Wound Healing And Wound Management

A 58-year-old man with poorly controlled diabetes undergoes excision of a large sebaceous cyst from the upper back. On postoperative day 6, the wound edges separate and a small amount of serosanguineous fluid is noted. There is no purulent discharge, surrounding erythema, or fever. Which biological process most likely contributed to this complication?

A 35-year-old woman presents 10 hours after sustaining a contaminated laceration to the lower leg while working on a farm. The wound contains soil and devitalized subcutaneous tissue but has no exposed tendon, bone, or major neurovascular injury. What is the most appropriate initial management?

A 67-year-old man undergoes wide local excision of an ulcerated skin lesion from the calf. Four days later, the wound has increasing pain, erythema extending 3 cm from the incision, purulent drainage, and a temperature of 38.5°C. What is the most appropriate next step?

A 46-year-old woman has a traumatic thigh wound that was irrigated and debrided at presentation. Because of moderate contamination, the wound was left open and treated with moist dressings. At 72 hours, it appears clean, viable, and free of purulence or surrounding cellulitis. What is the most appropriate wound-closure strategy?

A 72-year-old immobile patient has a sacral wound with healthy granulation tissue after serial debridement. Negative-pressure wound therapy is being considered to reduce wound volume before definitive reconstruction. Which finding would be a contraindication to applying negative-pressure therapy before further treatment?

A 49-year-old man undergoes excision of a large lipoma from the posterior neck. A closed-suction drain is placed, but it stops functioning overnight. The next morning, the operative site is tense and swollen, with increasing pain and dark blood visible beneath the skin edges. What is the most appropriate management?

A 63-year-old smoker with peripheral arterial disease presents with a chronic nonhealing ulcer over the lateral ankle. The wound has pale granulation tissue, minimal bleeding during gentle debridement, and cool surrounding skin. What is the most appropriate next step before attempting definitive closure?

A 56-year-old man with a large open abdominal wound has undergone repeated debridement for necrotizing soft-tissue infection. The infection is now controlled, but the wound is healing slowly. Laboratory assessment shows marked weight loss and inadequate protein intake. Which nutritional intervention is most important for supporting wound repair?

A 41-year-old woman presents with a 3-week-old wound over the shin after minor trauma. Despite appropriate dressings, one small area repeatedly drains and fails to epithelialize. Examination reveals a localized tender opening with exuberant granulation tissue. Plain radiography is normal. What is the most appropriate next management step?

A 52-year-old woman undergoes excision of a recurrent abdominal scar. At closure, the surgeon notes that the wound edges can only be approximated with substantial tension. Which operative principle would best reduce the risk of ischemia, dehiscence, and scar widening?

A 64-year-old woman receiving long-term systemic corticosteroids undergoes excision of a recurrent abdominal wall mass. Two weeks later, the incision remains fragile and shows delayed healing without infection. Which wound-healing abnormality is most strongly associated with corticosteroid therapy?

A 37-year-old man presents with a 6-hour-old clean laceration of the forearm caused by broken glass. Examination confirms intact tendons, nerves, and vessels. The wound has been adequately anesthetized and inspected, and no foreign body is present. Which irrigation method is most appropriate?

A 59-year-old man with diabetes has a plantar wound that has failed to heal for 4 months despite pressure relief, glucose optimization, and regular wound care. The ulcer has recently developed rolled, elevated edges and bleeds with minimal contact. What is the most appropriate next step?

A 70-year-old man undergoes emergency laparotomy. On postoperative day 7, he experiences sudden wound separation while coughing, and loops of bowel are visible beneath the opened incision. He is hemodynamically stable. What is the most appropriate immediate management?

A 45-year-old woman undergoes removal of a benign lesion from the groin. Ten days later, she presents with a soft, fluctuant swelling beneath the incision. The skin is viable, there is no erythema, and aspiration produces clear straw-colored fluid. What is the most likely diagnosis?

A 52-year-old smoker is scheduled for elective excision and reconstruction of a chronic lower abdominal wound. The surrounding skin is marginally perfused, and the operation can be safely postponed. Which preoperative intervention is most likely to reduce wound-healing complications?

A 61-year-old woman previously treated with radiotherapy for breast cancer develops a chronic ulcer in the irradiated chest-wall skin. The area is fibrotic, poorly vascularized, and repeatedly breaks down despite local dressings. What is the most appropriate definitive management principle?

A 68-year-old man has a chronic leg wound with increased drainage and delayed healing. The wound surface is covered by a thin adherent layer, but there is no spreading cellulitis, fever, or deep tissue destruction. A superficial swab grows several bacterial species. What is the best interpretation of this result?

