review the medical history or the observation of the progression of the disease, making it possible to standardize and systematically diagnose the various types of wounds. Moreover, the system is also conducive to multicenter, large sample epidemiological investigations, worth promoting.

13.2.2 Improve the Traditional Methods to Expand the Scope of Application of Wound Treatment

Traditional methods such as debridement, expansion, dressing or skin grafting are the basic technical means of wound repair. With the development of modern science and technology, various methods for wound healing have emerged, which have greatly improved the efficacy of wound repair. Vacuum sealing continuous drainage is a clinical technique that has been widely used in recent years. Although the clinical use of this method has achieved a relatively consistent positive effect, there are still some negative reports. It is well known that wound healing is a complex biological process. Different stages have different characteristics and different clinical interventions are needed to facilitate the perfect healing of the wound. Xie Ting and Xiao Yurui of Shanghai Ninth People’s Hospital, on the basis of the technology of “Vacuum Sealing Drainage, VSD,” supplemented by intermittent flushing, achieved good results and expanded the indications for the application of VSD technology.

VSD has become a common technical means of wound treatment. A treatment cycle is 3–7 days. If the operation of this technique is unskilled, film leakage may occur. Therefore, patients receiving negative pressure therapy are often hospitalized. Recently, some scholars have proposed to add a pressure sensing device and a signal transmitting device to the negative pressure meter. Once the air leaks, the negative pressure meter can send a signal to the mobile doctor or nurse’s mobile phone, and the doctor or nurse on duty can immediately know which negative pressure instrument is calling the alarm. This technological improvement has made it possible to treat home treatments with VSD. Once the patient’s negative pressure treatment film is found to leak, the patient can be recalled for treatment. At present, the prototype of this technology has been successfully developed and is expected to be marketed in near future.

13.2.3 The Treatment of Sinus Wounds Under the Support of Endoscopy

The principle of surgical treatment of sinus wounds is flushing with drainage strips packing and dressing change or sinus resection. After a liver operation, the sinus was formed for more than 2 years, and the sinus was not healed after drainage strip packing and dressing change and two sinus surgeries. The sinus was about 18 cm long and the diameter was about 5 mm. It was transferred from the external hospital to our department. Our team broke the tradition and performed sinus wound treatment with the support of endoscope. This kind of wound treatment under endoscopic direct vision reduced the “blindness” of drainage strip packing and dressing change compared with traditional methods; the inside of the sinus wound is usually “dendritic” and often has many bifurcations. It is often difficult to completely remove the surgical sinus resection for such sinus wounds. The sinus wound treatment technology supported by the endoscope can overcome the deficiencies of the above traditional methods, and conveniently enter each sinus cavity, and clearly and intuitively observe the morphological features of the sinus cavity. As a result, it was found that the absorbable suture used in the proximal peritoneum of the case was not “absorbed” and became “foreign bodies,” causing the sinus to be unhealed (Fig. 13.1). After removing the “foreign bodies,” the sinus wound quickly healed. It can be seen that the form of wounds is diversified, and our traditional means are limited.

Fig. 13.1

Case of long-term sinus failure. At the 12 cm insertion of the endoscope into the sinus, two unabsorbed “absorbable” sutures and three sinus bifurcations are seen

This requires us to innovate, improve traditional methods, and absorb interdisciplinary techniques to improve the level of wound healing.

