Wounds may be partial thickness of full thickness. This is the most important distinction to be made during the initial assessment. This is because a partial thickness wound still has the deeper part of skin intact and can heal itself while the full thickness wound needs plastic surgery – either direct closure or coverage by skin graft or flap. A partial thickness wound is like a scrape or what is medically called an abrasion. This requires only good cleaning to remove dirt particles followed by protective non-adherent absorbent dressing. It should heal in 2 weeks.
Diabetics: Wounds may also occur in diabetics usually in the foot where it is called diabetic foot. They do not heal well. The reasons are many. Long term diabetics have poor sensation so they do not realize when they get an injury. For the same reason they walk on the wound as there is no pain thus damaging it further. Finally the blood supply may also be poor. Plastic surgeons are able to heal many of these by paying careful attention to all the aspects and by off-loading the ulcers. We may also use specially developed products like Tegaderm Matrix or growth factors. Flap surgery may also be needed.
Burn wounds: Major burn need to be taken to a hospital equipped with specialized facilities or to a burn unit which are run by plastic surgeons usually. However minor and moderate burns are much more common in the community and may be treated by many doctors. Since plastic surgeons have specialized training and experience in this field, a plastic surgery consultation, if available, can be very useful.
Burn injury can be superficial [partial thickness] or deep. If superficial, these can heal in 2 to 3 weeks. If deep the burn needs early specialist attention of a plastic surgeon. If the burn involved more than 10% of the body area again a specialist should look at the patient. Early wound excision followed by grafting has improved the survival as well as improved the outcome deep burn patients. Recently Synthetic skin has become available. Sold as INTEGRA, it has improved the lives of many patients by minimizing the use of donor skin.
Complex wounds sustained as a result of traffic accidents, infection, war or disease is best managed by a team that includes a plastic surgeon. Plastic surgeons bring an enhanced understanding and a whole host of skills needed to manage these wounds effectively and get them to heal fast.
Dr. Mohan Rangaswamy offers a wound care service at the Welcare hospital where problematic wounds are seen and treated. Advanced techniques like VAC, NPWT, Integra graft, Recell keratinocyte spray and autologous PRP are available. Where indicated, grafting, flaps and tissue expansion are also used.