A 54-year-old man presents with a traumatic calf wound containing adherent black eschar and areas of clearly nonviable subcutaneous fat. There is no major vascular injury, and the patient is fit for surgery. Rapid preparation of the wound bed is required. Which debridement method is most appropriate?

A 48-year-old woman undergoes excision of a large soft-tissue lesion from the thigh. After closure, a substantial potential space remains between the skin flap and deep fascia. Which intraoperative measure best reduces the risk of postoperative seroma?

A 62-year-old man undergoes excision of a recurrent squamous cell carcinoma from the scalp with local flap closure. On postoperative day 5, the distal flap margin appears dusky, cool, and slow to bleed after pinprick. The inset is tight, and no hematoma is present. What is the most appropriate next management step?

A 48-year-old woman presents 3 weeks after abdominoplasty with a 4-cm area of wound separation at the central lower abdominal incision. The wound contains healthy granulation tissue, has minimal exudate, and shows no erythema or necrosis. The surrounding skin cannot be approximated without significant tension. What is the most appropriate management?

A 55-year-old smoker undergoes excision of a large posterior trunk lesion with advancement flap closure. On postoperative day 8, the wound edges separate. There is no purulence, but the margins are dark and nonviable. What is the most appropriate next step?

A 39-year-old man sustains a degloving injury of the lower leg. After serial debridement, the wound bed appears viable but has exposed tibial cortex without periosteum. Which reconstructive principle is most important?

A 67-year-old woman with a chronic breast wound after radiotherapy undergoes debridement. The residual tissue is fibrotic, pale, and poorly bleeding. Which factor most strongly explains the impaired healing capacity of the irradiated wound?

A 43-year-old woman undergoes excision of hidradenitis suppurativa from the axilla. Four days later, the wound shows increasing pain, gray discoloration, thin foul-smelling fluid, and rapidly spreading erythema beyond the wound margins. She is tachycardic and febrile. What is the most appropriate next step?

A 51-year-old man has a chronic traumatic wound over the Achilles region. The wound has healthy granulation tissue except for a small area of exposed tendon without paratenon. The surgeon is considering definitive closure. What is the most appropriate reconstructive approach?

A 60-year-old man undergoes excision of a large infected abdominal wall mesh. After debridement, the wound is clean but deep, with substantial dead space and moderate exudate. The fascia is intact, and no bowel or major vessel is exposed. What is the most appropriate temporary wound-management strategy?

A 34-year-old woman presents with a 2-week-old cheek laceration repaired elsewhere. The wound is healed, but several suture tracks are inflamed and one segment contains a small draining pustule around a retained nonabsorbable suture. What is the most appropriate management?

A 58-year-old man with diabetes undergoes reconstruction of a plantar foot defect. At follow-up, the wound remains intact but shows callus formation and recurrent focal breakdown at the same pressure point. Perfusion is adequate and there is no infection. What is the most important long-term management measure?

A 47-year-old woman undergoes wide excision of a lower abdominal lesion followed by primary closure. Three months later, the scar remains firm and erythematous but is gradually becoming flatter. Which process is primarily responsible for the progressive increase in wound tensile strength during this stage?

A 69-year-old man has a chronic lower-leg wound that remains stalled despite adequate arterial inflow, edema control, pressure relief, and appropriate nutrition. The wound has a slimy surface, recurrent malodor, friable granulation tissue, and only temporary improvement after short antibiotic courses. What is the most appropriate wound-management strategy?

A 42-year-old man sustains a crush injury to the thigh with extensive undermining of the skin from the underlying fascia. At exploration, the skin appears viable, but there is a large shearing cavity containing blood and lymphatic fluid. Which management principle best reduces the risk of recurrent fluid collection and skin necrosis?

A 55-year-old woman develops a 7-cm open wound after breakdown of a breast reduction incision. Following debridement, the wound is clean and granulating. Over the next several weeks, its surface area decreases substantially even before complete epithelial coverage occurs. Which cell type is primarily responsible for this reduction in wound size?

A 63-year-old man undergoes closure of a contaminated traumatic scalp wound after adequate irrigation and debridement. Forty-eight hours later, the wound is painful and swollen, but examination does not clearly distinguish early infection from a deep fluid collection. Which investigation is most useful as the next step when a localized postoperative collection is suspected?

A 50-year-old woman with obesity, diabetes, and a previous wound dehiscence is scheduled for elective abdominal wall reconstruction through a long midline incision. After meticulous closure, the surgeon wants to reduce the risk of postoperative seroma and superficial incisional breakdown. Which adjunct is most appropriate for this high-risk closed incision?