Plastic surgery descends from Reconstructive surgery

Plastic Surgery Descends From Reconstructive Surgery

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Complex Wound Surgeries

The Wound Consultation -
Wound Care Management in Dubai

Only a detailed doctor/patient consultation forms the basis for successful individual treatment and wound care management in Dubai.

Note: Please bring any existing medical reports and examinations (X-ray, MRI, …). They are helpful in any way

Core Group: Patients are initially seen by Plastic Surgery, Dermatology, and/or Vascular Surgery:

Multidisciplinary Wound Care Team: Depending on the findings of the initial wound examination, other specialities are consulted for individually tailored diagnostic and treatment.

wound care managemnet in dubai by dr robert hierner
wound healing in dubai

Systemic Wound Care

We care about the Patient, not just the Wound: Especially in chronic wounds, it is always important not to see the wound as an isolated local problem (local wound healing), but also as a systemic problem (systemic wound healing). 

Systemic wound healing includes, among other things:

  • Treatment of the Underlying Disease/Improvement of General Health
  • Treatment of Infection 
  • Pain Management
  • Nutrition

Patients with a chronic wound (decubitus) are often brought to the emergency room with the requirement that local wound treatment be carried out. A chronic, non-healing wound is often a sign of deficiency and/or reduced general health. Intensive cooperation with internal medicine is the key to the successful treatment of many patients for wound care in Dubai.

Generalized adjuvant antibiotic therapy as part of conservative therapy should not be given, except in the case of:

  • inflammatory, phlegmonous wounds
  •  septic conditions

Systemic antibiotic treatment of secondary infection should be started by untarget (initial) treatment and switched to well-target treatment once the antibiogram is available. 

There is no indication for local antibiotic application

treatment of infection - wound care

Pain can be caused by:

  • Wounds 
  • Treatment

Therefore, pain must always be evaluated by a specialist for adequate wound healing in Dubai.

If necessary, a planned, continuous and adequate pain therapy must be ensured at the beginning of the treatment. 

When choosing the pain medication, further immobilization by sedation must be avoided. Close cooperation with the wound management Pain Clinic in Dubai is highly recommended.

pain management - wound care

Eating well during wound healing helps you heal faster and fight infection. There is an increased energy requirement – calories, protein, fluid, vitamin A, vitamin C, and zinc – during wound healing 

NOTE: Many elderly people are malnourished

Due to the physical changes of getting older, it’s often considered “normal” to eat less. A decrease in appetite can also result from naturally fluctuating hormonal levels. Older adults might make dietary adjustments with dentures or when taking medication to avoid certain side effects.

Therefore a closed cooperation with Dietics & Nutrition is mandatory in almost all clinical admitted patients for wound care in Dubai. 

nutrition - wound care

Additional Treatment (optional)

The immobile patient faces several risks of immobilization as early as 24 hrs. .

  • Sitting in a (wheel) chair is better than lying in bed

With regard to chronic wounds, immobility and joint contractures significantly increase the risk pressure sore. Therefore close cooperation with Physiotherapy & Rehabilitation is of utmost importance. Contact Prof. Dr Robert Hierner for complete wound care management Dubai. 

immobilasation - wound care

Urinary and fecal incontinence can have a detrimental impact on skin health. Prolonged exposure to urine or stool can cause inflammation or erosion of the epidermis or stratum corneum skin. Incontinence-associated dermatitis (IAD) is one type of moisture-associated skin damage (MASD). 

Damaged skin will lead to

  • Reduced spontaneous wound healing capacity
  • Increased risk of pressure sores

Especially in the immobile, dement and fecal (stoel) incontinent patient  an enterostomy should be placed at an early stage for nursing and medical reasons

Close cooperation with Urology, Gynecology  and Abdominal Surgery is of utmost importance for complete wound care management in Dubai. 

incontinence - wound care

Local Wound Care

Local wound treatment includes

  1. the treatment of the wound
  2. the treatment of the surrounding skin


In local wound treatment, a distinction is made between the following steps:

1) Elimination of extrinsic and intrinsic risk factors

2) Wound cleansing

3) Wound bed preparation

4) Wound closure measur

local wound healing in dubai

Every local wound treatment begins with the removal/reduction or stabilization of the responsible risk factors, whereby a distinction is made between external and internal risk factors.

risk factors - wound care

The next step is to remove coarse dirt and foreign bodies from the wound area.

