In summary, expanding treatment options, diverse groups of clinicians caring for patients and changes in the nature of wounds seen in clinical practice are real issues that have to be faced, and solutions have to be found if patients are to receive optional care for their wounds.

I Background.- 1 The Pathophysiology of Acute Wounds.- 2 Pathophysiology of Chronic Wounds.- 3 Control of Infection.- 4 Radiotherapy and Wounds.- 5 The Sequelae of the Cutaneous Radiation Syndrome.- II Debridement of Wounds.- 6 Surgical Debridement.- 7 Use of High-Pressure Waterjets in Wound Debridement.- 8 Autolytic Debridement.- III Wound Preparations and Treatment.- 9 Wound-Bed Preparation - Promotion of Granulation Tissue.- 10 Cleansing and Cleansers.- 11 Control of Exudate and Periwound Skin Care.- 12 Topical Negative-Pressure Therapy in Wound Management.- 13 Maggot Debridement.- IV Surgical Interventions in Wounds.- 14 Pre-Operative Requisites.- 15 Dressings for Chronic and Acute Wounds.- 16 Suture Materials and Techniques.- 17 Surgical Incision.- 18 Skin Grafts.- 19 Local and Regional Flaps.- 20 Free Flaps: Interests and Limits.- 21 Post-Operative Management of Skin Graft and Flap.- 22 Dermabrasion and Management of Donor Sites.- V Specific Wound Problems.- 23 Flaps for Upper Limb Reconstruction.- 24 Loss of Soft Tissue in Lower Limbs.- 25 Vacuum-Assisted Closure: Orthopaedic Applications.- 26 Osteomyelitis.- 27 Principles of Surgical Management of War Wounds.- 28 Animal and Human Bite Wounds.- 29 Enterocutaneous Fistulae.- 30 Pilonidal Sinus Disease.- 31 Acne Inversa.- VI Chronic Wound Problems.- 32 Surgery for Arterial Ulcers.- 33 Interventional Radiology for Revascularisation.- 34 Venous Ulcer Surgery.- 35 Diabetic Foot Surgery.- 36 Polyneuropathic Ulcers Surgery.- 37 Pressure-Relieving Systems and Surgery.- 38 Surgical Therapy for Pressure Sores.- VII Burns.- 39 Thermal Burns Management.- 40 Electrical Burns.- 41 Chemical Burns Management.- 42 The Meek-Wall Micrograft Technique.- 43 Skin Substitutes - an Overview of Cultured Epithelia to Treat Wounds.- 44 Skin Equivalents - Integra® in Acute Wounds.- 45 Rehabilitation and Post-Burn Care.- 46 Compression Therapy.- 47 Frostbite: Current Concepts in Pathophysiology and Management.- VIII Treatment of Scaring.- 48 Fundamental Aspects of Extracellular Matrix.- 49 Prevention of Excessive Scar Formation - a Surgical Perspective.- 50 The Non-Surgical Management of Hypertrophic Scars and Keloids.- 51 Surgery of Scars: Hypertrophic, Keloid and Aesthetic Sequellae.- 52 Pathologic Scar Prevention.- 53 Psychological Consequences of Facial Scarring.- IX Future Perspectives in Wound Management.- 54 Prefabrication of Growth Factors and Gene Therapy.- X Conclusions.- 55 Changing Philosophies in Reconstructive Surgery.- XI Appendix.

The management of wounds poses a considerable challenge for clinicians. It is with great pleasure that we therefore introduce ‘Surgery in Wounds’ to the wound healing fraternity to convey some important surgical perspectives and philosophies that are utilised when dealing with an array of difficult wounds.

There is no doubt that our improved understanding of wound healing biology and new technologies will continually influence clinical practice. Traditionally, reconstructive surgeons have adopted a one-stop surgical approach for the closure of wounds over the last few decades using flap surgery as the cornerstone of their armamentarium. However, alternative and adjunctive solutions are now being developed which offer a new staged approach to wound management. In particular, we must embrace these ideas into surgical practice as well as integrating ideas from across all surgical disciplines.

This book brings together a veritable wealth of surgical experience and reflects practice on a global scale. It explores many avenues: from basic concepts to advanced reconstructive procedures. We hope that this may expose the reader to new ideas and generate the enthusiasm and desire to apply these lessons to their own clinical practice.

There are two kinds of knowledge: that which we already know, and that which we know where to find. ‘Surgery in Wounds’ offers an opportunity to find such knowledge readily and we hope will be a welcome addition to the libraries of individuals and institutions alike.

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