ABC of wound healing:Reconstructive surgery
Many surgical options are available to a reconstructive surgeon when faced with a difficult wound, say Dean E Boyce and Kayvan Shokrollahi
Any decision about management of a wound should be holistic and take into account factors such as the occupational circumstances of the patient and likely period of time off work, comorbidity, likelihood of success, donor morbidity, functional outcome, and the risks of surgery and anaesthesia. The basic principles of wound management apply to all wounds.
Reconstructive surgeons use the concept of a “reconstructive ladder”-the more problematic the wound, the higher up the ladder the surgeon has to climb. Simple wounds may be closed by primary suturing, sometimes in the primary care setting. But others may require complex reconstruction, including free tissue transfer, in hospital.
All traumatic wounds should undergo debridement and thorough irrigation before primary closure. The aim of debridement is to remove all potentially contaminated and devitalised tissue along with foreign material. Primary suture may not be indicated in heavily contaminated wounds, where the risk of infection is high.