Breast augmentation in the patient with von Willebrand disease.

The authors describe breast augmentation in a patient with von Willebrand disease (vWD), providing a template for treating such patients. Because there is no single ideal laboratory test predictive of surgical bleeding, preoperative history remains the most important diagnostic tool. A vigilant pursuit of signs of undiagnosed vWD or other coagulopathy in the preoperative patient may prevent unexpected intraoperative or postoperative hemorrhage.

Acute wounds.

The most important factors in the management of acute wounds are the history and physical examination. The goals of wound care are fivefold: avoid further tissue damage, achieve wound closure as rapidly as possible, restore function to the injured tissue, facilitate the patient's expedient return to normal daily activities, and restore the patient's quality of life. The treating physician must have a good understanding of the wound healing mechanism. One must rule out all associated occult injuries that may be life threatening. Proper wound assessment and management with minimal discomfort to the patient are crucial. The primary goal is to facilitate the healing process to achieve a cosmetically pleasing and functional result.