Wound Care

Wound care programs and wound reconstruction are based on the individual and on such factors as the severity of the deformity, injury, and tissue loss as well as the expected function from reconstruction or treatment program. In addition, we will discuss the time away from work required for rehabilitation, the overall systemic disease, and other factors (such as your age, nutritional status, ability to participate in the program, etc.) that affect the final outcome. The surgeon will examine the wound and assess for infection, loss of tissue and the volume needed for its replacement, and local blood supply. You may also be required to have imaging studies prior to an operation.

There is a moderate likelihood for blood transfusion with complex operations especially those involving different specialties for treatment.

Wound surgery is highly variable and can be done on both an inpatient and outpatient basis. The length of surgery is relative to the extent of the wound to be treated and the amount of reconstruction necessary. The surgery may be done under local anesthesia alone, a combination of local anesthesia and some sedation, or under general anesthesia.

There are many different types of procedures including wound debridement (wound cleaning), vacuum-assisted-closure, tissue expansion prior to closure over a wound, simple direct closure of the wound, skin grafting (using a strip of skin from your thigh to cover open soft tissue) to rearrangement of local soft tissue to close over open deep skeletal tissue. For larger wounds, a more complex option involves tissue transfer using microsurgery to connect blood vessels. This will provide robust tissue to help in the delivery of oxygen, blood and antibacterial medications.

As with any surgery, there is always a possibility of complications, including bleeding, infection, neurologic changes or reaction to anesthesia. Some patients may have delayed wound healing, especially those who are obese, who smoke, who have diabetes, who have poor nutritional status, and those who are immuno-compromised from adjunctive irradiation and/or chemotherapy. Increased wound healing time may add to disability and could possibly lead to loss of reconstructed tissue, exposed prosthesis, and ultimately lead to an amputation. Immobilization necessary for recovery could lead to blood clots in the veins, leading to possible pulmonary embolism (blood clot in the lungs). Blood thinning medication is frequently given in the post operative period to prevent such events.

The procedure will leave noticeable, permanent scars both in the original wound site, the donor and recipient sites, along with mismatched tissue that may not have sensation. Depending on the site of the donor tissue, there could be widening of scars and decrease in the function of the donor site, which can be compensated for by the surrounding tissue in the future.

You may require prolonged bed rest after the operation with a splint, cast or specialized dressing to allow healing of the operation site. Pressure relief measures are important to the newly operated sites, which may or may not have sensation, to prevent future ulceration of the tissue. Small tubes, which will be eventually removed, may be placed to drain fluid immediately after the operation. You will generally require daily dressing changes in addition to close monitoring early on. You will feel some discomfort for the first few days, especially when you move around. Your surgeon will prescribe pain medication. The daily dressing changes will be stopped after a short period of time when the tissue has healed. About this time, you will be allowed to get physical therapy and rehabilitation, if necessary, which could involve anything from range of motion exercises for the joints to getting out of bed and walking with assistance. You may have a gradual protocol from bed to sitting and then to standing position, based on the complexity of your reconstruction, and this could take up to six weeks.

Avoid lifting or pushing heavy objects for the first two months as the deeper tissues need this much time for full healing. Returning to work depends on the severity of the original injury, the complexity of the operation, and the time required for full healing and the rehabilitation process. This could last from some months to over a year.