13.2.4 Improve the Traditional Diagnostic System with New Ideas

The research on wound repair mechanism has accumulated in China for more than 20 years. Taking the diabetes mellitus refractory wounds as an example, the theory of diabetic skin microenvironment pollution is proposed, which is different from the traditional pathophysiological mechanism. The theory holds that: diabetes mellitus and refractory wounds are based on the metabolic disorder of diabetes mellitus, a pathological evolution mediated by subsequent events of metabolic abnormalities. The microenvironmental change caused by the increase of glucose content in skin tissue caused by diabetic metabolic disorder and local accumulation of glycosylation end products, namely “cutaneous environmental disorders,” is one of the initiating factors leading to the difficulty of curing diabetic wounds. “Cutaneous environmental disorders” causes a series of recessive damage characterized by histological and cellular functional changes in non-invasive diabetic skin, and continues to affect all aspects of wound healing after trauma, including diabetic skin that has undergone histological and cellular functional changes before it is externally injured, known as “recessive damage” of diabetic skin. In addition, growth factors and their receptors are glycosylated, progressive tissue damage caused by excessive inflammatory reactions, vascular dysfunction, and damage to myelinated and unmyelinated nerve fibers, which ultimately leads to delayed or unhealed wound healing. Based on this, we can regard the vasculopathy and neuropathy of diabetes mellitus as the pathological outcome after the local accumulation of high glucose and glycosylation end products, and it is not the starting point of diabetic wounds. The local accumulation of high glucose and glycosylation end products is another upstream event of “recessive damage” of diabetic skin. It is concluded that the pathological type of diabetic wounds, in addition to vasculopathy and neuropathy, should also be included in the pathological criteria of “recessive damage” of the skin. This inference is to be established after a multicenter large sample clinical trial.

13.3 Establish a New Medical Treatment Mode for Wound Treatment

The treatment of wound disease has the characteristics of “small ward and big outpatient,” that is, a considerable number of patients only need to change the medicine in the outpatient service and only need hospitalization when deep treatment or surgery is needed. In the current situation where there are not many wound repair specialists, it is difficult to meet the needs of patients living in different regions. The most suitable dressing change for wound patients should be at their doorstep, at the community health service center. To this end, with the support of various levels of government in Shanghai, Shanghai Ninth People’s Hospital and the National Primary Medical Demonstration Unit in Shanghai, the Zhoujiaqiao Community Health Service Center in Changning District, Shanghai have established a two-way linkage mechanism between wound repair specialists and community health care, namely wound patients in the region only need to change medicines in the outpatient clinic of the community health service center. Only when deep treatment or surgery is needed, they are referred to the wound repair specialist of Shanghai Ninth People’s Hospital. When the condition is stable after surgery, the patient is transferred back to the community health center for hospitalization or home treatment. The integration of this single disease vertical medical resource has made it easier for patients to seek medical treatment and reduced the medical burden. The state’s investment in primary health care has been utilized, enriching the connotation of community medical care and the management index of the third-level and first-class general hospital where the wound repair specialty is located has been guaranteed, and the average length of stay in the wound repair specialist was 14 days, with the drug accounting for only 14%. But there is an urgent problem behind this gorgeous surface, that is, the general practitioners of primary care usually lack experience in wound treatment and need training and improvement. The wound restoration specialist has sent experts to meet regularly every week, but we are acutely aware that this is only a stopgap measure, because there are 232 community health service centers in Shanghai, and the limited number of wound repair specialists is obviously unable to cope with such a huge community demand. The birth of 4G communication technology brought us a solution. With the support of the Shanghai Economic and Information Technology Commission and China Mobile, the connection between the wound repair division and the community health service center was established with the high-definition video system based on 4G technology. The system enables specialists to clearly see the wounds of patients visiting a community health center through high-definition video and can direct the general practitioner to deal with the wound directly through dialogue. The system not only solves the distress of specialists running around hospitals and community health centers, but also reproducibly establishes a two-way linkage mechanism between other community health centers and specialist hospitals. At The First China-EU Wound Restoration Conference held in Shanghai in April 2011, the system was unanimously recognized by experts from various countries as a “top class” technology and an innovative wound repair medical treatment model. Government departments, medical authorities, and wound repair experts agree that this 4G HD video-based wound repair specialist integrates with the single-species vertical medical resources of community medical care to solve the problem of medical treatment for patients with chronic wounds, and meets the requirements of medical reform, has a good demonstration effect.

