Surgical Wound

What is a surgical wound?

A surgical wound is a cut or incision in the skin that is usually made by a scalpel during surgery. A surgical wound can also be the result of a drain placed during surgery. Surgical wounds vary greatly in size. They are usually closed with sutures, but are sometimes left open to heal.

What are the types of surgical wounds?

Surgical wounds can be classified into one of four categories. These categories depend on how contaminated or clean the wound is, the risk of infection, and where the wound is located on the body.

Class I: These are considered clean wounds. They show no signs of infection or inflammation. They often involve the eye, skin, or vascular system.

Class II: These wounds are considered clean-contaminated. Although the wound may not show signs of infection, it is at an increased risk of becoming infected because of its location. For example, surgical wounds in the gastrointestinal tract may be at a high risk of becoming infected.

Class III: A surgical wound in which an outside object has come into contact with the skin has a high risk of infection and is considered a contaminated wound. For example, a gunshot wound may contaminate the skin around where the surgical repair occurs.

Class IV: This class of wound is considered dirty-contaminated. These include wounds that have been exposed to fecal material.

What causes surgical wounds?

Surgical wounds are created when a surgeon makes an incision or cut with a surgical instrument called a scalpel. A wide variety of medical circumstances require surgery. The size of a wound depends on the type of procedure and location on the body.

What are the risk factors for surgical wound infections?

Any surgical procedure will create a surgical wound. The likelihood of a wound infection after surgery is between 1 and 3 percent.

Risk factors for developing a surgical wound infection include having other medical issues, such as diabetes or a weakened immune system. Smokers, older adults, and people who are overweight also have an increased risk of infection. Emergency surgeries, abdominal surgeries, and surgeries that last longer than two hours bring a higher risk of infection, too.

What are the symptoms of surgical wound infections?

Surgical wounds are frequently monitored to make sure they are healing properly. Infections may affect only the skin, tissue under the skin, or implants, according to the Centers for Disease Control and Prevention. Signs of a surgical wound infection include:

• increased pain and redness around the wound
• delayed healing
• the presence of pus
• a foul smell, or drainage from the wound

In some cases, an infected surgical wound can appear dried out or deeper. Fever may also be a common symptom.

How are surgical wound infections diagnosed?

A physician can diagnose a surgical wound infection by examining the wound, assessing symptoms, or taking a culture of fluid drained from the wound.

How is a surgical wound treated?

Treatment for a surgical wound sometimes depends on where it’s located on the body. Surgical dressings are normally placed over the wound and may need to be changed regularly. The skin around the surgical wound will likely need to be cleaned, often with salt water and soap. The wound may also need to be irrigated with salt water. This involves filling a syringe with salt water and spraying the skin around the wound.

Home care

Home care for a surgical wound may involve some of the same procedures, including frequent dressing changes and cleaning. Over-the-counter pain medication can also reduce discomfort. Often, patients are discharged from the hospital before a surgical wound has completely healed. It is essential that patients follow all at-home care instructions. Following directions properly will promote healing and decrease chances of an infection.

What are some complications of surgical wounds?

When surgical wounds cause infection, it typically occurs within 30 days of surgery. Infections may be red, painful, hot to the touch, or drain pus. To treat infections, your physician may prescribe an antibiotic, or they may have to open the wound to clean it.

What is recovery like for surgical wounds?

Recovery varies and can last for weeks to months. Your surgeon should be able to give you specific information on when you can go back to work, exercise again, and return to your daily routine.

What is the outlook for surgical wounds?

The outlook for a surgical wound that is properly healing is good. Following infection control recommendations can increase the chances that the wound heals well.

Source 

https://www.healthline.com

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Surgical wound care

Surgical wound care - open

   

TOPNURSE~An incision is a cut through the skin that is made during surgery. It is also called a surgical wound. Some incisions are small, others are long. The size of the incision depends on the kind of surgery you had.

Sometimes, an incision breaks open. This may happen along the entire cut or just part of it. Your doctor may decide not to close it again with sutures (stitches).

What to Expect at Home

If your doctor does not close your wound again with sutures, you need to care for it at home, since it may take time to heal. The wound will heal from the bottom to the top. A dressing helps absorb drainage and keep the skin from closing before the wound underneath fills in.

Proper Handwashing

It is important to clean your hands before you change your dressing. You can use an alcohol-based cleanser. Or, you can wash your hands using these steps:

• Take all jewelry off your hands.
• Wet your hands, pointing them downward under warm running water.
• Add soap and wash your hands for 15 to 30 seconds (sing "Happy Birthday" or the "Alphabet Song" one time through). Clean under your nails also.
• Rinse well.
• Dry with a clean towel.

Removing the Old Dressing

Your health care provider will tell you how often to change your dressing. To prepare for the dressing change:

• Clean your hands before touching the dressing.
• Make sure you have all the supplies handy.
• Have a clean work surface.

