Surgical wounds and wound closure: clinical practice and technology trends

(Drawn from Worldwide Wound Management, report #s247, and Surgical Sealants, Glues, Wound Closure and Anti-adhesion, report #S180.”)

Surgical procedures generate a preponderance of acute wounds with uneventful healing and a lower number of chronic wounds, such as those generated by wound dehiscence or postoperative infection. Surgical wounds are most often closed and left to heal “by primary intent,” a term used by surgeons to indicate that the wound is left to heal by itself, the only external intervention being the use of products such as sutures, staples, or glues, where the two sides across the incision line are brought close and mechanically held together. Surgical wounds that involve substantial tissue loss or may be infected are allowed to heal “by secondary intent,” where the wound is left open under dressings and allowed to fill by granulation and close itself by epithelialization. Some surgical wounds may be closed through delayed primary intention where they are left open until such time as it is felt it is safe to suture the wound closed.

Surgery may be performed on an inpatient or outpatient basis, and the method of wound closure or dressings used may vary depending on whether or not the patient will remain in the hospital. The majority of acute wounds are treated at least initially in association with a hospital or acute care center, while most chronic wounds receive treatment in outpatient clinics, nursing homes, home health care settings, community clinics, or physicians’ offices.

A significant feature of all wounds is the risk of pathological infection. Surgical wounds are no exception, and average levels of infection of surgical wounds are 7%–10% depending on the procedure. These infections can be prevented by appropriate standards of cleanliness, surgical discipline and skill, wound care therapy, and occasionally antibiotic prophylaxis. Infections usually prolong healing, involve the use of more expensive products and drugs, significantly increased therapist time, and increased morbidity and rehabilitation time.

The incidence of surgical wounds is projected to increase at an annual rate of 3%, but the severity and size of surgical wounds will decrease as a result of the trend toward minimally invasive surgery.

See next, “Practices and Technology Trends in Wound Management and Wound Closure.”

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