Disorders of wound healing.

Abstract

AbstractThe healing wound offers a variety of potential end results. The surgeon's responsibility is to define what he wants and then arrange to get it. History has proved that technical improvements can eliminate disorders such as dehiscence and incisional hernias. Technical improvements should diminish the frequency of failed tendon repairs.When the author first became interested in wound healing and was asked to consult about a poorly healing wound, he could only offer the ideas that ascorbic acid might be given and that nutrition in some nonspecific way might be increased. Now, it is an unusual wound that cannot be made to heal in one way or another; wounds that cannot be made to heal are almost always a result of severe regional ischemia with or without osteoradionecrosis. Even moderately severe osteoradionecrosis can now be expected to heal by supplying the major deficiency consequent upon vascular damage by radiation, namely, oxygen (by hyperbaric administration).Perhaps most important to the surgeon is the knowledge that many kinds of disordered repair can be avoided. Liver disease can be treated, steroid hormone excess can be corrected or specifically treated with vitamin A, and nutritional defects can be anticipated and avoided. Familial tendencies to scar formation can be thwarted at an earlier rather than later, often hopeless, stage. Burn contractions in particularly susceptible joints can be anticipated and prevented by splinting and traction. In fact, we are coming very close to having effective treatment for most of the recognizable postsurgical reparative disorders.What we do not have is a prevention or cure for a vast variety of conditions of excessive repair, conditions that surgeons do not ordinarily recognize as complications. A vast amount of human misery is due to hypertrophic scar formation in arteries (arteriosclerosis), joints (arthritis), and ocular disease, especially those involving the scarring of the cornea. It is very likely that the surgeons will contribute to the prevention and cure of these disorders if they will accept the view that they can expect something close to perfection in any wound they make.