Nose injury, accident, reconstruction, repair. plastic surgery India, cosmetic surgery India, dr Alexander, plastic surgeon, cosmetic surgeon. India, cochin, kerala.+

wound healing, skin grafting, leg, diabetic, atherosclerotic, foot, hand, plastic surgery, Dr Alexander, plastic surgeon, cosmetic surgeon, kims hospital, Cochin, kerala, India+

Some wounds may need debridement ( cleaning up the wound of all dead tissue and debris) and then skin grafting. The gentleman above is a diabetic patient who had a skin grafting surgery done to his foot to heal his wounds.

Dupuytrens contracture, finger contracture, finger deformity, hand, plastic surgery, Dr Alexander, plastic surgeon, cosmetic surgeon, kims hospital, Cochin, kerala, India+

Our body is made up of skin, subcutaneous tissue or fat, fascia, muscles, bones and organs.  The fascia is a tough membrane made up of collagen that provides a partition to various structures as well as a strong structural support. Thus we have this fascia in our palm, feet, limbs, abdomen and other areas. Sometimes this fascia gets thickened and cause problems like pain, swelling and interference with the normal function. 

Here are a few examples:

Fascia thickening in the palm- dupuytren’s contracture

Foot fascia can get thickened and cause problems

The cause of dupuytren’s contracture is unknown but a number of factors may be responsible like- family history of Dupuytren's contracture, alcoholism, diabetes and smoking. It is more common after 40 and men are more frequently affected than women though it has also been reported to occur in children.

The picture above is of a gentleman who had dupuytren’s contracture and was operated whereby the facial thickenings were removed and function was restored+

Factors affecting wound healing: Emotional stress, age, Dr Alexander, plastic surgeon, cosmetic surgery, Cochin, kerala, India+

 Fetal tissues (baby in the womb) when injured heal perfectly- because these tissues have the ability to regenerate. At birth we loose this ability and our tissue can only repair- not regenerate new tissues or organs. The liver is probably the only organ that can regenerate in the adult presently. When we become old (old age) our skin is easily damaged. The ability of cells in old age to multiply is also reduced. These factors lead to poor wound healing in old age.

There is still hope: our anti aging scientist is seriously involved in finding the secrets to eternal youth.

One of the key players in now what is known as regenerative medicine is the stem cell. As you all know we evolve from the fusion of two cells- one from each parent. As these cells multiply it forms different types of cells. Stem cells are those that have the potential to develop into any type of cell that is required by the body. The problem is we do not know what triggers it or why it stops regenerating at some stage. It appears that everything is programmed to stop at some time. If not uncontrolled growth and regeneration would have led to a population explosion with no place to go.

Medical sciences are lost in trying to get this stem cell (harvesting) and then utilizing them to make the type of tissue the patient needs. For example if the patient has lost his wind pipe through cancer, then the stem cell can be stimulated to grow into a windpipe by providing it with a proper structure and other factors. The same would work for other organs also. Once we are able to do this there will be no need for any organ transplantation.

When we suffer an injury or have a wound, most of us get depressed or undergo stress. It has been shown that emotional stress hampers wound healing by increasing the blood pressure and blood levels of cortisol (steroids), which in turn decreases our immunity. Fear and distress prior to surgery has been found to lead to higher postoperative complications, longer hospital stays, higher rates of rehospitalization, poor wound healing  and ultimately poorer outcomes.

So guys sit back and relax when you have a wound

let the surgeon undergo stress!!

For more details follow the link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052954/figure/F1/

Atherosclerosis and wound healing, wounds, ulcers, injuries, chronic wounds, non healing wounds, vascular doppler study, ct scan, cat scan, mri, Dr Alexander, cochin, India+

Blood vessels are like roads that lead ‘to and fro’ from the damaged wound sites. The body sends workers and supplies to repair the damaged site by these blood vessels. Further adequate oxygen (carried by red blood cells) cannot reach the wound site and good oxygenation is required for proper functioning of all cells. If blood supply to the wound area is decreased from any reason then the ‘worker cells and specialist cells’ as well as nutrients and repair materials cannot easily reach the wound to begin the process of repair and healing effectively. Wounds like the one shown below need to be properly investigated before a treatment plan is made.

 

Atherosclerosis is a condition usually seen in elderly individuals where blood flow is reduced due to the narrowing of the lumen of the blood vessels from abnormal depositions (atheromas) in the vessel wall. This result in reduced blood supply to the wound area which in turn hampers wound healing. Smokers, individuals with high blood pressure and those who have a high cholesterol are high risk cases for atherosclerosis.

  Poor blood flow to the wounds can be diagnosed by a number of ways. Clinical examination will show the pulses to be absent or feeble when compared to the opposite side, leg or arm, unless both sides have a poor blood flow. Other investigations like vascular Doppler study, angiography where a dye is pushed into the vessel and xrays are taken, by itself or in combination with cat scan or mri,  all are helpful in delineating the blood vessels and evaluating the blood flow.

when dealing with chronic wounds that fail to heal,  one must evaluate the blood flow which may be the culprit. In some cases blood flow to an area can be increased by using medications or by surgery and this can aid in healing chronic non healing wounds.

