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The optimal timing of performing wound debridement and closure is debated and dependent on the severity of the injury, resources and antibiotics available, and individual needs. [20] [1] Debridement time can vary from 6 to 72 hours, and closure time can be immediate (less than 72 hours) or delayed (72 hours to up to 3 months). [20]
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.
The reconstructive ladder is the set of levels of increasingly complex management of wounds in reconstructive plastic surgery. [1] The surgeon should start on the lowest rung and move up until a suitable technique is reached.
The end goal of wound management is closure of the wound which can be achieved by primary closure, delayed primary closure, or healing by secondary intention, each of which is discussed below. Pain control is a mainstay of wound management, as wound evaluation, wound cleansing, and dressing changes can be a painful process. [27]
In one case, however, a particular type of collagen graft led to significant delay of wound closure. [6] Careful study of histology samples revealed that grafts that delayed wound closure induced the synthesis of new dermis de novo at the injury site, instead of forming scar, which is the normal outcome of the spontaneous wound healing response.
Periradicular surgery should be very considered where previous endodontic treatment has failed, and possible re-root treatment is the preferred option. [4] If re-root treatment is not possible, will not correct the problem or patient factors prevent it, periradicular surgery is indicated.
The concern for early closure of the abdomen with development of compartment syndrome is a real one. A method to pre-emptively evaluate whether fascial closure is appropriate would be to determine the difference in peak airway pressure (PAP) prior to closure and the right after closure.
Research into hormones and wound healing has shown estrogen to speed wound healing in elderly humans and in animals that have had their ovaries removed, possibly by preventing excess neutrophils from entering the wound and releasing elastase. [26] Thus the use of estrogen is a future possibility for treating chronic wounds.