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.

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.

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.

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

Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment are two critical components of a strong wound treatment plan and program. Bedside staff members should be comfortable with describing wounds, tissue types, and differentiating wound etiologies. Training should be provided by the certified wound care clinician, along with follow-up (chart reviews and documentation checks, one-on-one education as needed, and routine competency or education days). Additionally, the wound care clinician should be able to develop an appropriate treatment plan based on wound etiology, by involving additional disciplines as needed to best treat the whole patient.

Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.

Surgical site infections (SSIs) are a risk for the more than 10 million patients who undergo inpatient surgical procedures every year in the United States. Between 300,000 and 500,000 Americans develop SSIs annually. SSIs are defined as infections related to an operative procedure that occur at or near the surgical incision within 30 days of the procedure, or within 90 days if prosthetic material is implanted.