Basic plastic surgery techniques and principles: Chronic wound management
In the sixth part of our series, Aroushka L James and explain Ardeshir Bayat the management and treatment of chronic wounds
Visit any hospital in any country and many patients are likely to have chronic non-healing wounds. For example, in the United Kingdom the cost to the NHS of treating these patients is vast-estimated at £1000m ($1700m €1400m) a year.1Of course, this estimate does not take into account the effect on the patient's quality of life.
Healing is a highly complex process. The ordered sequence of events can be described as four key stages-thrombus formation, inflammation, cell proliferation and repair of the matrix, and epithelialisation and remodelling of scar tissue.2
In a chronic wound, this order has become deranged, disrupting the sequence at one or several of the stages.3 This may be because of defective remodelling of the extra cellular matrix, failure to re-epithelialise, or prolonged inflammation.4
General patient assessment can help to avoid a delay in healing. A wound that is poorly vascularised or flooded with oedema will not heal.11