General Surgeons know wounds. Whether it’s a superficial abdominal incision, a deep abdominal wound, or an incision that opens up after staples and/or sutures are removed, we typically know how to manage them. So how does the specialty of wound care (General Surgery) fit into our training and expertise?
General surgeons (and other specialists) learn the fundamentals and stages of wound healing. As surgeons, we must apply our knowledge of these concepts in order to properly treat and heal wounds.
There is more to a wound than just changing the dressings or treating with antibiotics. As surgeons, we also must understand the importance of debridement. In order for a wound to properly heal, all dead or necrotic tissue must be removed. Necrotic tissue allows for the growth of bacteria in a wound. When this occurs, it’s time to call your general surgeon. Removing this necrotic tissue is called debridement. Surgeons perform sharp debridement, which uses a scalpel to remove the dead tissue. It may be necessary to do this in an operating room. Healthy tissue may bleed a little and it appears pink without any extra yellow or black tissue around it. Surgeons can tell when a wound looks healthy and knows when the debridement is complete based on how much the wound bleeds and its color. Sometimes, multiple debridements are necessary to get a wound back to its normal appearance.
Diabetic foot ulcers, venous stasis ulcers, abscesses, and necrotizing soft tissue infections are different types of wounds that may require debridement. Sometimes, other surgical specialists may be need to help with further closure of the wound. Overall, early debridement is advised to help save limbs. In addition to proper debridement, surgeons also have knowledge of the appropriate wound dressings, the need for negative pressure wound therapy (wound vacs), or other biological tissue that can be used to cover wounds.
As more and more patients develop chronic wounds, and as we strive to salvage limbs, general surgeons will continue to play an important role and be a valuable member of the wound care team. Consult your surgeon early, and lets use a multidisciplinary team approach to care for our patients.