title: Complex wounds and their management.
abstract: Complex wounds present a challenge to both the surgeon and patient in operative management, long-term care, cosmetic outcome, and effects on lifestyle, self-image, and general health. Each patient with complex wounds usually manifests multiple risk factors for their development. This article focuses on complex wounds involved with traumatic and orthopedic blunt or penetrating injuries, particularly in the extremities, as well as massive soft tissue infections including necrotizing fasciitis, gas gangrene, and Fournier gangrene. The principles of management of complex wounds involve assessing the patient's clinical status and the wound itself, appropriate timing of intervention, providing antibiotic therapy when necessary, and planning and executing surgical therapy, including the establishment of a clean wound bed and closure/reconstructive strategies.
authors.affiliation: Department of Surgery, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
authors.forename: Habeeba
authors.initials: H
authors.lastname: Park
authors.forename: Carol
authors.initials: C
authors.lastname: Copeland
authors.forename: Sharon
authors.initials: S
authors.lastname: Henry
authors.forename: Adrian
authors.initials: A
authors.lastname: Barbul
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004954:Esthetics; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D018934:Fournier Gangrene / Q000175:diagnosis / Q000628:therapy*; D005738:Gas Gangrene / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D008134:Long-Term Care; D008297:Male; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents