Surgical wounds

All kinds of surgical interventions or accidents which involve braking the skin structure lead to wound formation.

 

                       Wound types, stages and wound treatment models

 

Wound healing process can be divided into three basic stages:

  • inflammatory (exudative) – debridement of the wound be   
  • proliferative – granulation tissue regeneration
  • diversified – maturing, epithelialization and scar formation (ulosis)

Inflammatory stage

Inflammatory stage is the first to cope with a cutaneous injury and inflammation and lasts up to 3-4 days if there is no contamination and complications. In the case of more severe traumatic injuries with disturbances to healing process  it can last up to several weeks or months. Oxygen, which is necessary for fagocytosis, is the key element of the inflammatory stage. Proper oxygen delivery to tissues is the effective protection against contamination. Thanks to its antibacterial properties ozon can also facilitate wound healing. Inflammation is a natural process accompanying any wound but the exudate may be intensified when fibrosis occurs or when microorganisms or contaminants take residence.

Wound inflammation characteristics include: skin reddening ( rubor), warming ( calor), swelling (tubor) and pain (dolor)

Proliferative stage

Proliferative stage (also referred to as granulation)  begins when the wound is clean, well-supplied with blood and ready for granulation tissue regrowth. It begins within 4-5 days of the skin injury (in physiological wounds) but in pathological conditions it may occur after several weeks or months.

 Epithelialization  stage                                                                                              

Epithelialization and scar formation stage begins after completed  wound granulation i.e. after 6-10 days of collagen fiber maturation. Proper blood flow makes the wound close. Epithelialization is strictly connected with tissue granulation which involves epidermis cell formation via mitosis cell regrowth from the wound edge.

Scar formation completes the wound healing process.

 

TIME is the strategy we apply in wound healing and care:

 T – (tissue debridement) – devitalised tissue removal

I – (infection control) –  inflammation and infection control

M – (moisture balance) – proper moisture balance maintenance

E – (epidermization stimulation) –  epidermalization stimulation

 

Abnormalities  and disruption to the healing process may lead to the formation of chronic wounds such as ulcers or, depending on the location, bed sores. Complicated wounds after surgical interventions or due to comorbidities or improper care can become a chronic condition.


Photo gallery of cases:

Patient 1. A 56-year-old patient after endovascular aortic grafting in a lower limb. 

After surgery the wound formed at the vascular access lock opened in the groin.

Before treatment:

When the patient came to our clinic the wound was open and deep, non-healing for three months, covered in fibroma accompanied by redness, exudate and pain. 

On the basis of ultrasound diagnostics and antibiogram an antibiotic was selected and applied orally. Throughout the healing and care process multitargeted desinfectants were used and specialist dressings were always adjusted to the wound healing stage.

Wound rehabilitation was also implemented. The patient followed the dietary instructions and individual recommendations.

Photo 1. During treatment, Photo 2. After treatment

The wound was healed completely within 6 months. The post-surgery area causes no pain and does not disturb functioning..

Patient 2. 54-year-old female came to the clinic approx. 3 months after hallux valgus surgery due to post-surgical complications.

Post-surgery wound opened, fibroma appeared on its bed and oedema and pain occurred. Post-surgery care provided was ineffective in wound healing which caused the wound to grow bigger every week.

Photo 1. Before treatment , Photo 2. During treatment

Photo 3. After treatment completion

Patient 3. A female patient (aged 22) after surgical removal of a birth-mark. Being concerned about poor healing, and actually the wound getting bigger, she came for help to our clinic.

Photo 1. Before treatment , Photo 2. During treatment

Photo 3. After treatment completion

The treatment took nearly 4 weeks.

Patient 4.  A volleyball national team player, aged 21, after an injury underwent a knee surgery. Unfortunately, after several weeks of treatment and rehabilitation the wound did not heal and started to swell and cover with fibroma.

When the patient came to our clinic he suffered pain, oedema and depression caused by his exclusion from competitions.

Photo 1. Before treatment , Photo 2. During treatment

What appeared to delay healing was the sutures left in the wound which irritated it from the inside. It resulted in pathological hypergranulation while healing process on the outer layer led to tissue necrosis.

Photo 3. After treatment completion

The wound was healed completely within 2 months. The remnants of the sutures were removed and long-lasting dressings were used according to the healing stage. Further treatment included limb rehabilitation and skin immunisation.

The patient is now back again part of his volleyball team.

Patient 5. A 68-year-old male patient came to the clinic with a non-healing wound on the side of his foot which was caused by an accident 40 years earlier. Several years ago an ulceration appeared on the neoarthrosis on the side of the ankle joint.

Many medical units could not cope with the patient’s non-healing wound.

Before treatment:

Years of dressing dried the wound up and led to partial fibroma. The wound bed was covered with fibroid and maceration and exudate was present. Callosity was formed around the wound and the skin was very tense and dry.

During treatment: Stage 1:

  The wound was cleansed, which automatically caused skin regrowth.

During treatment:

Rehabilitation which involved skin immunisation and moisturising stimulated blood supply. Professional dressings triggered granulation especially on the macerated wound edges.

Treatment and care: Stage 1:

The patient was prepared for neorthrosis surgery. Sufficient blood supply in the granulated tissue and formation of skin ready for wound healing were achieved.

Treatment and care: Stage 2:

Several weeks of plaster dressing and simultaneous wound treatment

Treatment and care: Stage 3:

The treatment was successfully completed with osteosynthesis and joint stabilization as well as ulceration healing.

Ultimate result:

After several months the patient showed us the treatment and care outcomes. His life quality was improved and he could enjoy normal walking and could wear shoes again.

Patient 6. A patient, aged 78, with an open wound with necrosis after coronary artery by-pass graft (CABG). The patient tried various treatment methods but after 8 months there still was chronic ulceration on his shin and toe. 

Photo 1. Before treatment  Photo 2. During treatment

Photo 1. After treatment completion.  The wound healing took 5 months.

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