Editors Sujata Sarabahi MS MCh DNB (Plastic Surgery) MNAMS
Associate Professor and Senior Plastic Surgeon Department of Burns, Plastic and Maxillofacial Surgery Vardhman Mahavir Medical College and Safdarjung Hospital
New Delhi, India
VK Tiwari MS MCh
Professor and Consultant Plastic Surgeon Department of Burns, Plastic and Maxillofacial Surgery Vardhman Mahavir Medical College and Safdarjung Hospital
New Delhi, India
Foreword SP Bajaj
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Principles and Practice of Wound Care
First Edition: 2012
9789350258644
Printed at
5Dedicated to
The fond memory of
(Padmashree) Late Dr LC Gupta
Our Guide and Mentor who continues to be a constant source of encouragement and inspiration and without whose guidance this work would not have seen the light of the day.
7Contributors
- Anshumali Mishra ms
- Senior Resident
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Anurag Agarwal mbbs dnb (Surg) mnams
- Consultant
- Division of Peripheral Vascular and Endovascular Sciences
- Medanta—The Medicity Hospital
- Gurgaon, Haryana, India
- Arun Goel ms mch fics
- Consultant Plastic Surgeon and Head
- Department of Burns, Plastic and Maxillofacial Surgery
- Lok Nayak Hospital
- Associated Maulana Azad Medical College
- New Delhi, India
- Ashish Dey ms (General Surgery)
- Clinical Assistant
- Department of General Surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- Ashish Kumar Duggal
- Senior Medical Officer
- Department of Medicine
- Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research
- New Delhi, India
- Ashish Rai ms mch (Plastic Surgery)
- Assistant Professor
- Department of Burns, Plastic and Maxillofacial Surgery
- Postgraduate Institute of Medical Education and Research and Ram Manohar Lohia Hospital
- New Delhi, India
- Ashok Damir md (Foot Fellowship) dscpm (Chicago)
- Senior Diabetic Foot Specialist
- Fortis C-DOC
- New Delhi, India
- Atul Shah ms mch (Plastic Surgery)
- Professor of Plastic Surgery
- Grant Medical College
- Sir JJ Group of Hospitals
- Byculla, Mumbai
- Maharashtra, India
- Chintamani ms frcs (Edin) frcs (Glas) frcs (Ire) facs fics fiams
- Professor
- Department of Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Deepak Balasubramanian ms dnb
- Fellow
- Head and Neck/Plastic Reconstructive Surgery
- Amrita Institute of Medical Sciences
- Kochi, Kerala, India
- Deepak Nanda ms mch (Plastic Surgery)
- Associate Professor and Senior Plastic Surgeon
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Durga Karki ms mch dnb (Plastic Surgery) mnams
- Assistant Professor
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Harish Chellani md (Pediatrics)
- Professor
- Consultant Pediatrician
- Department of Pediatrics Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Harsh Mohan md fams fuicc fic (Path)
- Professor and Head
- Department of Pathology
- Government Medical College
- Chandigarh, India
- Imran Ahmed ms mch (Plastic Surgery)
- Reader
- Department of Plastic Surgery
- Aligarh Muslim University
- Aligarh, Uttar Pradesh, India
- Irneet Mundi md dnb
- Senior Resident
- Department of Pathology
- Government Medical College
- Chandigarh, India
- Karoon Agrawal ms mch (Plastic Surgery)
- Director-Professor and Head
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Krishna Asuri ms
- Senior Resident
- Department of Trauma Surgery
- All India Institute of Medical Sciences
- New Delhi, India
- Malini Capoor md (Microbiology)
- Assistant Professor
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Maneesh Singhal ms mch (Plastic Surgery)
- Associate Professor
- Department of Trauma Surgery
- All India Institute of Medical Sciences
- New Delhi, India
- Mary Babu
- Director Grade Scientist
- Head of Biomaterials (Retd)
- Central Leather Research Institute
- Chennai, Tamil Nadu, India
- Megha Tandon
- Department of Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Mohit Sharma ms mch (Plastic Surgery)
- Professor
- Plastic and Reconstructive Surgery
- Amrita Institute of Medical Sciences
- Kochi, Kerala, India
- Moris Topaz md phd
- Head
- Plastic Surgery Unit
- Hillel Yaffe Medical Center
- Hadera, Israel
- NK Agrawal
- Associate Professor
- Department of Plastic Surgery
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- PG Raman md frcp (Edin)
- Retired Professor of Medicine
- Mahatma Gandhi Memorial Medical College
- Indore, Madhya Pradesh, India
- Pratap Duggirala ms
- Senior Resident
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Pratima Anand md (Pediatrics)
- Medical Officer
- Department of Pediatrics
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
- Praveen Bhardwaj ms mch
- Junior Consultant
- Division of Plastic Surgery
- Hand and Reconstructive Microsurgery and Burns
- Ganga Hospital
- Coimbatore, Tamil Nadu, India