13.4 Challenge the History of Patients with “Rotten Foot Disease” Treatment

13.4.1 The Background

In Jinhua, Lishui, and Quzhou, Zhejiang Province, there are a number of patients with suspected biological-warfare-related foot ulcer during World War II. The number of patients is as many as hundreds. The patients’ wound ulceration has not been cured for decades. Because of the inability to find direct clinical evidence related to the bacteriological warfare in the case, we refer to these patients as historically leftover patients.

In response to the call of the famous social activist Wang Xuan for the diagnosis and treatment of patients with biological-warfare-related foot ulcers, in September 2014, led by Academician of Chinese Academy of Engineering, Professor Xiaobing Fu, Professor Lu Shuliang from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, in association with the Surgeons Branch of Chinese Medical Doctor Association and Shanghai Wound Healing Research Center and Chinese Wound Management Association, and all related experts across the country, formed a volunteer medical team to jointly carry out treatment for these patients.

13.4.2 Patient Characteristics

These patients have the following characteristics:

• A. The patient’s wound disease has been plagued for decades, many treatments have failed to heal and lose confidence in treatment.

• B. Patients have limited economic conditions and are unable to bear the cost of treatment.

• C. The patients are all elderly patients (70–90 years old), with varying degrees of senile diseases, and the risk of treatment is high.

• D. A considerable number of patients are less likely to be cured by conventional dressing treatment, but relying on modern technology can be cured by reasonable surgical treatment.

13.4.3 The Treatment Plan

In response to the above situation, the medical team has carefully discussed the following:

• A. Treatment Plans

  Three patients were admitted to the Shanghai Traditional Chinese Medicine-Integrated Hospital with no charge. The Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine received nine patients free of charge through the Wang Zhenguo Traumatic Medicine Foundation.

  The purpose of the first phase of the plan is to lay the foundation for further and more extensive treatment. At the same time, it can prove that these patients can be cured under the current medical conditions in our country using existing medical technology, thereby enhancing patients’ confidence in healing the wounds. Another challenge we face is how to benefit from a limited charitable donation. This requires us to explore a safe, economical, and effective treatment.

  Clinically, the fibrillar connective tissue of these patients are thick and dense, and some even have obvious calcified tissues (Fig. 13.2), which must be removed to form a wound bed with adequate blood supply, otherwise the skin grafts will not survive; elderly patients have thin skin. If the donor area is not handled properly, it is easy to form a new wound. Based on decades of experience in burn surgery, the medical team chose the scalp as the donor area. As a result, a treatment plan for these patients has been formed. By thoroughly removing the fibrillar connective tissue combined with VSD for 5–7 days, the patient’s autologous scalp skin had been obtained and small size skin grafts had been used to cover the wound. It had been proved that the treatment plan’s safe and effective, and all patients were cured by one skin grafting procedure. The average treatment cost for wounds was less than 20,000 yuan ($3000); it also proved that the application of TCM and medicine to cure such long-term difficult-to-heal wounds has considerable advantages.

  Ten out of twelve patients who received free treatment in Shanghai were cured and discharged, with one patient who requested to be discharged early due to family reasons and one patient with skin diseases who did not fall into the group.

• B. The Second Phase of the Plan

  Two surgical residents from Ruijin Hospital were sent to patients’ local hospitals to assist local doctors. The newly developed intelligent glass was used as a communication tool to provide real-time consultation from Shanghai’s senior experts as needed during operation.

  The purpose of the second phase of the plan was to explore the possibility of entry-level doctors to carry out treatment plans correctly with remote help from senior experts over the internet.

  After 2 months of operation, the results showed that patients can be treated according to the medical plans by the local doctors with the help of remote experts. During this period, there were a total of nearly 300 wound dressing changes, and four operations were performed on two patients, and patients were recovered and discharged.

