Complications of wound healing

Hemorrhage Blood dyscrasias or extensive malignancies or in alcoholics with cirrhosis patients

Hematoma Localized collection of blood underneath tissue

Hypertrophic scars Occurs when there is excess production of collagen tissues Inappropriately large, red, raised and hard Remains confined to the wound edge Regress in time

Keloid formation Is an even greater protrusion of scar tissue Extend beyond the wound edge Tumors – like masses They are permanent without any tendency to subside. Pain, tenderness and hyperesthesia (increased sensitivity) Scar can be excised but tend recur

Contracture Excessive contraction results in deformity Shortening of muscle or scar tissue results from excessive fibrous tissue formation Mainly seen in burns

Wound dehiscence Separation and disruption of previously joined wound edges Occurs due to – infection (may cause an inflammatory process) - obese individuals – adipose tissue interfere with healing

Wound Evisceration Protrusion of wound contents Occurs when wound edges separate to the extent that intestines protrudes through the wound

Adhesions These are bands of scar tissue between or around organs or tissues Adhesions may occur in the abdominal cavity or between the lungs and pleura

Wound infection It is a serious consequence of a common cause of delayed wound healing Causes -Due to lack of blood supply, lack of oxygen, contamination or exposure to pathogens.

Clinical manifestions Increased bloody drainage Purulent drainage Odor from wound and drainage Erythema around the entire wound Increasing pain Fever Leukocytosis- WBC count above the normal General malaise

Diagnostic measure Swab culture of wound drainage While obtaining the swab – remove the excess visible drainage first – then swab the wound bed

Surgical wound – 4th or 5th post op day inflammation is expected. Fever, tenderness, pain, disability and increased WBC count Pus discharge usually foul smelling and purulent – varied in color