Downloaded 11 times
- 1 / 49
- 2 / 49
- 3 / 49
- 4 / 49
- 5 / 49
- 6 / 49
- 7 / 49
- 8 / 49
- 9 / 49
- 10 / 49
- 11 / 49
- 12 / 49
- 13 / 49
- 14 / 49
- 15 / 49
- 16 / 49
- 17 / 49
- 18 / 49
- 19 / 49
- 20 / 49
![Hidradenitis suppurativa and pilonidal sinus wounds
Hidradenitis, an infection of apocrine sweat glands, affects
armpits and groins; pilonidal sinus, a tissue infection caused by
ingrowing hair, mainly affects the natal cleft.
Failed, repeated drainage of the abscesses requires complete
excision. The defect usually heals by secondary intention.
Initially, excision wounds are usually dressed with polymeric
foam. Once the wound has reduced in size, a topical
antimicrobial dressing (such as those that contain iodine or
silver) may be used. However, grafts or flaps are also used, either
as the primary treatment or for non-healing wounds. These
wounds often become infected and require prolonged
treatment to cover Gram positive and anaerobic organisms.
The picture of Ambroise Paré is published with permission from TopFoto.
David J Leaper is visiting professor of surgery at the Wound Healing
Research Unit, Cardiff University, Cardiff.
The ABC of wound healing is edited by Joseph E Grey
(joseph.grey@cardiffandvale.wales.nhs.uk), consultant physician,
University Hospital of Wales, Cardiff and Vale NHS Trust, Cardiff, and
honorary consultant in wound healing at the Wound Healing
Research Unit, Cardiff University, and by Keith G Harding, director of
the Wound Healing Research Unit, Cardiff University, and professor
of rehabilitation medicine (wound healing) at Cardiff and Vale NHS
Trust. The series will be published as a book in summer 2006.
Competing interests: DJL has received an educational grant for his
research group from Merck Sharp and Dohme and had expenses and a
fee paid by Ethicon for attending an advisory panel and for the making of
an educational film. For series editors’ competing interests, see the first
article in this series.
BMJ 2006;332:532–5
Excision wound in
hidradenitis suppurativa
Further reading
x Téot L, Banwell PE, Ziegler UE, eds. Surgery in wounds. Berlin:
Springer, 2004.
x Leaper DJ, Harding KG, eds. Wounds. Biology and management.
Oxford: Oxford Medical Publications, 1998.
x Bales S, Harding K, Leaper DJ. An introduction to wounds. London:
Emap Healthcare, 2000.
x Leaper DJ, Harding KG, Phillips CJ. Management of wounds. In:
Johnson C, Taylor I, eds. Recent advances in surgery. 25th ed. London:
Royal Society of Medicine, 2002.
x Leaper DJ, Low L. Surgical access: incisions and the management
of wounds. In: Kirk RM, Ribbons WJ, eds. Clinical surgery in general.
4th ed. Edinburgh: Churchill Livingstone, 2004.
x Leaper DJ. Basic surgical skills and anastomoses. In: Russell RCG,
Williams NS, Bulstrode CJK, eds. Bailey and Love’s short practice of
surgery. 24th ed. London: Arnold, 2004.
When I use a word
The very last word
What is the last word in the dictionary? Easy to answer, you might
think. But there is a problem. We talk blithely about “the
dictionary,” as if there was only one. But there are many, even
among monolingual dictionaries of English. And they don’t all
end with the same headword.
Samuel Johnson’s dictionary (1755) ends with zootomy,
“dissection of the bodies of beasts.” Not a great effort, but then he
wasn’t going for broke. Collins English Dictionary (sixth edition)
makes a better stab: Zyrian, the language spoken by the people of
the Komi, in the erstwhile Soviet Union. Zyrian belongs to that
curious group of languages, the Finno-Ugric (one of two
branches of Uralic, the other being Samoyed). Its main members,
despite the geographical divide, are Finnish and Hungarian; it
also includes Estonian, Vogul (or Khanti), Ostyak (or Mansi), and
the language of Sibelius’s Karelia.
