Wounds

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Overview 

Wounds are disruptions in the body tissues and can involve any of the layers including skin, muscle, and bone. They are the result of trauma like a laceration or burn or intentional from a surgical procedure. Wounds can also occur because of poor blood flow towards or away from the tissue.

The body heals wounds by creating a scar. Several factors must be present and functioning for efficient wound healing and ultimately scar formation to occur. One factor is adequate blood flow which provides oxygen, nutrients and other chemical building blocks necessary for tissue repair. Another factor is a clean wound bed free from infection causing microorganisms and debris like dead tissue cells or foreign bodies like dirt. Yet another factor is prevention of further harm to the area by mechanical and chemical insults. Edema (swelling of the tissue) hinders the transmission of oxygen and nutrients to the wound bed by increasing the distance they must travel. Shear stress (sliding of tissues against each other) disrupts connections of newly formed blood vessels. Tension from sutures or attempting to close too great of an area can restrict blood flow. Finally tobacco and nicotine substitute use also cause restriction of blood flow due to constriction of blood vessels.

Our goal is to optimize the tissues ability to heal a wound and form a scar. Modalities commonly used in the operating room, physician’s office, and patient’s home are as follows. Dressings protect the wound and can serve to keep both open wound areas moist and intact skin areas dry. Dressings can help remove debris and infection. Elevation of the wounded part helps swelling (tissue fluid build-up) drain by gravity. Antibiotic medications aid in treating infection however are seldom required to prevent infection in the wound that has been adequately débrided. Commonly granulation tissue grows in the wound and this indicates a healthy bed. The wound now progresses through phases of skin growth and contraction until it is healed shut. There are occasions when a granulated wound may be surgically closed by suture alone or a skin graft.

Once the wound has closed and healed as a scar there are additional beneficial modalities that can improve the appearance of the scar. Scar massage helps to improve circulation, sensation, and smooth rough areas. Protection with sunscreen and avoidance of sun exposure, lessen the chance fro pigmentation changes within the scar. Both sun protection and massage will help the redness subside in a timelier manner.