Shaoliang Wang (王韶亮)
Director, Plastic Surgery & Aesthetics Medical Center · Vice Chief Physician, Associate Professor, Doctor of Medicine · Lead Physician of This Site
Separation of a surgical incision · assessment of depth and tissue viability · the decision between dressings, delayed closure and revision
Dr. Shaoliang Wang is Director of the Plastic Surgery & Aesthetics Medical Center at Chongqing West District Hospital and the physician responsible for this site.
His part on this site is the assessment of depth rather than the repair. When a patient arrives with an incision that has parted, the first thing he establishes is not how large the gap is but what is visible inside it, because skin that has separated over intact tissue and a separation that reaches the layer beneath it are two different problems with two different timescales. He examines the wound by hand rather than from a photograph, reads the colour and the bleeding of the edges, and looks for a collection under the scar by asking the patient to cough and stand. He treats infection and tension before he considers closing anything, because a closure attempted over either tends to come apart again. He asks what the patient has been doing since discharge, how their blood sugar and weight have been, and whether they smoke, because those are the reasons a wound fails to hold and they are also the things a patient can change. When the honest answer is that the wound should be left to heal from its base and the scar revised months later, he says so rather than closing it to look decisive.
Clinical focus
Depth decides the urgency, not the size on the surface
A separation of a few millimetres that exposes the layer beneath the skin is a different problem from a longer split that has stayed superficial, and only one of them is a same-day matter. This is why a photograph usually does not settle the question, and why the assessment is made at the wound rather than over the telephone. If you are unsure which you are looking at, cover it and telephone the team.