• C. The Third Phase of the Plan

  Based on the successful work done during phase two, coordinated by Professor Han Chunmao, Vice Chairman of the Trauma Surgeons Branch of the Chinese Medical Doctor Association, a two-way intelligent remote visualization system between The Second Affiliated Hospital of Zhejiang University and The First People’s Hospital of Wucheng District of Jinhua City had been established in 2014. There were nine fully recovered patients who were operated by Qiu Xuguang, Director of Jinhua Hospital, through the system.

  Through the implementation of the three-stage plan, we concluded that a considerable part of the patients with biological-warfare-related foot or leg ulcers can be cured; relying on high-speed visual technology, under the guidance of remote experts, doctors from primary hospitals are fully capable to carry out complex wound treatments.

  At present, the Tencent Foundation and the Wang Zhengguo Trauma Medicine Foundation are collaborating to collect donations for the victims with biological-warfare-related foot or leg ulcers. The Trauma Surgeons Branch of the Chinese Medical Doctor Association is also working together with Shanghai Wound Healing Research Center to support the action and to promote the “two-way linkage model” so that more chronic wound patients can be effectively treated [9].

  In summary, the wound healing specialty is an emerging discipline that has emerged due to changes in the spectrum of diseases. It involves the crossover of multiple disciplines. Many diagnoses and treatment technologies and methods need to be further improved, and there is a lot of room for innovation. Therefore, in the face of the wound repair departments that have been established today, we must emphasize: We should pay attention to the connotation construction of the wound healing specialty.

Fig. 13.2

The thick, dense fibrous tissue of the wound surface and the removed calcified tissue

13.5 Construction of Wound Centers in China

The history of wound healing is also the history of surgery. From the prehistoric period, humans had already started treating wounds. Promoted by the development of human civilization, wound treatment is divided into three stages: original wound treatment, experience wound treatment, and scientific wound treatment. With the continuous advancement of the industrial revolution, scientific wound treatment has become the mainstay of wound healing. Various new technologies derived from the combination of practice and theory is continuously used for wound healing. At the same time, wound centers as the “carriers” of wound treatment developed. In modern society, with the changings of lifestyle and the aging problem, the disease spectrum changed. Chronic disease proportion increases significantly, consequently chronic wounds, which are complicated and difficult to treat, increase fast. Previous wound centers can’t meet the needs of patients anymore, they need to be updated and improved, a new model of wound center was born, here let’s call it modern wound center. At the end of twentieth century, many developed countries began to establish the modern wound centers, which always maintained a multidisciplinary cooperation group, and the centers grew fast. In China, modern wound centers began in the early twenty-first century and also developed rapidly. Due to different national conditions, the development of wound centers in China have their own characteristics.

13.5.1 The Predecessor of Wound Center in China

The predecessor of the wound center in China derived from the dressing rooms of large hospitals, some affiliated with outpatient departments or nursing departments, some belong to different clinical departments, such as burns, general surgery, and plastic surgery. In the 1950s, the population of burn patients grew rapidly because of the extensive steel-making, which made the burn departments expanded around China. Most of these burn department had separate dressing rooms which were the prototype of most wound centers in China [10].

The characteristic of the early dressing rooms was simple, simple diseases, simple conditions, simple staffs, and simple treatments as follows.

• A. Single Disease

  Patients needing dressing at that time were mainly acute wounds. Only a few chronic wound patients, mainly venous ulcers. It is worth mentioning that there were more intracutaneous foreign bodies injury cases at that time, because many jobs required manpower.

• B. Poor Conditions, Less Equipment and Dressing

  Early patients’ wounds were simple, and simple treatment was enough. Otherwise because of relatively few patients the hospital paid less attentions. Therefore, the conditions of the early dressing rooms were poor. Except for some basic equipment, such as dressing trays, tweezers, scissors, there was no other equipment.

  There were also very few materials only gauze, Vaseline gauze and bandages. At that time, the management of antibiotics was not strict. External application of intravenous drugs, such as gentamicin, clindamycin, and chloramphenicol, was common.

