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KEY POINTS

KEY POINTS

  • The four phases of wound healing are hemostasis, inflammation, proliferation, and maturation/remodeling.

  • Significant influences on wound healing include age, nutrition, body habitus, and social history.

  • The decision to use antibiotics for a wound will depend on host factors (eg, age, comorbidities, immunocompromised state), wound characteristics, and location.

  • Wounds with significant contamination, ischemia, or tissue loss are left open to heal by secondary intention.

  • Transmission of HIV or hepatitis C through saliva from a bite is rare, and HIV testing after human bites is not necessary.

  • Jaws of larger dogs are capable of generating 200 to 450 pounds per square inch of pressure, and fractures under the injury to soft tissue should be ruled out.

  • Rabies is a vaccine-preventable viral disease primarily caused by the bite of a rabid animal and has a worldwide distribution.

  • In up to 40% of patients, the bite of a brown recluse spider will lead to necrosis of soft tissue due to local ischemia.

  • Pit vipers including rattlesnake, water moccasin, and copperhead snakes have a heat-sensing pit located behind their nostrils.

  • Although the mouth of a snake is colonized with bacteria like all animals, local infection following a snakebite is rare.

INTRODUCTION

Millions of patients are treated for traumatic wounds annually. These wounds are managed by a variety of practitioners, including surgeons, specialty surgeons and physicians, and advanced practice providers. The majority of wounds are straightforward and heal satisfactorily regardless of the technique used; however, there are wounds that require special care or attention, which will be discussed in this chapter. Wound management priorities include healing without infection, maintenance of normal function, and acceptable cosmesis. The simplest technique that will meet these requirements should be employed in treating a wound and will vary with the nature of the wound, its anatomic location, and the clinical situation.

WOUNDS

Wound Healing

Wounds, whether created electively or as a result of traumatic injury, are an integral component of the surgical patient; thus, understanding the pathways and mechanisms of wound healing is critical for the optimal care of surgical patients. This fund of knowledge is applicable to the care of patients with acute wounds and facilitates the development of therapeutic options for patients with chronic or nonhealing wounds. Wound healing is often divided into phases in order to aid understanding of the complex process. These phases are hemostasis, inflammation, proliferation, and maturation and remodeling (Table 50-1). Although these phases are often described as discrete events, it is important to realize that characteristics and elements of these phases overlap. Wound repair is a dynamic and complex process of inflammation characterized by a well-coordinated pattern of cell migration, proliferation, and differentiation, along with angiogenesis and matrix remodeling. The essential characteristics of the early phase include hemostasis and inflammation. The intermediate phase is characterized by cell proliferation, migration, angiogenesis, and epithelialization, whereas ...

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