Surgical Wounds

  • Definition
  • Wound Care
  • Patient Advice and Prevention
  • Products

A surgical wound is a skin incision made with the objective of eliminating a skin lesion or creating a path for reaching deep organs under the sterile conditions of the operating theatre.

Types of surgical wounds

Surgical cavities

plaie_chir01Surgical cavities are generally clean wounds with a healthy bed that should heal without complication.

Suitable dressings to pack, protect the wound and manage exudate are required.

 

Surgical cavities

Are created at the time of surgery when the surgeon has decided that healing should be by secondary intention. Normally undertaken when there is extensive tissue loss which would prevent primary closure of the wound, or because the wound is heavily contaminated, or was infected at the time of surgery.

Reference: Pudner R. Managing cavity wounds Journal of Community Nursing March 1998

Skin grafts

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Skin grafts are widely used in reconstructive surgery often following trauma or burns. Skin grafts may also be used to repair chronic wounds e.g. pressure ulcers or leg ulcers. Skin grafting is a technique that transfers a portion of skin from one part of the body to another part of the body.

To find out more

There are several classifications of skin grafts:

  • Autografts- graft of the patient’s own skin
  • Allografts- graft taken from another individual
  • Xenografts- graft taken form another species

It is important that a graft ‘vascularises’, non-adherent dressings to protect the graft, reduce pain, and manage any initial exudate are necessary.

Donor sites: A donor site is the site the skin to be grafted has been taken from. These sites are often very painful due to exposed nerve endings in the case of superficial dermo-epidermal graft or deeper if the graft includes the entire thickness of the skin (full thickness graft). Donor sites can bleed heavily initially requiring pressure to stop the bleeding. Alginate or hydro-desloughing dressings may be used initially for their haemostatic properties. Non adherent, absorbent dressings that provide a moist healing environment should be considered. Dressings are usually left in place for up to 10 days and then removed. Analgesia may be required for several days.

Closing Surgical wounds

The main aims of surgical wound closure and management are to restore function and physical integrity with the minimum deformity and without infection. Wound assessment is necessary to identify the method of surgical closure. The method of wound closure chosen will be the best to achieve these aims.

There are 3 methods of wound closure:

Primary closure (or first intention)

plaie_chir03The skin edges are held together using sutures, clips or tapes. This allows the skin edges to seal and epithelialise very quickly providing a barrier to the entry of bacteria.

 

 

Delayed primary closure

This method of wound closing is used when there has been bacterial contamination. The wound will be left slightly open to allow the free drainage of pus.

After a few days the wound will be closed and then allowed to heal by primary closure. Sometimes wound drains are used to assist the drainage of fluid from the wound.  Cavity dressings may be appropriate to pack this type of wound, e.g. rope for absorbency. When dressing this type of cavity wound it is important to manage any exudate and also keep the wound bed moist to protect and aid the process of granulation and healing.

Healing by second intention

plaie_chir04In this case the wound is left open and heals by granulation, contraction and epithelialisation. This method may be used when there is considerable tissue loss, the surface area is shallow but large e.g. a donor site, or where there may have been an infection e.g. where an abscess may have been to allow the drainage of pus.

When dressing this type of cavity wound it is important to manage any exudate and also keep the wound bed moist to aid the process of granulation and healing.

Managing complications of surgical wounds

Sometimes closing of surgical wounds is hindered by complications including:

Haemorrhage

Haemorrhage can be associated with poor surgical technique or infection. Occasionally several wound sutures will be removed in case of secondary haemorrhage to allow free drainage of any blood that may have accumulated in the wound space at risk of infection.

Dehisced wounds

plaie_chir05Dehiscence means the breaking down, or splitting open of all or part of a wound healing by first intention. This can be caused by systemic factors or local factors e.g. wound closure technique (e.g. suturing too tightly so affecting the vascularity of the skin edges causing necrosis) or infection. The management of any infection in dehisced wounds is vital and the wound is often allowed to heal by secondary intention.

Sinus formation

A sinus is a track to the body surface from an abscess or another irritant such as suture material and can be a focus for infection. Sinuses can become chronic and it is difficult to identify the root of the problem. A wide excision of the sinus is often the most appropriate treatment to allow any drainage of pus.

Fistula formation

A fistula is an abnormal track between internal organs (such as between the intestine and the bladder or vagina), between two loops of the intestine, or between an organ and the skin. Care of the surrounding skin is important as exudate may excoriate and irritate surrounding skin. Infection may need to be treated. Fluid drainage and fluid loss will need to be managed, monitored and corrected.


These advices or recommendations do not replace expert opinion based on a full diagnosis.

If your patient is now at home,specify him/her to contact their health professional if any of the following signs appear:

  • Pain in the wound and/or surrounding area
  • Redness or swelling
  • Liquid or pus
  • Unpleasant smell
  • You have a temperature

If dressing change is made by the patient, specify him/her the following recommendations:

  • Wash your hands with soap and water
  • Remove the used dressing carefully
  • Not to touch the wound with fingers
  • Not to touch the inside of the new dressing

If the wound has been stitched, an appointment would have been planned for the removal of the stitches if necessary, some are self-dissolving and will disappear in 7-10 days.

  • Do not pull or interfere with the stitches
  • If stitches are causing discomfort the patient should contact their healthcare professional.

The patient should wait 24 hours before washing. The healthcare professional will tell the patient when washing is possible:

  • Showering is preferable to bathing
  • Some dressings are waterproof and can be left in place
  • Try and avoid wetting the wound
  • Do not use soap, shower gel or other cosmetic products directly on the wound
  • Do not rub the wound, pat it gently with a clean towel to dry it

If you have any concerns about your wound or the dressings please contact your healthcare professional.


These advices or recommendations do not replace expert opinion based on a full diagnosis.
Last update : October 20, 2017