• C. Simple Staff Structure and Professional Skills

  In general, there were two to four nurses arranged in the dressing room. Although these nurses usually contacted with dressing changing, but they did not have formal training and knew few theory knowledge of wound. They were just arranged in the dressing room, started to work, taught by the nurse in the dressing room hand by hand. There was no doctor in the dressing room. If the patients needed doctors, they had to go to different departments.

• D. Burning Department Dressing Room Was Relatively Complicated

  Early in China, because of few car accidents and low proportion of chronic diseases, wounds were always simple except for burns. Dressing change was relatively complicated. That was one reason why a large ratio of wound centers in China was attached to the burn department.

13.5.2 The Development of Wound Centers in China

The rapid development of China’s economy began in the 1980s. Meanwhile, chronic diseases became a major health problem. Consequently, chronic wounds patients increased. Farsighted experts in China begun to write relevant medical treatment norms and recommendations to promote the development of related medical treatment. Guiding Opinions on Chronic Wound Diagnosis and Treatment 2, which was started by Academician Xiaobing Fu, was the first guiding literature for chronic wound treatment in China [11]. At the same time, with the efforts of relevant experts such as Academician Xiaobing Fu, Professor Lu Shuliang and Professor Han Chunmao, the wound centers in China started a new development.

13.5.2.1 The Start of the Wound Centers in China

As in other countries and regions, changes in disease spectrum and increased patients were the root causes of wound centers’ construction. But the start of wound centers in China had its own characteristics. Its main feature is that they belonged to the different departments. The department that started the establishment of modern wound centers in China was the burn department. That was related to historical development as we talked. In the 1950s, the burn department developed rapidly. However, with the development of science and technology, large-scale burns were rapidly reduced. For living, burn surgeons began to look for new outlet with their rich experience in wound treatment. At the same time, general surgeons couldn’t cope with the increase in chronic wounds anymore, they begun to seek help from burn surgeons. As a result, the burn department began to intervene in the treatment of various wounds rather than burns.

As mentioned above, some prospective burns departments, after analyzing the situation of foreign wound center, started to establish independent and standard wound center according to the domestic situation. They pioneered the treatment of wounds and developed into a leader in this field in China. Among them, the wound center of the second affiliated hospital of Zhejiang University Medicine College, which was established in 2004, was the first wound center led by surgeons.

In addition, some of wound centers in China were affiliated with other departments, such as endocrinology. They mainly treated diabetic foot ulcers. Diabetic foot center of Chinese People’s Liberation Army 306th hospital was the most famous one. This center even equipped with its own surgeon and independent operation room. Of course, some of wound centers in China were also wound care centers affiliated with nurse department. They started earlier and developed well. Especially after the first nursing staff wound treatment school in Guangzhou, the level of wound care in China entered a new stage.

In 2015, a survey of wound centers in China was conducted which was organized by Academician Xiaobing Fu. The survey showed that most of the wound centers were derived from burns and outpatients departments [12] (Fig. 13.3).

Fig. 13.3

Predecessor of wound center and wound care center in China

13.5.2.2 Development of Wound Centers in China

From the beginning of the twenty-first century, in response to the needs of social development, the wound center began to develop. Many experts have done a lot to promote its development, and their efforts have also attracted more attention from medical staff and institutions to wound centers. In the early days, the main members of the Organizational Rehabilitation Professional Committee (Group) of several Chinese Medical Association Trauma Branches, such as Xiaobing Fu, began to discuss the possibility of establishing a comprehensive wound center in China. In 2005, they proposed to build a standardized and exemplary wound center. In 2009, Academician Xiaobing Fu published an article entitled “The Construction of Wound center Is Imperative” in Chinese Journal of Burns. The article states that wound treatment is not only the basis of all trauma treatment, but also the key to prevent late complications and promotion early recovery of trauma patients, and a wound center with a certain scale and characteristics, is to promote the development of new technologies for wound healing and to benefit the trauma patients. Further calls for the establishment of a national wound center through the establishment of a demonstration wound center.

