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Closure of Complicated Wounds Workup

  • Author: Erik A Hoy, MD; Chief Editor: William D James, MD  more...
 
Updated: Oct 05, 2015
 

Laboratory Studies

Laboratory studies are not required in the vast majority of wound closure settings, but in cases of complex wounds or chronic/nonhealing wounds, they may aid the surgeon in tailoring treatment. Nutrition laboratory studies, including albumin and prealbumin levels, can indicate if the patient is appropriately nurished and able to heal the wound. Zinc or iron deficiencies, along with other mineral deficiencies, can prolong or inhibit the wound healing process altogether. Similarly, deficiencies in vitamin C, D, and other key vitamins can prevent a patient's wounds from properly healing. In select patients, a preoperative nutritional workup may be warranted.

 
 
Contributor Information and Disclosures
Author

Erik A Hoy, MD Aesthetic and Reconstructive Plastic Surgery

Erik A Hoy, MD is a member of the following medical societies: Medical Society of Delaware

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Lifecell Corporation.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Santiago A Centurion, MD Dermatologist, Dermatology Associates of Central NJ

Santiago A Centurion, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Sigma Xi

Disclosure: Nothing to disclose.

Mark S Granick, MD, FACS Professor of Surgery, Chief, Division of Plastic Surgery, Rutgers New Jersey Medical School

Mark S Granick, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons, Phi Beta Kappa, Northeastern Society of Plastic Surgeons, New Jersey Society of Plastic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Waterjel, Inc.; Reconstat, LLC; DSM<br/>Serve(d) as a speaker or a member of a speakers bureau for: Novadaq<br/>Received none from Waterjel Inc. for board membership; Received none from Reconstat LLC for board membership; Received none from Open Science Co., LLC for board membership.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery

Disclosure: Received grant/research funds from Genentech for investigator.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Desiree Ratner, MD Director, Comprehensive Skin Cancer Center, Continuum Cancer Centers of New York; Director of Dermatologic Surgery, Beth Israel Medical Center and St Luke's and Roosevelt Hospitals; Professor of Clinical Dermatology, Columbia University College of Physicians and Surgeons

Desiree Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

References
  1. Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg. 1985 Aug. 76(2):239-47. [Medline].

  2. Burget GC, Menick FJ. Aesthetic reconstruction of the nose. St. Louis, Mo: Mosby Year-Book; 1994.

  3. Menick FJ. A 10-year experience in nasal reconstruction with the three-stage forehead flap. Plast Reconstr Surg. 2002 May. 109(6):1839-55; discussion 1856-61. [Medline].

  4. Menick FJ. Facial reconstruction with local and distant tissue: the interface of aesthetic and reconstructive surgery. Plast Reconstr Surg. 1998 Oct. 102(5):1424-33. [Medline].

  5. Tschoi M, Hoy EA, Granick MS. Skin flaps. Clin Plast Surg. 2005 Apr. 32(2):261-73. [Medline].

  6. Pribaz JJ. Master's Panel: Moh’s Reconstruction. Northeastern Society of Plastic Surgeons, 3rd Annual Workshop. March 7th, 2009;

  7. Omidi M, Granick MS. The versatile V-Y flap for facial reconstruction. Dermatol Surg. 2004 Mar. 30(3):415-20. [Medline].

  8. Attinger CE, Janis JE, Steinberg J, Schwartz J, Al-Attar A, Couch K. Clinical approach to wounds: debridement and wound bed preparation including the use of dressings and wound-healing adjuvants. Plast Reconstr Surg. 2006 Jun. 117(7 Suppl):72S-109S. [Medline].

  9. American Medical Association. Current Procedural Terminology: CPT 2011. Chicago, Ill: AMA Publications; 2011.

  10. Devansh S. Neo-flaps for facial reconstruction: can we create the desired thin-skin flaps?. Plast Reconstr Surg. 1998 Oct. 102(5):1633-8. [Medline].

  11. Fisher J, Gingrass MK. Basic principles of skin flaps. Georgiade GS, Levin LS, Riefkohn R, eds. Georgiade Plastic, Maxillofacial and Reconstructive Surgery. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996.

  12. Jackson IT. Local Flaps in Head and Neck Reconstruction. Chicago, Ill: Quality Medical Publishing; 1985.

  13. Place MJ, Herber SC, Hardesty RA. Basic Techniques and Principles in Plastic Surgery. Aston SJ, Beasley RW, Thorne CHM, eds. Grabb & Smith's Plastic Surgery. 5th ed. Philadelphia, Pa: Lippincott-Raven; 1997.

  14. Schrudde J, Beinhoff U. Reconstruction of the face by means of the angle-rotation flap. Aesthetic Plast Surg. 1987. 11(1):15-22. [Medline].

  15. Tuncer S, Celik M, Emekli U, Kesim SN. Subcutaneous bipedicle island flaps on the face. Plast Reconstr Surg. 2001 Jan. 107(1):148-51. [Medline].

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Preoperative planning for a banner flap to repair a facial defect (same patient as in Image 2).
Postoperative photo showing the completed banner flap repair (same patient as in Image 1).
A nasal defect after excision of squamous cell carcinoma and prior to repair with an interpolated flap (same patient as in Images 4-6).
The preoperative plan for the interpolated flap is designed to leave the donor scar in the natural wrinkle line of the nasolabial fold (same patient as in Images 3 and 5-6). The interpolated flap is most similar to a banner flap, and, in this case, it is folded over to reconstruct the nasal ala.
Intraoperative appearance of the interpolated flap, folded upon itself to provide greater thickness and coverage of skin and mucosal surfaces (same patient as in Images 3-4 and 6).
Final appearance of the interpolated flap repair, illustrating the advantage of placing the donor scar along a natural wrinkle line (same patient as in Images 3-5).
A large lesion of the right cheek amenable to repair with a rotation flap (same patient as in Images 8-9).
An intraoperative illustration of the rotation (cervicofacial) flap transposed into the defect site (same patient as in Images 7 and 9).
Postoperative appearance of the completed rotation flap repair of the right cheek defect (same patient as in Images 7-8).
A leiomyosarcoma of the scalp to be excised and closed via opposing rotation flaps (same patient as in Images 11-13).
A scalp defect following excision of a leiomyosarcoma. Preoperative marking for repair with opposed rotation flaps is seen in blue. The anterior portion of the scar is oriented parallel to the patient's original hairline (as indicated by the dashed line) (same patient as in Images 10 and 12-13).
Postoperative appearance of the opposed rotation flaps scalp repair (same patient as in Images 10-11 and 13).
Final appearance of the rotation flap scalp repair (same patient as in Images 10-12).
A lesion due to amyloidosis amenable to a V-Y closure (same patient as in Images 15-16).
Postoperative appearance of the V-Y advancement flap (same patient as in Images 14 and 16).
Final appearance of the V-Y advancement flap closure (same patient as in Images 14-15).
 
 
 
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