Pathophysiology, diagnosis, and treatments by plastic surgeon for chronic wounds
wound bed preparation
negative pressure wound therapy
In addition to wound size, general prostration and/or unfavorable local wound conditions contribute to the development of chronic wounds. Frailty is known to be associated with chronic wounds ; therefore, frailty prevention is important through adoption of measures such as appropriate exercise, optimal nutrition, and participation in community activities. Unfavorable local wound conditions should be determined based on the TIME theory. Notably, wound hygiene is a recent concept that was introduced as a therapeutic strategy for chronic biofilm-associated wounds. In most cases, sufficient and frequent maintenance debridement of the biofilm on the wound surface is the first step to achieve better granulation tissue. Negative pressure wound therapy (NPWT) contributes to wound healing by inducing mechanical stress (macrodeformation) and cellular stimulation (microdeformation). To reduce the burden on patients, we developed a one-stage perifascial areolar tissue with split-thickness skin graft combined with NPWT for refractory ulcers with exposure of bone and tendons without removal. Free tissue transfer is also effective for salvage and reconstruction of diabetic foot ulcers in patients with osteomyelitis. Moreover, a distal bypass is performed in cases of severe critical limb ischemia. Use of appropriate plastic surgery techniques to improve survival of affected extremities is important for long-term patient survival.
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