At the same time, the rapid increase of various acute and chronic wounds, especially chronic wound patients and the extremely lack of related medical resources, has formed a sharp contradiction. More and more problems caused by this contradiction have begun to become the burden of hospitals. Chronic diseases and aging of the population are two important reasons for the increase of chronic ulcers. The latest epidemiological survey shows that the incidence of chronic wounds in hospitalized patients in China is significantly increased, among which diabetic wounds, chronic wounds after trauma, and pressure ulcers are the top three chronic wounds. The contradiction between the medical needs brought about by wound diseases and the lack of medical resources in China has become increasingly prominent, as shown in the following aspects:

• A. Most hospitals, including large-scale comprehensive hospitals, have few specialized departments for wound treatment. Wound patients often cannot find suitable clinics, and the difficulty of treating patients with wounds became a real problem.

• B. Patients often had various basic diseases and need multidisciplinary comprehensive treatment, which also caused wound patients need to transfer in different departments, but couldn’t get a more systematic and comprehensive treatment. In addition, patients with wounds often have inconvenient movements, which bring many inconveniences to patients, and even lead to unsatisfactory emotions.

• C. The diagnosis and treatment of wound treatment lacked new knowledge and new technology, and a standardized diagnosis and treatment path to guide doctors to treat, which also led to the uneven effect of the current wound diagnosis and treatment.

  Wound treatment professionals are extremely scarce. At first, they were just doctors from different departments not professional. It is worth mentioning that in recent years, under the impetus of Academician Xiaobing Fu, Professor Lu Shuliang, Professor Han Chunmao, Professor Xu Zhangrong, Professor Xie Ting and other experts, the training courses for various wound treatment doctors started in China. At the same time, a wound healing association established in China to further standardize and normalize related wound medical training. In addition, some of the nursing staff trained in the wound treatment and enterostomal therapist training courses of the nursing staff in China gradually played a great role in transforming them into wound specialist nurses.

• D. In some places, patients with chronic wounds couldn’t get the treatment” in the outpatient clinic but could only be admitted to the hospital. These patients have long hospital stays and high medical resources, which have brought considerable influence to the management indicators of various hospitals. In fact, the treatment of wound disease has the characteristics of “small ward and large outpatient service,” that is, except for some patients who need hospitalization for surgery, a considerable number of patients only need to spend time in outpatient consultation and dressing change. This feature leads to the need for our patients to have larger outpatient clinics to meet their medical treatment. The above contradictions have attracted more attention, which has become a driving force for the construction of wound centers in China.

  In the 5 years from 2006 to 2010, nearly 20 hospitals established wound centers. As expected, these wound centers taken a good lead and demonstration role in China which became temples. With the establishment of the demonstration center, wound centers developed rapidly, grown by more than 10 per year [13] (Fig. 13.4).

Fig. 13.4

Established time map of wound center and wound care center in China

13.5.2.3 Mode of Wound Center in China

Wound centers in China have their own characteristics because of the different characteristics of each region, each hospital, and each subordinate department. However, they have some common characteristics and models in terms of their overall structure, management and norms, details as follows.

• A. Doctors Were the Center

  More and more people have realized that wound treatment is not a simple dressing, and the knowledge structure of the caregiver can no longer afford all the wound treatment. The wound centers established by academic leaders in various regions and hospitals have begun to be doctor-centered. These doctors not only have a passion for wound treatment, but also have various knowledge structures related to wound healing. In addition, they have taken the initiative to absorb the experience of foreign developed countries, take their essence, draw on their successful cases, and then establish standardized treatments for various wound centers according to their own characteristics. This kind of impetus is undoubtedly huge.

