Complications of wound healing:

 Complications of wound healing:

1-  Wound failure: 

•              Healing trials failed due to one or more of general or local factors. 
•              Full thickness failure of abdominal wounds causes burst abdomen. 
•              Treatment :        

                                         of underlying cause.

                                          wound closure either early or delayed.

2- Stretched scar; 

•                 The width of the scar increases depending on degree of tension across the wound.  
•                 Avoid tension by wound support with non absorbable or long term absorbable sutures + minimize the scar stretching 

3- Contracture or contracted scar: 

•                   -It is pathological shortening of scar tissue due to persistent wound contraction in the remodeling stage. 
•   Usually affects incision crossing joints causing deformity. 
•    Avoided by curved and zigzag incision. Treatment: Z-plasty or multiple V-Y plasty.
•    Excision and grafting or flap.

4-  Pigment changes:  

•       New epidermis of the scar has not have the same degree of pigmentation.  
•       Most are hypopigmented but some are hyperpigmented.  
•       Treatment Cosmetic camouflage or tattooing.  

5-  Poor alignment:  

   

•        Where a scar crosses the junction between different anatomical features as vermillion or red line of the 
•          It should be realigned. 

 6-  Tattooing 

•        In traumatic wounds where particles of dirt soot are  or implanted during healing.  
•       Tattooing is apparent through black or blue scar.  
•       Treatment: 

1.               brushed and irrigated.  
2.               Abrasions should be Deeply tattooed wounds should be excised.  

7-  Stitch marks 

•          occur if skin sutures are left in place for more than 7 days
•          Treatment: 

1.                  Removal of skin sutures before 7 days.  
2.                  subcuticular sutures whenever possible

8-  Excessive scarring:  

•                 Due to prolonged remodeling phase. 
•                 Scars are more cellular and vascular than mature scar.  
•                 Excess collagen production in relation to collagen breakdown.  
•                 Following Burn,  trauma,  surgical incision,  ear holing inflammation,  vaccination.  

        a-  Hypertrophic scars:  

•                 Genetically : Not familial.  
•                 Race: Not race related.  
•                  Sex : Female Male. 
•                  Age :Children.  
•                  Aetiology : Related to tension.  
•                 Delayed wound healing due to infection or wound failure
•                 Clinically: 

                         Early: Raised,  red,  itchy,  tender borders within the confines of the wound. 

                         Site:  Flexor surfaces,  shoulders,  prestemal areas.  

                         Natural histo May subsides with time(month pale,  flat.  

•            Treatment:

1.                     Ensure primary healing.  
2.                    Massage of the scar by moisturing. 
3.                    Pressure garments silicon gel sheets)  will accelerate scar maturation by ischemia.   
4.                   Surgical revision is appropriate with minimal recurrence in:.Complicated wounds.  Stars crossing joints.  

            b-  keloid scars :

•       Genetically?  May be familial. 
•       Race : Black > white. (African > Caribbean). 
•       Age :10-30 years.  
•       Sex: Female > male. 
•       wounds - Unknown,  often occur in Aetiology healed perfectly.  
•       clinically :Identical to hypertrophic scars but extends beyond the wound.  
•       Site - Presternum,  shoulder, are lobule.  
•       Natural history - rarely subsides.