Wounds are defined as a disruption of the normal structure and function of skin and underlying soft tissue that is caused by trauma or chronic mechanical stress (e.g., decubitus ulcers).

Wound treatment is performed according to pathology, the extent, and circumstances of the lesions. General wound treatment includes surgical wound closure, open wound treatment, and plastic reconstruction of skin defects. In addition, infectious or concomitant disease prevention should be considered (e.g., antibiotics, tetanus vaccine, diabetic control etc). Surgical intervention is usually required with traumatic injuries, whereas chronic wounds and ulcers can often be treated conservatively. In the case of severe or nonhealing wounds, surgical intervention including debridement may be necessary.

Symptoms of wounds
• Pain
• Swelling
• Bruising
• Cuts, scrapes or puncture
• Burn

Causes-

Superficial wounds
• Trauma- Stab wounds, Lacerations, Punctures, Gunshot wounds, trap-door injuries, assaults, crush injuries
• Impaired healing process, e.g.Vascular ulcers (venous and arterial), Diabetic ulcers, Pressure ulcers

Deep tissue pressure injuries
Pressure ulcers/injuries are localized areas of tissue necrosis that typically develop when soft tissue is compressed between a bony prominence and an external surface for a long period of time. It is common for a thin blister to form over the surface of the dark wound bed, and the wound may further evolve to become covered by thin eschar. Deep tissue injuries are also known to deteriorate quickly even under optimal care.

Causes
• Direct pressure to the skin and soft tissue
• Muscle injury associated insufficient nutrient delivery through the arterioles that feed the muscles (infarction)
• Injury or damage to the fascia (the layer of fibrous tissue that surrounds muscles, bones, blood vessels and nerves)Shearing injury

Risk Factors
• Immobility or limited mobility
• Spinal cord injury
• Diseases that affect blood flow such as diabetes or atheroscelerosis
• Fragile skin
• Urinary or fecal incontinence
• Poor nutrition or dehydration
• Decreased mental awareness
• Obesity
• Neuropathy
• Fever
• Anemia
• Infection
• Ischemia
• Hypoxemia
• Neurological disease

Complications of injuries-
Infection is the most common major complication of pressure ulcers/injuries. If the ulcer progresses far enough, it can lead to osteomyelitis (infection of the underlying bone) or sinus tracts, which themselves can be either superficial or connect to deeper structures.
A diagnosis can be made just by examination by a doctor. Investigations like Ultrasound, doppler blood flow studies and Tissue biopsy may be necessary

Open wound treatment by Surgeons-
For clean wounds without any infection only cleaning wound toilet under local anaesthesia may suffice. Other options available could be excision of the wound edges and wound irrigation, Tension-free adaptation of the wound edges using suture material or staples. Sterile dressing will then be applied and immobilization advice will be given
For Dirty or infected wound treatment- The goal is to remove contamination and or foreign body. This will require cleaning using warm saline, taking away dead tissues under local anaesthesia. The wound may be left without suturing for continued dressings till it becomes healthy and suitable for closure. Sterile dressing will then be applied and immobilization advice will be given

We at MACS Clinic provide initial assessment and treatment for soft tissue injury and minor burns (scald). We provide surgical treatment of soft tissue laceration in our well equipped operation theatre under local anesthetics.