- PS Barooah
- Senior Resident
- Department of Medical Surgery
- Institute of Medical Sciences
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Rajiv Parakh ms frcs (Vascular Surgery)
- Chairman
- Division of Peripheral Vascular and Endovascular Sciences
- Medanta—The Medicity Hospital
- Gurgaon, Haryana, India
- Rakesh Kain
- Assistant Professor
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Ram Shanmugam bpt
- Physiotherapist
- Department of Orthopedics
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Ranjith James Babu
- Medical Officer
- Department of Surgery
- Gajanan Rao Multispecialty Hospital
- Chennai, Tamil Nadu, India
- RK Chittoria ms mch dnb mnams phd
- Additional Professor and Head
- Department of Plastic Surgery
- Sri Venkateswara Institute of Medical Sciences University
- Tirupati, Andhra Pradesh, India
- Rohan Khandelwal
- Department of Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- RS Mohil ms
- Consultant Surgeon and Associate Professor
- Department of Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- S Bhattacharya
- Postgraduate Student
- Department of General Surgery
- Institute of Postgraduate Medical Education and Research and SSKM Hospital
- Kolkata, West Bengal, India
- S Shanmuganathan
- Professor
- Department of Pharmaceutics
- Faculty of Pharmacy
- Sri Ramachandra University
- Chennai, Tamil Nadu, India
- Sameek Bhattacharya ms mch (Plastic Surgery)
- Assistant Professor
- Department of Burns, Plastic and Maxillofacial Surgery
- Postgraduate Institute of Medical Education and Research and Ram Manohar Lohia Hospital
- New Delhi, India
- Sandeep Mehta ms mch (Plastic Surgery)
- Senior Plastic Surgeon
- Rajeev Gandhi Cancer Institute
- New Delhi, India
- Savita Arora ms mch (Plastic Surgery)
- Associate Professor and Senior Plastic Surgeon
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Shalini Duggal
- Junior Specialist
- Department of Microbiology
- Baba Saheb Ambedkar Hospital
- New Delhi, India
- S Raja Sabapathy ms mch dnb (Plastic Surgery)
- Chairman
- Division of Plastic Surgery
- Hand and Reconstructive Microsurgery and Burns
- Ganga Hospital
- Coimbatore, Tamil Nadu, India
- Sujata Sarabahi ms mch dnb (Plastic Surgery) mnams
- Associate Professor and Senior Plastic Surgeon
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Sumit Arora ms (Ortho) dnb (Ortho)
- Department of Orthopedics
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Sumit Batra ms dnb (Orthopedics)
- Assistant Professor
- Department of Orthopedics
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- Sushma Sagar ms
- Associate Professor
- Department of Trauma Surgery
- All India Institute of Medical Sciences
- New Delhi, India
- TD Chugh
- Chairman and Senior Consultant
- Department of Microbiology
- BLK Superspecialty Hospital
- Pusa Road, New Delhi, India
- Thakur Thussu ms
- Senior Resident
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
- V Bhattacharya ms mch (Plastic Surgery)
- Professor
- Department of Plastic Surgery
- Banaras Hindu University
- Varanasi, Uttar Pradesh, India
- Vinod K Malik ms (Gen Surg)
- Senior Consultant and Vice Chairman
- Department of General Surgery
- Sir Ganga Ram Hospital
- New Delhi, India
- VK Tiwari ms mch
- Professor and Consultant Plastic Surgeon
- Department of Burns, Plastic and Maxillofacial Surgery
- Vardhman Mahavir Medical College and Safdarjung Hospital
- New Delhi, India
Wounds are as old as the creation of the universe. Healing and repair of injured tissues is an integral part of all living structures from the most basic single-cell structure to the most complex human body. The lower we go in the developmental order, the more complete regeneration we see; while as we go higher in the strata, the process of regeneration becomes less while the process of repair takes over.
Wounds have fascinated mankind; therefore, over time special groups of people developed to manage the wounds. These people were termed as surgeons and in due course of time wounds and surgeons became synonymous. Wounds still remain a problem in the healthcare world and more than 30 percent of the budget of any hospital is spent on materials which are used for wound care. This may be a simple gauze or a bandage, antibiotics to stop infection, topical creams or ointments and other dressing materials to be applied over the wounds. This in association with different cleansing agents and antiseptic materials takes away the major budget of any institution. No wonder maximum numbers of advancements have been made in different types of wound care materials as all wounds are not alike and different wounds have different demands for their management. However, there is a paucity of literature which could describe how different materials should be utilized.
