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The basic principles and available options for the management of various wounds will be reviewed. The efficacy of wound management strategies for the treatment of specific wounds is discussed in individual topic reviews: (See "Management of diabetic foot ulcers".)
The differential diagnosis and procedure for incision and drainage of skin abscesses will be reviewed here. The epidemiology, microbiology, treatment, and prevention of skin abscess are discussed separately. (See "Skin abscesses in adults: Treatment".)
WOUND DEFINITIONS AND CLASSIFICATION. Acute wounds — Acute wounds occur suddenly and usually have an easily identifiable mechanism of injury leading to disruption of skin integrity. Regardless of etiology, wound healing normally progresses at a sustained, measurable rate through the stages of healing as expected.
Control of external hemorrhage may be needed in other circumstances (eg, severe postoperative bleeding) and follows a similar approach. Initial management of the trauma patient, hemodynamic resuscitation, and damage control and resuscitation strategies are reviewed separately.
(See "Risk factors for impaired wound healing and wound complications" and "Overview of control measures for prevention of surgical site infection in adults" and "Antimicrobial prophylaxis for prevention of surgical site infection in adults".)
Negative pressure wound therapy (NPWT), also called vacuum-assisted wound closure, refers to wound dressing systems that continuously or intermittently apply subatmospheric pressure to the system, which provides a positive pressure to the surface of a wound.
Wound, injury, or medical device — Management of abscesses associated with wounds or injury (eg, bites, pressure ulcers, diabetic wounds) or with underlying medical devices (eg, mesh, prosthetic joint, vascular graft) requires specific approaches, which are discussed elsewhere:
Perianal and perirectal abscesses are common anorectal problems. The infection originates most often from an obstructed anal crypt gland, with the resultant pus collecting in the subcutaneous tissue, intersphincteric plane, or beyond (ischiorectal space or supralevator space) where various types of anorectal abscesses form.
The ideal abdominal wound closure provides strength and a barrier to infection. In addition, the closure should be efficient, performed without tension or ischemia, comfortable for the patient, and aesthetic. Closure of abdominal incisions will be reviewed here.
The term "open abdomen" refers to a defect in the abdominal wall that exposes the abdominal viscera. Damage control surgery associated with trauma and abdominal compartment syndrome are the most frequent reasons for leaving an abdomen open.