Wounds come in a few different varieties. Some happen accidentally, such as from trauma. Others are surgical wounds following operative procedures. Wounds need to have optimum conditions in order to heal well. Regardless of the cause of the wound, complications in wounds can prevent wound healing. When wounds fail to heal due to complications, they can create local tissue deformities, unsightly scars or even physical disabilities.
Infection
We are constantly exposed to various bacteria, but the skin keeps the rest of the body insulated from becoming infected. When the skin barrier is broken, such as from a wound, it creates an opening for bacteria to enter. Infections are some of the most common complications in wounds. Infections can vary in depth between superficial skin infections and deeper ones, such as cellulitis or fasciitis. The deeper infections are generally more severe and require more intense treatment.
Dehiscence
For reasons such as high tension or poor surgical closure, the wound edges can come apart. The term for that is wound dehiscence. Physicians try to avoid this wound complication by placing sutures into multiple tissue layers to hold the wound together under minimal skin tension. The wound can heal even when the skin edges come apart, but the process often creates unsightly scars.
Tissue Necrosis
When tissues do not receive enough blood supply, the cells start to die in a process called necrosis. When physicians create a surgical incision, they must be careful to leave enough blood supply to the skin. If the skin is left too thin, it may not have enough blood supply from deeper tissues to support it, and cells around the wound start to die. A similar process can also occur if surgeons close a wound under too much tension, which can also decrease the blood supply to the wound edges.
Scarring
Scarring is an inevitable part of wound healing. In most people, if the wound is closed properly, the scars are small and barely visible. The size of the scar varies by location on the body and the individual person. For example, the forehead receives very good blood supply and wounds heal with minimal scarring. But the skin on the abdomen gets less blood perfusion and so scars there tend to be more visible. Some people are also genetically predisposed to forming large scars if they have a condition called hypertrophic scarring.
References
- "Surgery"; Josef Fischer; 2008
- "Mont Reid Surgical Handbook"; David Fischer; 2005
- "Introduction to Surgery"; David Levien; 1999
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