Module 1 - Wound care & Healing

Abnormal Wound Healing

1.) Hypertrophic scars

  • Remain within boundaries of original scar
  • Common areas of occurrence are back, shoulders or sterum
  • Red, raised and often pruritic
  • Can resolve with time and often treated conservatively

2.) Keloid scarring

  • Extend beyond boundaries of original scar
  • Common areas of occurrence are sternum, deltoid and earlobe
  • More frequently occur in darkly-pigmented people
  • Do not spontaneously heal and demand treatment with pressure bandages, surgery, radiation or topical steroids; reoccurrence is common.

3.) Chronic Wounds

  • Lacerations and open injuries older than 24h
  • Require débribement, irrigation, and healing by secondary or tertiary intention
  • Wound sepsis is determined by the total bacterial load per gram tissue (>105 bacteria/gram tissue)
  • Systemic antibiotics not useful, however topical antibiotic creams (silver sulfadiazine, bacitracin, Neosporin) for areas of partial thickness loss may be useful. Be aware that some of these agents inhibit epithelialization and the initial stages of wound healing
  • Biological dressings can be used
  • Final closure should be performed only after bacterial contamination is controlled
  • Deep sutures should be kept to a minimum and monofilament. If any signs of infection seen on reevaluation, portion of wound is opened by removing sutures

 

Author: SP Zinn