Surgical Wound
Description
A surgical wound is the result of a planned procedure, either elective or emergency, where the clinician creates the wound in order to perform a surgical procedure. This wound type is expected in general to follow a rapid, predictable pathway towards healing with minimal scarring and loss of function. The wound may be either incised and closed (this wound heals by primary intention) OR incised and laid open (this wound heals by secondary intention).For guidance see cavity wounds.
Wound Healing by Primary Intention Reproduced by permission of NHS Lothian Treatment If a dressing is required: Treatment Aim
• To restore physical integrity and function without infection and with the minimum of deformity.
• Approximation of wound edges immediately using sutures, clips staples or adhesives, so that each layer (muscle, subcutaneous fat and skin) comes together, thereby expediting haemostasis and the healing mechanism.
• Occlusive dressings should be used post operatively, which may be removed within 48 hours as the wound should be totally sealed, thus preventing the ingress of bacteria (Dealey 2005).
• If there is strike through or leakage, dressing can be replaced or reinforced.
Wound Healing by Secondary Intention Treatment Aim The wound is left open to heal by granulation, contraction and epithelialisation, for several reasons:
• There may be considerable tissue loss, eg radical vulvectomy
• The surgical incision is shallow, but has a large surface area, eg donor sites
• There may have been infection, eg a ruptured appendix, or an abscess may have been drained, and free drainage of any pus is essential (Dealey 2005). Treatment
• Surgical wounds should be dressed according to the wound type.
REFERENCE
Dealey, C. (2005 ) General Principles of Wound Management. In: The Care of Wounds, 3rd edn. Oxford: Blackwell Science. 23
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