Immunity, wound healing, Dr Joseph Murray, HIV, AIDS, diabetes, malnutrition, chronic illnesses, burns, major wounds, bedridden patients, long term intensive care patients, vaccination, mercenary cells, killer cells, evidence based immune therapy, Dr Alexander, plastic surgeon, cosmetic surgery, Cochin, Kerala, India+

                                      Dr Joseph Murray
                                                                                             (pic fromhttp://jentytharian.blogspot.com)

The world lost Dr Joseph Murray on Nov 26, 2012. He was the first and only plastic surgeon to be awarded the Nobel Prize for the first organ transplantation in the history of medicine which he did in 1954. He had transplanted a kidney in a 23 year old gentleman from his twin brother (donor). He became an international leader and pioneer in transplantation biology and immunology. Without his knowledge in immunology, organ transplants which he had done would have been rejected. 

Immunity deals with our ability to fight and prevent infection, to know what belongs to our body and to reject what does not. Diseases like AIDS (Acquired immune deficiency syndrome) directly attack the immune system and destroy it so that the immunity of these patients is impaired. Similarly taking steroids for long term (for any reason) can reduce the immunity again. Diabetes and malnutrition are other causes for decreased immunity as we discussed. If these patients have wounds obviously the healing will be hampered. Major burn patients have decreased immunity and therefore their wounds have a higher predisposition to infection. 

For bedridden patients and those undergoing major surgeries and long term hospital treatment, taking care of the immune requirements may be beneficial in reducing their hospital stay and getting their wounds to heal faster.

While we have gone a long way in preventing diseases by vaccinations, the medical field is still in its infancy in providing evidence based immune therapy for diseased patients and I believe that future research in this direction will be beneficial. If we can stimulate individual cells to do their functions at the time and place that we choose, then we could use them as warriors in our fight against super bugs and others to prevent, heal and treat diseases.There are billions of cells in our body and we need to know how to control them sometime in the future.

  

Imagine signalling and sending a few 'mercenary cells' to do the job!!!

Diabetes, wound healing, non healing, chronic wounds, management, diabetic eye and kidney disease, atherosclerosis, Dr Alexander, cochin, plastic surgeon, cosmetic surgery, kerala, India+

Uncontrolled diabetes can be a great enemy of wound healing. If your diabetes is not under control you need to be seen by a physician or a diabetologist who will first test your blood and then depending on your diagnosis- put you on diet control, exercises, weight reduction or  proper medications ( tablets or insulin injections) to control the blood sugar. Besides wound healing diabetes also affects the eyes ( diabetic retinopathy), nerves (diabetic neuropathy), kidneys (diabetic nephropathy) and other systems so that the patient may manifest with a number of other problems which might be missed if the diabetes is undetected.

The common test include:

fasting blood sugar

post prandial blood sugar ( two hours after a meal)

when these tests are doubtful other tests will help

glucose tolerance test where your body’s ability to control the blood sugar level over a period of time is tested

HBA1c which gives an idea of the blood sugar level control over the past three months

There are a number of reasons why diabetes affects the wound healing and causes other problems:

a) In diabetics the small and big blood vessels that supply the wound are diseased (diabetic angiopathy) so that the blood flow to the wound is diminished.
b) Further the disease affects the nerves (peripheral diabetic neuropathy) and this leads to increased tissue pressure as the pain sensations that tell us to relieve the pressure are affected or absent. In fact sensory loss or inability to feel pain sensation from any cause like nerve injury can result in ulcers or wounds that progress and don’t heal. As the person does not realize or feel the pain he fails to prevent repeated injury to himself nor does he shift his position to avoid continuous pressure on a particular part of skin.
c) The immune system is affected in diabetes (decreased neutrophil function) so that there is a greater chance for germs (microorganisms) to attack the wound and cause infection.
Many patients present with non healing wounds without prior history of diabetes.

A non healing wound is often a pointer to the onset of diabetes or undetected underlying diabetes.

Non healing wounds, Lymphedema, lymph, limb swelling, Wound healing, ulcers, skin breakdown, discoloration, blisters, Dr Alexander, plastic surgeon, cosmetic surgery, Cochin, India+

While obstruction of veins can cause back pressure and swelling of the limbs, sometimes the drainage of tissue fluid (lymph) itself may be blocked or hampered leading to severe swelling of limbs (lymphedema). This is commonly seen when surgeons remove the lymph nodes in the axillary region (armpit) following cancer of the breast and the arm gets swollen. Sometimes diseases like filariasis(elephantiasis) block the lymphatic system, similarly causing lymphedema or swelling. Sometimes the abnormal lymphatic vessels maybe present from birth, leading to swelling of the limbs. At other times tumors may cause pressure on these drainage channels in the abdomen and lead to swelling of the limbs.

In all these cases one should find out the actual cause of the limb swelling and then plan the treatment according to the cause. Reducing the lymphatic edema will help in the faster healing of the wound. When faced with a non healing wound, lymphatic edema may be a cause that one should rule out.