Repair of complex wounds

A wound is described as complex when it cannot simply be stitched: an extensive or jagged wound, with loss of skin, crushed or contaminated, a bite, or a wound affecting a delicate area such as the face, eyelids, lips or hand. A wound to the hand can reach a tendon or a nerve, even if it looks small. Treatment begins with careful exploration under anaesthesia to check the deep structures. The wound is then cleaned, non-viable tissue is removed and the repair is carried out layer by layer. If skin is missing, the surgeon can use a local flap or a skin graft. Tetanus prevention and, depending on the case, antibiotic treatment are checked. The aim is twofold: solid healing without infection and a scar that is as discreet as possible. When the wound is heavily contaminated or not recent, closure may be done in two stages, after a few days of wound care. Facial wounds are repaired with particular attention to landmarks (the edge of the lip, eyelid, eyebrow). At Clinique Pasteur Tunis, complex wounds arriving through the emergency department are treated in the operating theatre by a plastic or orthopaedic surgeon depending on the area, with dressing follow-up until healing.