Wound Management
Body physiology helps in healing wounds naturally. Large wounds, infected wounds or wounds associated with diabetes or vascular disorders, postoperative wounds need special attention and care. Minor traumatic wounds may sometimes also need specific attention to rule out involvement of any important structures such as bone, nerve, vessel or tendon underneath.
As a Plastic Surgeon, Dr. Sumita Shankar has a great experience in wound management. She has performed more than three thousand reconstructive surgery procedures requiring skin grafting, flap cover or microsurgery. She has passionately worked towards understanding the basic physiology and science of wound healing and conducted workshops to train and impart knowledge to the budding surgeons. She along with other international wound surgeons organized CME (Continuing Medical Education) in the city of Hyderabad and other districts of Andhra Pradesh.
Various Causes of Wound:
Acute Wounds:
Trauma: Minor abrasions, Deep Cuts, Lacerations
Infective
Snake Bite
Burns
Electric Shock Injury
Cellulitis
Hand Injuries
Facial Injuries
Limb Trauma
Postoperative Wounds
Chronic Wounds
Diabetic Foot
Venous Ulcers
Vascular diseases
Bed Sores
Nonspecific Ulcers
Advanced Wound Care and Management
ABCDE of wound management entails:
Assessment Initial wound assessment is important to know about the depth, chronicity, and involvement of associated important structures, wound bed preparedness.
Biology: to rule out any bacterial growth by taking swab culture particularly in chronic wounds
Comprehensive treatment: Wounds heal if the general nutritional status is taken care of too. Cause of the wounds such as venous incompetency, restoring vascularity or treating infections with appropriate antibiotics cures wound and prevents their further formation too
Documentation: involves not only for maintenance of record but also keeping a tab on progress of wound
Debridement:
Depending on the wound bed most of the chronic wounds would need removal of dead and necrotic tissue to cleanse up the wounds till the wound bed is covered with healthy pink granulation tissue.
Dressings:
Most of the wounds also require repeated dressings. The type of discharge or the exudate plays a crucial role in determining the type of dressings required to cover up the wounds so as to assist in quicker healing
Definite treatment:
Some wounds may heal with dressings alone. Ointments and creams, local stem cells injections and Platelet rich growth factors (PRP) help in rapid and painless healing in most of the smaller wounds. NPT or Negative Pressure Therapy very effectively helps in healing of wounds faster by removing exudate, creating a milieu for promotion of granulation tissues.
According to the necessity wounds may also be covered with skin grafts, local, regional or distant flaps. If necessary we can also do micro vascular surgery to restore the healthy cover.
Evaluation:
To prevent recurrence it is essential to take care of diabetes, neuropathy, venous incompetency and vascularity of limbs. One may also need to rule out if there is any underlying malignancy or cancer by biopsy in case of doubt.
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