Remove the old dressing:

• Carefully loosen the tape from your skin.
• Use a clean (not sterile) medical glove to grab the old dressing and pull it off.
• If the dressing sticks to the wound, wet it and try again, unless your provider instructed you to pull it off dry.
• Put the old dressing in a plastic bag and set it aside.
• Clean your hands again after you take off the old dressing.

Caring for the Wound

You may use a gauze pad or soft cloth to clean the skin around your wound:

• Use a normal saline solution (salt water) or mild soapy water.
• Soak the gauze or cloth in the saline solution or soapy water, and gently dab or wipe the skin with it.
• Try to remove all drainage and any dried blood or other matter that may have built up on the skin.
• DO NOT use skin cleansers, alcohol, peroxide, iodine, or soap with antibacterial chemicals. These can damage the wound tissue and slow healing.

Your provider may also ask you to irrigate, or wash out, your wound:

• Fill a syringe with salt water or soapy water, whichever your doctor recommends.
• Hold the syringe 1 to 6 inches (2.5 to 15 centimeters) away from the wound. Spray hard enough into the wound to wash away drainage and discharge.
• Use a clean soft, dry cloth or piece of gauze to carefully pat the wound dry.

DO NOT put any lotion, cream, or herbal remedies on or around your wound, unless your provider has said it is OK.

Putting on the New Dressing

Place the clean dressing on the wound as your provider taught you to. You may be using a wet-to-dry dressing.

Clean your hands when you are finished.

Throw away the old dressing and other used supplies in a waterproof plastic bag. Close it tightly, then double it before putting it in the trash.

Wash any soiled laundry from the dressing change separately from other laundry. Ask your provider if you need to add bleach to the wash water.

Use a dressing only once. Never reuse it.

When to Call the Doctor

Call your doctor if:

• There is more redness, pain, swelling, or bleeding at the wound site.
• The wound is larger or deeper, or it looks dried out or dark.
• The drainage coming from or around the wound increases or becomes thick, tan, green, or yellow, or smells bad (which indicates pus).
• Your temperature is 100.5°F (38°C) or higher.

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6 Key Factors in Treating a Diabetic Wound

TOPNURSE~By 2030, it is estimated that more than 550 million people around the world will have diabetes. Approximately 25% of these diabetic patients will develop foot ulcers during their lifetime, which often require advanced diabetic wound treatment to prevent complications. To help achieve the optimal healing environment and protect against problems, there are six key factors to consider when treating diabetic wounds.

1. Wound Assessment

Diabetic wounds fall into three categories: neuropathic, ischemic, and neuroischemic. Knowing the distinct features of each wound category is essential to identifying wound progression, infection, and healing. Failure to properly identify the type of wound that exists can lead to an ineffective diabetic wound treatment plan, causing long-term complications or amputation.

2. Tissue Debridement

Wound debridement, or the removal of necrotic tissue from a wound, will reduce pressure, stimulate wound healing, allow for the inspection of underlying tissue, help with secretion or wound drainage, and optimize a wound dressing’s effectiveness. Clinicians typically recommend sharp debridement by scalpel or scissors, but there are other tissue-removal treatments they may recommend, including larval, autolytic, and ultrasonic.

Only an experienced practitioner who knows which section of the tissue to remove without damaging blood vessels, nerves, or tendons should perform a debridement procedure. Understanding the importance of debridement to your diabetic wound treatment plan is often essential with advanced diabetic wounds.

3. Infection Control

Infections are the top concern in any diabetic wound treatment plan. Due to the high morbidity and mortality rates associated with diabetic wounds, more aggressive forms of infection control are necessary. Both oral and topical antibiotics are recommended for all diabetic wound treatment patients who show signs of infection, even mild ones. Topical antimicrobials can reduce bacteria, protect against further contamination, and prevent the spread of infection deeper into the wound. Typical wound dressings used in treating diabetic wounds are those impregnated with antimicrobial agents to help fight infection. Clinicians often prescribe advanced wound care dressings that include silver, iodine, medical-grade honey, or polyhexamethylene biguanide (PHMB) which work to enhance healing by keeping your wound moist.

4. Moisture Balance

Choosing the optimal dressing for a diabetic wound is essential to successful wound healing. The proper wound dressing will help maintain a balanced moisture environment (not too wet or too dry) and allow the wound to drain and heal properly. The location of the wound will also be taken into consideration by your clinician when they choose a dressing. While each wound needs to be assessed properly, some common dressings that can be used for diabetic wounds include alginates, hydrocolloids, and films.

5. Pressure Offloading

For most diabetic wound treatment plans for patients suffering from foot or leg ulcers, pressure reduction or offloading is a key factor in preventing complications. A non-removable total contact cast (TCC) redistributes pressure evenly throughout the lower leg and can reduce healing times. However, TCC is not always the best choice, especially for infected wounds, so other removable offloading devices may be used including removable cast walkers, Scotchcast boots, or healing sandals.

