Wound healing and wound infection - What surgeons and anesthesiologists can do

Wound healing can be enhanced and wound infections tan be prevented, often by simple, inexpensive, readily available means. Preoperative evaluation for impediments to healing such as malnutrition, vasoconstriction, hyperglycemia, and steroid use allows correction before operation. Intraoperatively, the surgeon should concentrate on surgical technique, appropriate antibiotic use, and prevention of vasoconstriction (i.e., volume, warming). Postoperatively, the focus should be on prevention of vasoconstriction through pain relief, warming, and adequate volume resuscitation, and on maintenance of nutrition and normoglycemia. These approaches also apply to chronic wounds. Additionally, maintenance of a moist environment, correction of local vasospasm with sympathetic blockade or warming, and stimulation of angiogenesis through aggressive debridement or hyperbaric oxygen therapy enhance healing of chronic wounds.