The Chambers Dictionary (new ninth edition, 2003) does better
still: zythum, a kind of barley beer brewed by the ancient
Egyptians and others, from the Greek word zuthos (beer). And a
zythepsary is a brewery, got by adding hepsein (to boil). Hepsein
also meant to smelt metals and to digest food, reminiscent of
another Greek word, pepsis, meaning digestion or fermentation.
And the yeast in zythum was called zyme, which gives us enzyme,
a word that the Heidelberg physiologist Wilhelm Kühne
introduced in 1877 to describe substances such as pepsin.
The Oxford English Dictionary (second edition) takes us further
still: zyxt, which turns out to be, wait for it, an obsolete Kentish
form of the second person singular present indicative of see. In
other words, zyxt is “seest [thou].”
Now the OED is pretty comprehensive, but Philip Gove’s
controversial Webster’s Third New International Dictionary (1961)
went one better: zyzzogeton, a genus of large American
leaf-hoppers having the pronotum tuberculate and the front
tibiae grooved (well that’s what the dictionary says).
No dictionary that I’ve seen has another candidate: zyzzya, from
Zyzzya fuliginosa, a marine sponge found in the South Seas. It
contains pyrroloiminoquinone alkaloids belonging to the
makaluvamine family, which inhibit the enzyme topoisomerase II
and so produce a cytotoxic action by cleavage of DNA. And
zyzzyposide (modelled on etoposide) would be a great name for
an anticancer drug.
However, this is trumped by The American Heritage Dictionary of
the English Language (fourth edition, 2000), which has unearthed
zyzzyva, any of various tropical American weevils of the genus
Zyzzyva, and by The Random House Unabridged Dictionary (1997)
with Z-zero particle, one of three particles, intermediate vector
bosons, that are thought to transmit the weak nuclear force.
Finally, turn to Mrs Byrne’s Dictionary of Unusual, Obscure and
Preposterous Words (yes really) of 1974. Mrs Byrne, a concert
pianist and composer, was Jascha Heifetz’s daughter, Josefa, so it
is not perhaps surprising that the last word in her dictionary is
musical: zzxjoanw, pronounced ziks-jo’-un and defined as a Maori
drum. But anyone with the least smattering of Maori would look
suspiciously at those zeds, the ex, and the jay. Here’s a sample of
the real thing, from the famous haka: “ Tenei te tangata
puhuruhuru nana mei i tiki mai whakawhiti te ra.” Zzxjoanw can’t
be Maori. In fact, it turns out (Word Ways, November 1976) to
have been invented by Rupert Hughes for inclusion in his Music
Lovers’ Encyclopedia of 1914, where he says that it is pronounced
“shaw” and means “1. Drum. 2. Fife. 3. Conclusion.”
To which one the only possible concluding response is “Pshaw,”
followed by a bout of heavy zzzz-ing.
Jeff Aronson clinical pharmacologist, Oxford
(jeffrey.aronson@clinpharm.ox.ac.uk)
Practice
535BMJ VOLUME 332 4 MARCH 2006 bmj.com
on 12 January 2009bmj.comDownloaded from](/proxy?url=https%3A%2F%2Fimage.slidesharecdn.com%2Fabcofwoundhealing2009-191115093355%2F85%2FAbc-of-wound-healing-2009-22-320.jpg)
Skip to main content
MH
Uploaded bymostafa hegazy
690 views
Abc of wound healing 2009
The document provides an overview of wound assessment and factors that can impede wound healing. It discusses the importance of a thorough clinical history and examination of the wound, including factors like size, edge, site, and condition of the wound bed. Local factors like poor blood supply or presence of infection as well as systemic factors like age, nutrition, or illness can slow healing. The document also provides charts summarizing investigation recommendations before treatment and associations between common wound sites and ulcer types.