Dr VK Tiwari and Dr Sujata Sarabahi should be complimented for bringing a comprehensive book on practical aspects of wound care with full scientific principles. Both the editors are highly acclaimed plastic surgeons and have a lot of experience in managing different types of wounds at one of the largest burns unit of the country. The layout of the book is simple and attracts both, a very well-experienced person in wound management and those who are going to come in contact of a wound for the first time. This is a multi-authored book and each contributor is an authority over the topic, they are writing about. The topics chosen in the book practically cover all different types of wounds which are commonly known while sufficient space is given for the historical grounding of wounds also, which starts with the beautiful work of Dr Savita Arora on the evolution of wound care. The book provides an insight to the reader about how the wound care has changed from the initial medieval days to the present day of a more scientific thinking.
Logically, these chapters move from the pathology of wound healing to the most recent advances and finally on the management of scars and its maturation. Justifiably, there are some repetitions of the topics as the authors intended to cover all the intricacies involved with these wounds. The topics of woundbed preparation by Dr RK Chittoria, and debridement and preparation of wound by Dr Raja Sabhapathy, though fall in the same category require a separate mention as both the editors have done justice to the job assigned to them. Dr Sushma Sagar has enlightened the reader about the life-threatening wounds and has also given glimpses of problems of wounds.
The book covers practically all different types of wounds in detail, therefore, reader gets an idea of managing practically all different types of wounds and how the treatment of one wound differs from the other.
The book has done justice by providing knowledge about the other factors influencing wound management which involves nutrition, changes in environment either by negative pressure or by increasing the oxygen pressure.
I am confident that this unique book will be of immense significance and knowledge to all the surgeons and other health personnels involved with wound management—nurses, technicians, research workers, etc.
SP Bajaj
mbbs ms mch frcs mnasc
Senior Consultant and Ex-Professor of Plastic Surgery
University of Delhi
13Preface
While writing the preface of Principles and Practice of Wound Care, we are reminded of the world renowned messiahs in this field, Mother Teresa and Florence Nightingale. Both are famous for spending time with patients, who become unacceptable in the society because of their wounds and giving them their healing touch. They have indeed taught us how to be kind, caring and loving while treating wounded patients.
A new book on wounds and wound care. Is it really needed? Has enough not been written on wound and wound care? The answer is yes and no. Wounds have been the bête noir of the human race and clinicians since the time immemorial. Wound management is a field which involves all specialties, yet, there is not a single department which takes full responsibility for taking care of wounds. Generally, therefore, patients with wounds are found shunting between the departments dealing with the cause and the plastic surgeons who are ultimately going to cover them. A comprehensive approach to wound care is thus lacking and this is what this book sets out to achieve.
The book is an amalgamation of ideas from specialists from many departments. It provides a comprehensive and extensive review of wound healing and its management, treatment and also its prevention. Therefore, all healthcare professionals who are dealing with wounds in their day-to-day practice will find useful and advanced information and tips on handling them so that they can provide optimal care.
The contents of the book cover all types of wounds and every aspect of wound management. Recent advances in wound management have also been covered in detail along with each contributor's own individual experiences in using different modalities of treatment. The broad scope of the book endeavors to give an in-depth knowledge of wound management as well as prevention; in other words, a holistic overview of wound care.
The subject of wound care now encompasses a very wide canvas from the age old physiology and pathology of wound and wound healing to a plethora of wound care products each of which propose to have a unique mode of action and promote wound healing. The book has chapters which deal with all the newer products delving in detail about their mechanism, role and utility in wound healing allowing the reader to make an informed choice about these products, since there is a huge market building up because of increased interest in wound care. However, all these newer products and latest technologies have to be evaluated more realistically and used sensibly to get the best outcome.
One should never forget about the suffering of the patient due to the wound that he or she has. As clinicians, it is our responsibility to see the wound not as a mere disease but as a process which has a bearing on the day-to-day life of the patient. The treatment should, therefore, be quick, adequate and tailored specifically to suit the needs of individual patients. This is only possible by a comprehensive effort from the healthcare professionals and by evolving a system wherein proper training is imparted to all the personnels allowing them to optimally handle wounds.
The book has been written with these objectives and aims to be a comprehensive, yet lucid text on this complicated matter of wound, wound healing and care.
We would like to thank all the contributors for sharing their knowledge and clinical experience with the readers. We are all part of this fast-changing world and cannot remain behind. Let us change our thinking for change is life. We wish good luck to all our readers!
Sujata Sarabahi
VK Tiwari