management of chronic non healing wounds, the old vs the new

1. SURGICAL MANAGEMENT OF
WOUNDS
Dr Makanga

2. Fundamentals
• Break in epithelial surface
– Abrasion
– Laceration
– Ulcer
• Acute vs Chronic wounds
• The wound as an organ

3. Hindrances to healing
Local Systemic
Poor vascularity, ischemia
Infection
Tension
Foreign body
Edema and exudation
Pressure
Radiation
Nutrition
Immunity
Chemotherapy
Uremia
Jaundice
Tobacco
Alcohol
Age
Diabetes

4. Basic tenets of wound care
• The ‘TIME’ principle
• T – Tissue (unviable) removal
• I – Infection control
• M – Moisture maintenance
• E – Edge (advancing)

6. Good control

7. Poor control

8. Tissue control
• Surgical toileting – sharp excision*
• High pressure water jet (Versajet™)
• Wet to dry dressing
• Autolytic debridment
• Enzymatic debridment
• Biologic debridment

10. Infection control
• Abscess drainage and debridment
• Drains and packing
• Local application of antibiotics
• Systemic antibiotics if has SIRS

11. Moisture & edema control
• Occlusive dressings
• Cradle for burns
• Negative pressure wound therapy
• Unna boot
• Adsorptive dressing for exudative wounds*

12. Standard Unna boot

13. VAC system

14. Edge management
• The wound closure pyramid
Free flaps
Pedicle flaps*
Full thickness graft*
Split thickness graft
Direct wound closure by stitching, adhesive strips
Allow direct healing*

16. Thank you
Questions…