Surgical Wounds

Surgical wounds originate when a surgeon cuts into tissue with a surgical tool, such as a scalpel. The size and placement of a surgical wound will depend entirely on the procedure performed due to varying incision requirements.

Regardless, most surgical interventions aim for wound closure with primary repair. Tissue edges are typically brought together and held in place by various modalities, such as sutures or staples. However, this result isn’t always the case, as some wounds may be left open to heal secondarily or may fail to heal primarily. This piece will discuss the surgical wound timeline, various complications of a surgical wound, signs/symptoms of infection, along with the recovery process for patients.

Acute wound: An alteration in skin integrity, such as a simple laceration or a surgical wound, that typically moves through the healing process and heals in a predictable timeframe without complication. An acute wound results from a documentable event with the assumption that it will progress normally through the 4 phases of wound healing.

Christine Miller, DPM, PhD, FACCWS

A limb salvage program aims to prevent major amputations and thus improve patients' quality of life and overall longevity. Despite the efforts of a multidisciplinary team approach, amputation prevention remains a challenging endeavor.¹ Providing both physical and socioemotional guidance for patients undergoing a major amputation is crucial for recovery. A multifaceted approach to post-amputation care may seem like a relatively modern concept, but it has deep roots in earlier civilizations.

Holly Hovan MSN, GERO-BC, APRN, CWOCN-AP

Ideally, most wound care professionals may want to prevent surgical wound dehiscence before it occurs. If clinicians prevent dehiscence, the healing process and, subsequently, the patient's ability to return to normal daily activities is typically quicker. Some methods to prevent surgical wound dehiscence include supporting the abdomen when coughing, sneezing, or moving around/sitting up in bed, avoiding strain or pressure to the wound area (heavy lifting, exercise, coughing, constipation/straining with bowel movements), and maintaining a good diet and good oral intake to prevent dehydration. It is essential to practice good hygiene, keep the wound clean, dry, and intact, and follow the provider's specific instructions on wound care and any prescribed medications.

By WoundSource Editors

Diabetic foot ulcers (DFUs) are open sores or wounds caused by a combination of factors that include neuropathy (lack of sensation), poor circulation, foot deformities, friction or pressure, trauma, and duration of diabetes with complication risks. DFUs occur in 34% of people with diabetes, and approximately 14% to 24 % of patients with diabetes who develop a DFU will require an amputation.

Abscess: Inflamed tissue surrounding a localized gathering of pus, often caused by infection.

Antimicrobial resistance: The process that occurs when bacteria, fungi, and parasites (microorganisms) change over time and no longer respond to antimicrobial medications. This resistance makes it more difficult to treat infections and increases the risk of spreading diseases that result in severe illness and death.

Antimicrobial stewardship: Collective measures that are taken to slow the evolution of multidrug-resistant organisms.

Surgical site care is vital in preventing complications such as infection and dehiscence. Advanced therapies can help in the prevention of infection and the management of surgical sites and wounds. In patients who are deemed at risk, consider beginning the use of advanced technologies earlier in treatment to maximize overall outcomes.

It was reported in 2014 that approximately 14 million operations were performed in the United States. The health care–associated infection prevalence survey conducted by the Centers for Disease Control and Prevention found an estimated 110,800 surgical site infections (SSIs) associated with inpatient surgical procedures in 2015. Even though many advances have been made in infection control practices, SSIs contribute to an overall surgical mortality rate of 3%, and 75% of deaths are specific to the SSI.

Although advances in surgical techniques and operating room technologies have made many surgical procedures more successful and have led to easier recovery for many patients, surgical site infections (SSIs) remain a clinical problem. These infections are associated with increased morbidity, mortality, and health care costs.

Despite modern precautions and protocols in place, surgical site infection (SSI) continues to be a risk. SSIs are the most common and costly of all hospital-acquired infections, with an estimated annual cost of $3.5 to $10 billion in the United States. Johns Hopkins Medicine reports that up to 3% of people who undergo a surgical procedure will develop an SSI. Additionally, SSIs can increase hospital length of stay by up to 9.7 days. Other complications of surgical wounds include osteomyelitis, gangrene, periwound dermatitis, periwound edema, wound dehiscence, and hematomas.