The present medical school curriculum, today’s healthcare system and the current malpractice environment provide few opportunities for students and non-surgical residents to acquire competent skills in basic wound care. Also, many outdated paradigms are still being taught. These considerations and the desire to relate what 45 years of plastic surgery practice, a lot of it devoted to trauma, has taught me what was the genesis for this brief text.

The observations and recommendations which follow, that focus primarily on trauma, were not derived from a distillation of meta-analyses, double-blind studies or p-values but rather on observation and reflection. I have the greatest respect for the scientific method but also much confidence in straightforward, common sense approaches that work. Others may have equally or more satisfactory regimens than the ones outlined in the following pages. The latter have proved most efficacious for me.

Some of the procedures to be referenced are beyond the technical ability of the novice. However, the descriptions provide a guide to the salient steps and should be helpful particularly to the more experienced.

Millennia ago it was observed that there is no royal road to geometry. The same maxim applies to acquiring sound judgment and technical proficiency in surgery.

To expand somewhat on an old cliché, good judgment in love, war, personal-finance and surgery comes from experience and unfortunately experience comes from bad judgment. We usually learn little from cases that go well but often learn a great deal from cases that go badly.

In all likelihood, the management of traumatic wounds in the future will involve skills similar to those important today. It is unlikely that a robot will replace a qualified surgeon anytime soon. Molecular biology may be able to resolve many of the diseases that today require surgical intervention. Whether the same discipline will lead soon to enough improved brain function in the general population to reduce most of the inane activities that result in patients coming to trauma centers is questionable.

Some repetition in the chapters that follow was purposeful, to accommodate those who may be using the text as a quick reference about a particular problem.

I want to express my deep appreciation to my mentors, colleagues and students. The ensuing suggestions and opinions are in part based on concepts learned from them.

The same compliment applies to women involved in healthcare, obviously.

Acknowledgements

If it were not for the encouragement, technical assistance, proofreading and computer expertise of my son, Eric, and the computer skills of his son, Thomas, this text would have never been published on the internet. They have my heartfelt gratitude.

Wendell B. Whitacre, MD
Tucson, Arizona, October 2017