The most common problem with healing when using removable devices is that some patients do not wear them properly, which can delay wound healing. In these cases, studies have found that patients with removable offloading devices only wear them less than 30% of the day. If you have questions about how to utilize offloading devices, speak with your doctor.

6. Underlying Factors

A diabetes wound patient must be treated holistically in order to identify underlying issues and reduce risk factors that are causing wounds in the first place. Achieving control of diabetes is difficult but essential, especially concerning blood glucose levels, proper nutrition, high blood pressure, and smoking cessation. Other factors, such as proper footwear and adequate blood supply to extremities, need to be assessed. No matter the level of injury, a clinician specializing in this field should prescribe a diabetic wound treatment plan.

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How does diabetes affect wound healing?

Diabetes can cause wounds to heal more slowly. This raises the risk that someone with diabetes will develop infections and other complications.

A person who manages their diabetes well can improve wound healing and reduce the chances of developing a serious infection.

Diabetes and wound healing

Those with diabetes may find that different types of wounds are slow to heal.

TOPNURSE~Minor wounds, cuts, and burns are a part of life, but for people with diabetes, they can cause serious health issues.

Many people with diabetes develop wounds that are slow to heal or never heal. Wounds that do not heal well can become infected.

An infection can spread locally, to surrounding tissue and bone, or to further away areas of the body. In some cases, they may even be fatal.

Diabetic foot ulcers affect 15 percent of people with diabetes. These are painful sores that can ultimately lead to foot amputation.

Even when a wound does not become infected, it can affect a person's health and quality of life. Cuts or injuries on the feet or legs can make it difficult to walk or exercise without pain.

Keeping diabetes under control can reduce the risk of slow-healing wounds and complications, including foot ulcers.

A 2013 study found a clear correlation between blood glucose and wound healing. People undergoing surgery for chronic diabetes wounds were more likely to fully heal if their blood glucose was well-controlled at the time of surgery.

Why does diabetes affect wound healing?

Diabetes makes it more difficult for the body to manage blood glucose levels. When blood glucose remains chronically high, it impairs the function of white blood cells, resulting in an inability to fight bacteria.

Diabetes, particularly if uncontrolled, is also associated with poor circulation. As circulation slows, red blood cells move more slowly. This makes it more difficult for the body to deliver nutrients to wounds. As a result, the injuries heal slowly, or may not heal at all.

Nerve damage is another factor affecting wound healing. Uncontrolled blood glucose can damage the body's nerves, which means that people with diabetes may sustain trauma to their feet more easily without being aware that they are injured. This can prevent them from seeking treatment, allowing a wound to become even worse.

Impaired sweating, dry and cracked skin, toenail infections, and foot deformities are more commonly found in people with diabetes, increasing the risk of a bacterial infection.

Research is consistently uncovering other ways that diabetes affects wound healing, including:

• weakened production of hormones associated with growth and healing
• decreased production and repair of new blood vessels
• weakened skin barrier
• decreased collagen production

Complications

People who exhibit poor wound healing due to circulatory and neurological effects of diabetes may have other complications as well. These include heart disease, kidney disease, and eye problems.

A wound left untreated may become infected, and the infection may spread locally to muscle and bone. This is called osteomyelitis.

If the infection spreads into the bloodstream, it is called sepsis and can be life-threatening. Deep infections may sometimes become severe and require amputation.

Prevention

Maintaining good foot hygiene by washing and moisturizing daily may help to promote wound healing.

Strategies that can prevent slow-healing wounds due to diabetes include managing blood glucose, proper foot care, and treating wounds promptly.

Proper foot care includes:

• washing feet daily
• patting dry and applying moisturizing lotion
• avoiding walking barefoot
• carefully trimming toenails
• wearing comfortable shoes
• inspecting feet and looking inside shoes daily
• having a doctor check feet at each visit

People with diabetes should carefully monitor their wounds. While it is normal for diabetic wounds to heal slowly, it is not normal for them to remain open for several weeks, to spread or ooze, or to be extremely painful.

People with well-managed diabetes are less likely to suffer from serious wounds that do not heal.

People with type 1 diabetes must take insulin for life. Those with type 2 diabetes have more options for controlling their blood glucose, including several anti-diabetic drugs and insulin.

Both types of diabetes benefit from a carb-controlled diet. In the case of type 2 diabetes, lifestyle interventions, such as diet, exercise, and weight loss, may substantially improve blood sugars and may even allow a person to manage their diabetes without medication.

Outlook

A wound that does not heal can quickly become life-threatening. A positive outlook for slow-healing wounds depends on receiving prompt treatment.

People with diabetes should immediately contact a doctor when they develop serious or painful wounds, or if a wound appears infected, causes a fever, or does not heal after several days.

A combination of aggressive antibiotic treatment, cleaning the wound, surgical treatment to remove dead tissue, and better glucose control can help. If the wound does not respond to treatment, such as with a severe or extensive diabetic foot ulcer, amputation may be necessary.

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