Wounds. wounds healing amp complications

Tidy incised wound on the finger

Untidy avulsed wound on the hand

Facial trauma – apparent tissue loss but none found after careful matching

Degloving hand injury

Dog bite in a child

Degloving buttock injury

Fasciotomy of the lower leg

(a) Early inflammatory phase with platelet-enriched blood clot and dilated vessels. (b) Late inflammatory phase with increased vascularity and increase in polymorphonuclear lymphocytes (PMN) and lymphocytes (round cells). (c) Proliferative phase with capillary buds and fibroblasts. (d) Mature contracted scar.

Multiple keloid scars

Burn contractures showing hyperextended fingers and hyperflexed elbow.

Post-traumatic (chainsaw) midline neck contracture

Multiple Z-plasty release of finger contracture

Treatment of hypertrophic and keloid scars
Pressure – local moulds or elasticated garments
Silicone gel sheeting (mechanism unknown)
Intralesional steroid injection (triamcinolone)
Excision and steroid injectiona
Excision and postoperative radiation (external beam or brachytherapy)a
Intralesional excision (keloids only)
Laser – to reduce redness (which may resolve in any event)
Vitamin E or palm oil massage (unproven)

MANAGING THE ACUTE WOUND
The surgeon must remember to examine the whole patient
A bleeding wound should be elevated and a pressure
Clamps should not be put on vessels blindly as nerve damage is likely and vascular anastomosis is rendered impossible
Devitalised tissue must be excised until bleeding occurs with the obvious exception of nerves, vessels and tendons
Muscle viability is judged by the colour, bleeding pattern and contractility
In a tidy wound, repair of all damaged structures may be attempted

Meshed split-skin graft

Managing the acute wound
Cleansing
Exploration and diagnosis
Debridement
Repair of structures
Replacement of lost tissues where indicated
Skin cover if required
Skin closure without tension
All of the above with careful tissue handling and meticulous technique

CHRONIC WOUNDS
1.Leg ulcers
Aetiology of leg ulcers
Venous disease leading to local venous hypertension (e.g. varicose veins)
Arterial disease, either large vessel (atherosclerosis) or small vessel (diabetes)
Arteritis associated with autoimmune disease (rheumatoid
arthritis, lupus, etc.)
2.