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Open circuit voltage in electrosurgical waveforms is typically in the range of 300–10,000 V peak-to-peak. Higher precision can be achieved with pulsed waveforms. [ 11 ] [ 12 ] Using bursts of several tens of microseconds in duration the tissue can be cut, while the size of the heat diffusion zone does not exceed the cellular scale.
Wounds that cannot be closed primarily due to substantial tissue loss can be healed by secondary intention, a process in which the wound is allowed to fill-in over time through natural physiologic processes. When healing by secondary intention, granulation tissue grows in from the wound edges slowly over time to restore integrity of the skin.
The wound can be allowed to close by secondary intention. Alternatively, if the infection is cleared and healthy granulation tissue is evident at the base of the wound, the edges of the incision may be reapproximated, such as by using butterfly stitches , staples or sutures .
Basal keratinocytes from the wound edges and dermal appendages such as hair follicles, sweat glands and sebaceous (oil) glands are the main cells responsible for the epithelialization phase of wound healing. [42] They advance in a sheet across the wound site and proliferate at its edges, ceasing movement when they meet in the middle.
Jenkin's rule was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds. [19] [20] A later study suggested 6:1 as the optimal ratio in abdominal closure. [21]
Sen CK. Human wounds and its burden: An updated compendium of estimates. Advances in Wound Care, 2019; 8(2):39-48 ; Phillips T, StantonB, Provan A, Lew R. A study of the impact of leg ulcers on quality of life: financial, social, and psychologic implications. J Am Acad Dermatol. 1994;31(1):49–53
Trauma surgeons at Temple had to open his abdomen to repair the injuries, but fistulas developed, holes that wouldn’t heal, and until they healed, the incision couldn’t be closed. He spent the next 11 months in the hospital, immobilized in bed, with an open wound down the front of him that had the circumference of a basketball.
Negative pressure wound therapy device. Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess wound exudate and to promote healing in acute or chronic wounds and second- and third-degree burns.