Optimizing Wound Outcomes in Surgery: Top Ten Tips Editorial Summary Surgical wound complications can range from surgical wound dehiscence, hypergranulation, periwound maceration, scarring, medical adhesive related skin injury, seroma, and haematoma. Surgical wound complications cause significant morbidity and have significant cost implications.
Introduction
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· Scarring
“Dura est manus cirurgi, sed sans.”
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T
· Medical adhesive-related skin injury (MARSI)
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· Seroma and haematoma
ranslated to ‘the hand of the surgeon is hard but healing’, is a famous quote by Walter Map. Thought provoking in its nature, because often surgery can be hard, tough and intensive on the patient. But our role as surgeons is to try to minimise damage to the tissue whilst carrying out extensive dissections, moving tissue flaps and performing skin substitute surgery and skin grafting. In other specialties such as vascular surgery procedures, lengthy dissections in multiple tissue planes are performed. Obstetric surgery has its own challenges too, including restoration of tissue to their original anatomical positions.
Surgical wound complications remain one of the most common managed wound type in clinical care and a cause of significant morbidity2. The International Surgical Wound Complications Advisory Panel (ISWCAP) has been set up to optimise care for patients with a focus on early identification of complications. The consensus report they produced is a useful guide for clinicians in their wound practice1.
Surgical wound complication (SWC) can range from the following1: •
Surgical wound dehiscence (SWD)
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Hypergranulation
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Periwound maceration
Consultant Plastic and Reconstructive Surgeon (Locum) Editor of Wound Masterclass London, United Kingdom
Tip 1: Surgical Technique Although techniques in surgery are ever evolving, the basic tenets of good surgical technique remain unchanged over time. Essentially a surgeon should consider every step of his or her procedure in advance to optimise all the steps in the procedure. For most procedures we perform, we tend to write down each step of the procedure as a roadmap ahead of time. Within each of those steps of surgery it is important to optimise your technique.
Miss Negin Shamsian
At the basis of these types of surgery remains an underlying set of principles of good technique that minimise wound complications. Careful tissue handling involves: •
Minimal skin edge handing with toothed forceps thus avoiding crush and tissue damage at the edges of your surgical wounds
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Judicious use of cautery devices that can cause heat damage to localised tissues and impair wound healing
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Careful placement of sutures to avoid tension and strangulation and subsequent necrosis of subcutaneous tissues.
Mr Andrew Diver Consultant Plastic and Reconstructive Surgeon (Locum) London, United Kingdom
Wound Masterclass - Vol 1 - June 2022
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