Wound care

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Wound care




Wounds



Fundamentals of wound healing




image The wound healing process is like a symphony, requiring many integral components to work together toward a common goal—healing a wound.


image Normal wound healing begins with the initial platelet plug in the inflammatory phase, to a proliferative collagen-producing phase and an ultimate remodeling phase, which can last up to 1 year. Platelets, neutrophils, macrophages, and fibroblasts interact via multiple cytokines and cell signaling pathways to coordinate the transition from one phase to another.


image The arrest of a wound in one of those states, as well as prevention of progress to the next phase, may result in a nonhealing wound. As part of a surgical team, it is helpful to recognize potential challenges to normal wound healing and prepare patients for delayed wound healing or refer them promptly when indicated.





Physical examination








Principles of wound care: Treatment



Acute wounds




Closure



image To minimize scarring, close acute wounds on extremities (excluding the hand and fingers) in layers.




Chronic wounds




image Treatment is based on the etiology of the chronicity of the wound. Identify (on the basis of the history) the main etiology for the delayed wound healing.



• Treat contaminated wounds with mechanical débridement in the office or enzymatic débridement or dressings that will débride the wound (normal saline wet-to-dry dressing changes twice daily). Chemicals such as Dakin solution should not be used for more than 48 hours because they can be toxic to healthy tissues.


• Treat pressure ulcers with appropriate orthotics for pressure offloading or total contact casts if the patient is a candidate.


• Treat arterial ulcers with referrals to vascular surgery for evaluation of inflow.

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Jun 7, 2016 | Posted by in ORTHOPEDIC | Comments Off on Wound care

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