Summary of Surgical Wound Management

## Introduction Surgical wound care is the set of practices used to assess, clean, dress, and monitor wounds after a surgical incision or other tissue injury. Proper wound care promotes healing, prevents complications, and supports the patient’s recovery. > Definition: A wound is a disruption of tissue integrity and function. A surgical wound (incision) is a planned break in tissue created by a surgeon during an operation. ## Wound classification Break wounds into useful categories to guide management. > Definition: Wound classification groups help decide expected healing patterns and appropriate care. ### By etiology - Traumatic wound - Chronic wound - Surgical wound ### By onset and duration - Acute wound - Chronic wound ### By healing process (intention) | Type | Description | Typical examples | | --- | --- | --- | | Primary intention | Edges approximated and closed early | Clean surgical incision closed with sutures | | Secondary intention | Wound left open to heal from base up | Large tissue loss, infected wounds | | Tertiary intention (delayed primary) | Initially left open, closed later once clean | Contaminated abdominal wounds managed then closed | Fun fact: Proper wound classification helps tailor dressing choice and follow-up frequency, which can reduce infection risk. ## Phases of wound healing Understanding phases helps interpret wound appearance and expected progress. > Definition: Wound healing proceeds through staged biological processes that restore tissue continuity. 1. Haemostasis/coagulation - Immediate vasoconstriction and clot formation; fibrin mesh and scab form. 2. Inflammation - Neutrophils and macrophages remove bacteria and debris; the wound may appear red, warm, and swollen. 3. Proliferation / granulation - Fibroblasts produce collagen, angiogenesis forms new capillaries; wound contraction and epithelialization occur. 4. Maturation / remodeling - Collagen reorganizes, tensile strength increases and scar forms. Practical example: A clean surgical incision typically shows minimal inflammation, early epithelialization, and progresses rapidly through proliferation to maturation if no complications occur. ## Factors affecting wound healing Separate local and systemic factors to guide interventions. - Local factors - Oxygenation, infection, venous insufficiency, pressure, foreign bodies - Systemic factors - Age, comorbidities (e.g., diabetes, peripheral vascular disease), medications (glucocorticoids, chemotherapy), malnutrition, smoking, alcoholism, stress, cancer, radiation, immunosuppression Did you know that smoking reduces wound oxygen delivery and can double the risk of wound complications after surgery? ## Common complications of wound healing Know the signs to act early. - Hemorrhage — persistent or sudden bleeding from the wound - Infection — increased pain, purulent discharge, erythema spreading beyond wound margins, systemic signs - Dehiscence — partial or complete separation of wound edges - Evisceration — protrusion of internal organs through a wound (surgical emergency) Real-world application: Early recognition of dehiscence or evisceration requires immediate surgical consultation and protective sterile covering until definitive care. ## Wound assessment (systematic approach) Use a consistent method to track changes over time. - Inspect: location, size, shape, edge condition - Measure: length, width, depth, and percentage of tunneling or undermining - Assess exudate: amount, color, consistency, odor - Inspect wound bed: granulation tissue, slough, necrosis - Check surrounding skin: erythema, maceration, edema - Pain assessment and systemic signs (fever, tachycardia) Practical tip: Photograph wounds with consistent lighting and include a ruler for size comparison when allowed by policy. ## Dressings: purpose, layers, and selection Dressings protect the wound, manage exudate, and support healing. > Definition: A dressing is sterile material applied to a wo