The wound shower has proven itself for cleaning wounds

  • A sufficient amount of liquid is necessary for a sufficient cleaning effect. Sprinkling the wound with 50 ml NaCl is not sufficient. This must be considered when douching the immobile patient.
  • Mechanical manipulations (brushing, scratching, ….) must be avoided in the shower.
  • wound cleansing - wound care

According to FALANGA, wound bed conditioning is the entire “management” of the wound in order to increase endogenous healing or to facilitate the effectiveness of other therapeutic methods. The following steps are distinguished:


(Removal of necroses and wound coverings)

Debridement is performed as an independent primary treatment step as part of wound bed conditioning. 

The definitive extent of the defect only becomes apparent after adequate debridement, so that a decision on the final type of further therapy can only be made at this point in time

There are different debridement techniques from non- surgical (Alginat) to minimal-invasive (Maggot, Water jet) to surgical

wound preparation

Bacterial Balance

(Establishing a bacterial balance on the wound surface)

Every chronic wound shows colonization with microorganisms. Bacterial growth in the microbiological swab is normal. Up to 1000 microorganisms per gram of tissue are considered physiological.

Complete elimination of a clinically relevant (pathological) wound infection is necessary for wound healing in Dubai. The diagnosis of a clinically relevant wound infection is primarily based on

  • clinical symptoms (heat, redness, swelling, pain, loss of function) 
  • Laboratory chemical infection parameters

infection - wound care

Wound Exudate Management

Avoiding skin maceration by managing wound exudate is another prerequisite for undisturbed wound healing. One distinguishes:

  • Indirect management of wound exudate
    • Silver dressing
    • Antiseptics (Lavasept ®, Octinisept ®, …)
  • Direct management of wound exudate
    • absorbent dressings
    • TNP (VAC) therapy
    • compression treatment

moisture - wound care
Moist Wound Healing

For the treatment of dehiscent acute wounds and chronic wounds, it has been shown that the phases of secondary wound healing proceed more quickly in a moist wound environment

moist wound healing

Oxygen Balance

Oxygen is vital for healing wounds. Oxygen is known to accelerate wound healing and reduce wound infection. It is intricately involved in numerous biological processes including cell proliferation, angiogenesis, and protein synthesis, which are required for restoration of tissue function and integrity.

role of oxygen balance in wound healing

Wound closure measures 

Conservative (non-operative) and operative therapy are available for wound closure and defect coverage. It is important to note that these are not competing but complementary processes.

Conservative therapy is the basic therapy of any wound treatment.

Surgical therapy can be understood as a supportive measure of conservative therapy. There are several surgical procedures to choose from for defect coverage, which can be arranged in the sense of a reconstructive ladder. The choice of the surgical procedure depends on the etiology, the general condition and the expected future stress on the defect area to be reconstructed.

wound closure measures

Prevention of Recurrence

The best wound care in the hospital is only short-lived if it cannot be continued after discharge from the hospital at home. Close contact and communication between the Hospital and Home are of utmost importance. The wound network is a cooperation platform for all those involved in the care of chronic wounds at home in the catchment area of the Wound Care Center (Hospital)

Hospital-to-Home Transition

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Home Wound Care Awareness/Preparedness

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Home-to-Hospital Transition

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A standardized wound care transition from hospital-to-home is of crucial importance. Only a complete continuation of the treatment started in the hospital, at home, guarantees the sustainability of the treatment success. We specifically seek contact with the GP and the outpatient nursing service, as they often know the patient and their living conditions best. 

It must be ensured that all necessary nursing aids (assistants, wheelchair, decubitus mattress, ….)

– could be obtained before dismissal

– that these also work

– and can be perfectly operated by home nursing care.

Most chronic wounds and problem wounds can be successfully treated by outpatient treatment (Outpatient Nursing Service). The following principles should be applied:

Awareness: Outpatient nursing Service must be familiar with the prevention of wounds

Preparedness: In case of a recurrence, the outpatient nursing Service must be familiar with basic principles of wound care

Response: In case of a recurrence, the outpatient nursing service must be able to decide, whether to go on with home wound care or (re-) admission to the wound center

Home care can be delivered by several systems

  • Health Home Care: qualified wound care nurses from the hospital
    • Permanent
    • Temporary (“visiting educational nurse”: in-person or Telemedicine)
  • Home nursing: Nursing staff from a third provider

In the event of a significant deterioration in the wound condition, which cannot be improved despite changes in the outpatient care measures, rapid admission to the hospital is necessary in order to avoid further harm to the patient

Treatment of Specific Wound Types

We offer the full range of “state of the art” multidisciplinary und multiprofessional systemic and local Wound Care at the highest level.