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Surgical Wounds & Incisions A Comprehensive Review
Assessment & Management
Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C
Advanced Practice Nurse / Adult Clinical Nurse Specialist
www.woundcarenurses.org
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Objectives
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▪ Understand pathophysiology of the surgical wounds
▪ Understand the types of surgical closure
▪ Understand cascade of infection
▪ Understand management strategies
▪ Identify best practices in home care setting for the management of patients
with surgical wounds & incisions
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Statistics
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▪ There are more than 110 million surgical incisions every year, which require some wound management treatment.
▪ In the U.S., >40 million inpatient surgical procedures occur each year; 2-5% are complicated by surgical site infection.
▪ SSIs are the second most common nosocomial infections, Costing $400-$2,600 per infection (TOTAL: $130-$845 million/year)
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Definition
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Wounds & Incisions resulting from a surgical procedure are called Surgical Wounds & Incision
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Infected Surgical Wound
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Infected Surgical Wound
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Infected Surgical Wound
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Infected Surgical Wound
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Phases of Wound Healing
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Surgical Wound
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Inflammation
◼ The inflammatory phase commences as soon as tissue integrity is disrupted by injury; this begins the coagulation cascade to limit bleeding.
◼Duration 0 – 14 days
◼ In wounds closed by primary intention, lasts 4 days.
◼ Characterized by erythema, edema and pain.
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Inflammation
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Inflammation
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Proliferation Phase
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The proliferative phase begins as the cells that migrate to
the site of injury, such as fibroblasts, epithelial cells, and
vascular endothelial cells
Fibroblast proliferation stimulated by macrophage-released
growth factors
Granulation tissue and neo-vascularization
Duration 4 – 42 days
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Proliferation Phase
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Maturation / Remodeling Phase
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Duration 24 days – 18 month
Collagen degradation, and collagen remodeling
Scar Tissue formation
Realignment of collagen fibers
Tensile strength 80%
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Maturation / Remodeling Phase
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Types of Wound Healing
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Primary IntentionDescribes a wound closed by approximation of wound
margins or by placement of a graft or flap, or wounds
created and closed in the operating room
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Types of Wound Healing
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Types of Wound Healing
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Secondary IntentionDescribes a wound left open and allowed to close by
granulation, contraction and epithelialization.
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Types of Wound Healing
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Types of Wound Healing
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Tertiary IntentionDelayed closure or partial closure. Often
used for infected wounds where bacterial
count contraindicates primary closure.
Wound edges are approximated within 3-4
days and tensile strength develops as with
primary closure
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Types of Wound Healing
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Risk Factors
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Comorbidities – Uncontrolled Diabetes mellitus,
Cancer, Renal disease, Liver disease, Obesity,
weakened immune system.
Age of the patient
Malnutrition
Tobacco use
Inappropriate use of dressings
Systemic Steroid use
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Wound Infection
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CONTAMINATION COLONIZATIONCRITICAL COLONIZATION
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Wound Infection | Signs & Symptoms
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Wound is painful, even though there is no visible
evidence (early sign)
High or low temperature, low blood pressure, or a fast
heart rate
Discharge & odor from the wound
Increased swelling, redness, warmth
Wounds that do not improve with treatment
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Wound Infection | Signs & Symptoms
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Topical Antimicrobials
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Topical Silver Dressings
Cadexomer Iodine Gel
Antimicrobial Cleanser
Topical Antibiotics
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Conclusion
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Appropriate dressing selection to manage the drainage is
vital.
No “ WET TO DRY DRESSING” ORDERS.
Keeping the surgical site clean and dry is the goal.
Weekly follow ups to assess & monitor, until the wound is
completely healed.
Early intervention to prevent possible infection.
Multidisciplinary approach when dealing with difficult
wounds. Infectious disease specialist, Wound care nurse
and Physical therapist.
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Questions ?
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Alex Khan, APRN ACNS-BC Advanced Practice Nurse |Adult Clinical Nurse Specialist
Pro Healthcare Medical Group
Wound Care Consultant | Educator
Phone: (972) 584-7616
Fax: (214) 853-5364
Email: [email protected]
Web resource: www.woundcarenurses.org