• B. Multidisciplinary Cooperation, Diagnosis, and Treatment Norms

  The exemplary wound centers all attach importance to multidisciplinary cooperation. For example, in the diagnosis and treatment of diabetic foot, many wound centers have established a multidisciplinary cooperation framework, focusing on the specialists of the wound center, at the same time, doctors from endocrinology, orthopedics, vascular surgery, radiology, cardiology, nutrition are involved in the and other departments intervene in the systematic diagnosis and treatment of patients through consultations and other methods. At the same time, various medical treatment norms have also received attention from everyone. For example, the Wound Diagnosis and Treatment Center of the Second Affiliated Hospital of Zhejiang University School of Medicine has established a variety of outpatient diagnosis and treatment paths for chronic wounds, and its diabetes foot clinic diagnosis and treatment path has been promoted by the whole hospital.

• C. Active Use of New Technologies, New Methods, New Materials

  Although there are few medical insurances for new dressings or equipment related to wound healing in China, the application of various new dressings by various wound centers has been welcomed by more and more patients. We can find a variety of advanced dressings in most wound centers, such as hydrocolloids, hydrogels, foam dressings, alginate dressings, silver ion dressings, and more. In addition, the application of various new technologies is also in full swing. For example, vacuum sealing drainage technology, China has more than ten domestically produced closed vacuum sealing drainage materials.

• D. A Demonstration in a Region

  Although the establishment of a wound center is growing rapidly, there is currently a wound center that can be used as a model in a region. This demonstration center will often be the core of various wound healing institutions in the region. The hospitals in this demonstration center are often large comprehensive hospitals in the area, so the equipment is relatively new and comprehensive. The general demonstration sites have equipment for ankle-brachial index, vascular Doppler, and vibration threshold inspection. There are even equipped with transcutaneous oxygen partial pressure tester, plantar pressure tester, laser Doppler, ultrasonic debridement instrument, and red light therapy instrument and so on. These demonstration sites have also begun to become training bases for wound healing personnel in the region and are beginning to play an increasingly important role.

13.5.2.4 Wound Training Programs, Meetings and Organizations

• A. Wound Diagnosis and Treatment Training Program

  In 2010, the World Diabetes Foundation (WDF) and the Chinese Medical Association Trauma Branch Tissue Rehabilitation Professional Committee (group) jointly launched a diabetes foot and related chronic wound education program for doctors and nurses in China. The project officially launched the Chinese wound treatment training, trained thousands of medical staff, and established dozens of training bases. In addition, the training of diabetic foot is relatively early. The training of diabetes foot initiated by Professor Xu Zhangrong was started in 2005. These projects led to more comprehensive training programs. In addition, in 2014, Academician Fu Xiaobing, Professor Han Chunmao and Lu Shuliang organized an expert group to write the wound guidelines base on Chinese literature. After 1 year the first Chinese wound treatment guideline completed.

• B. Related Meetings

  There are a lot of relevant domestic conferences. At present, there are several conferences with influential scales.

  • (a) The meeting of the Tissue Restoration Group of the Chinese Medical Association Trauma Branch: The group has held several related meetings, which have received the attention of relevant experts and played the leading role in wound healing.

  • (b) Relevant meeting of the Association of Trauma Surgeons of the Chinese Medical Association: the association has a number of groups, including the Wound Treatment Therapy Branch, and the annual meeting brings together the nation’s wound treatment experts. The first director of the club is Professor Lu Shuliang.

  • (c) International Diabetes Foot Forum: the conference was initiated by Professor Xu Zhangrong. It started in 2005 and held every year. The forum invites famous domestic and foreign experts from different fields such as diabetes, endocrine, vascular surgery, diabetic foot disease, orthopedics and burns, conduct academic reports and exchange of clinical experience around diabetic foot and related diseases.

  • (d) Sino-Europe Wound Repair Conference Wound Repair: co-organized by the Tissue Restoration Committee (Group) of Chinese Medical Association Trauma Branch, and the European Wound Technology Society, every 4 years, the first session was held in 2011 by Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, hosted the theme of “Transformation Practice of Wound Repair.”

  • (e) National Burns Annual Meeting and National Burn Treatment Symposium: Since most of the doctors in wound treatment come from the burn department, there are a large number of reports on wound treatment every year at burn-related meetings, and the relevant committees will also discuss issues of wound treatment.

• C. Related Organizations

  As the development of wound, more and more organizations founded. The earliest and most famous national organization is “Chinese Wound Management Association.” On December 26, 2011, the Chinese Medical Association Trauma Brach held a special meeting in Shanghai. The chairman of the committee, Xiaobing Fu, announced the establishment of the “Chinese Wound Management Association.” This Association also connected with other countries and areas’ wound associations represented as Chinese wound doctors.

13.5.2.5 Limitations of the Construction of Wound Centers in China

Of course, the construction of wound centers in China also has many limitations, involving systems, concepts, subject codes, and charge. The resolution of these problems requires the cooperation of government authorities and hospitals. Mainly as follows:

• A. Medical Insurance Limitations

  At present, medical insurance in China has not included many relevant examinations and treatments for wound treatment, such as the examination of the sputum index. Various new dressings, new technologies such as negative pressure drainage technology, stem cell therapy, etc. are often not covered by medical insurance. However, it is encouraging that medical insurance institutions have begun to pay attention to wound diagnosis and treatment and have begun to include some wound-related medical treatments and dressings in some areas and some hospitals into the scope of medical insurance. In the near future, most of the wound treatment can be included in the scope of medical insurance.

• B. Concept

  Although people’s living standards have improved greatly, many concepts have not changed. For example, patients’ perceptions, many patients are afraid to let others see their own broken skin, so there is no medical treatment! For example, doctors, many doctors often like to engage in “classic” professions, have no concept of wound healing. In addition, the concept of managers needs to be changed. At present, some hospital administrators have certain concepts about wound treatment. Compared with patient satisfaction, the relevant economic benefits are relatively low, which often affects their support for the construction of the center. The department’s managers are still paying little attention to wound centers.

• C. Subject Code

  There is still no special discipline code for wound treatment in China, which means that many wound treatments can’t be done alone, which brings us great difficulties.

• D. Charge

  Wound treatment is becoming more and more complicated, but the current fee system still stays for decades or even decades, which is undoubtedly counterproductive for the construction of a discipline.

• E. Others

  In addition, many disciplines in China are not as perfect as those in other countries. For example, there are no podiatrists and orthotists in China. The relevant decompression insoles, shoes or brace are not equipped with professional personnel.

  In short, the construction of wound centers still has many limitations, which require us to pay more attention and care, and need our efforts to change and improve.

13.5.3 The Prospect of the Construction of Wound Center in China

The wound center in China has developed rapidly, which is closely related to the development of social economic science and technology, and has also played a role in the experience of other countries. Under the promotion and efforts of relevant experts such as Xiaobing Fu, the development of wound centers in China is gratifying. At the same time, the team of wound treatment experts in China has also begun to attract attention in the international arena. The Chinese Wound Management Association, led by Xiao Xiaobing, introduced wound diagnosis and treatment discipline in China to the world when applying for the 2020 World Union of Wound Healing Societies (WUWHS). Although it was unsuccessful, the Chinese wound diagnosis and treatment discipline began to shine on the international stage. In March 2018, at the first Asian Wound Treatment Annual Conference, Professor Lu Shuliang took over the banner of the conference from the organizers of the conference and announced that the second Asian Wound Treatment Conference will be held in Shanghai in May 2019. Looking ahead, our prospects are limitless. In order to strengthen development, we need to work harder. First, we must arm ourselves with new theories and new technologies. In the information age, we should adopt more advanced electronic processing models to better evaluate wounds, record data, and facilitate more effective, large-scale clinical research and promote the development of disciplines; second, we need to be guided by innovative ideas to promote the development of disciplines; finally, the construction of the wound center needs the support and attention of all parties. I believe that the government departments will give greater support in the near future, and medical insurance can also be included more projects. We will also serve our patients better! Wound healing: let the mind fly! [14]