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Are incisions the forgotten wound? Rethink incision care to improve patient outcomes

Sara Carvalhal, Daniel Chaverri

20 February 2024

This report summarises the findings of several studies into the efficacy and implementation of undisturbed wound healing (UWH) in a series of surgical and post-surgical settings. Particular focus is given to surgical oncology and the care of incision wounds during and after orthopaedic surgery. UWH is a principle that reduces patient mortality, improves recovery time, increases patients’ quality of life and reduces costs.

It is generally accepted that a moist environment provides the optimal setting for wound healing, both in acute and chronic wounds. In recent years, a new concept has emerged in the field of surgical wound care: ‘undisturbed wound healing (UWH)’. This concept advocates allowing the healing process to progress uninterrupted, not disturbing the wound unless absolutely necessary (Brindle et al, 2019; Davies et al, 2019). It is based on maintaining a constant temperature, an optimal moist environment and keeping the wound free of external agents in order to facilitate the normal wound healing process.

When is the best time to start surgical wound care?
The simple answer is: in the operating theatre, a sterile environment where the wound is fresh and clean.

There is consensus in the literature that dressings applied in the operating theatre should remain on the wound for at least 48 hours after surgery, and it is strongly recommended to leave them in place for up to four days, unless bleeding or wound exudate necessitates an early change. In these first four days, the wound has the highest risk of surgical wound infection (especially during the first 48 hours; Stryja et al, 2020). With this evidence in mind, it therefore makes no sense to change the dressing frequently – something often done out of habit or routine – unless deemed absolutely necessary.

Why is simple gauze not enough?
To facilitate UWH, there is a need for advanced dressings. This means dressings with a gentle adhesive that avoid blisters and peri-wound injuries, dressings with good exudate management and that allow the patient to shower and experience a free range of motion (Stryja et al, 2020).

What are the cost benefits of UWH?
Although advanced surgical dressings have a higher initial price than conventional ones, the lower number of dressing changes, reduced time spent by healthcare practitioners and reduction of complications make these advanced dressings an important tool, demonstrably saving overall healthcare costs. Furthermore, evidence clearly recommends their use as best practice (Stryja et al, 2020; Clin Guidel, 2020; Parvizi and Gehrke, 2018).

Finally, fewer dressing changes – or even potentially none – will enable the wound to heal, reduce dressing-related costs and dramatically decrease the amount of dressing-related medical waste. For example, comparing the usual 5—7 changes of a conventional dressing (including the consumables required to change those sterile or aseptically) with a dressing having the capacity to remain undisturbed for a much longer period of time in line with best practices.

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Disclaimer: This report is supported by an educational grant from Mölnlycke Healthcare.

References

Ailaney N, Johns WL, Golladay GJ et al (2021) Closed incision negative pressure wound therapy for elective hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty 36(7): 2402-11

Bohle B, Pera M, Pascual M et al (2010) Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery 147(1): 120-6

Brindle T, Farmer P (2019) Undisturbed wound healing: a narrative review of the literature and clinical considerations. Wounds International 10(2): 40-8

SSERA Group (2023) The case for surgical population assessment: The simplified surgical site event risk assessment (SSERA) model. Wounds International

Cohn SM (1997) Perioperative myocardial ischemia: an overlooked cause of long-term morbidity and mortality. J Trauma 43(2):244-50

Cooper HJ, Roc GC, Bas MA et al (2018) incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee. Injury 49(2): 386-91

Cui W, Xie Y (2023) Oncological results in women with wound complications following mastectomy and immediate breast reconstruction: A meta-analysis. Int Wound J 20(5): 1361-8

Curran T, Alvarez D, Pastrana Del Valle J et al (2019) Prophylactic closed-incision negative-pressure wound therapy is associated with decreased surgical site infection in high-risk colorectal surgery laparotomy wounds. Colorectal Dis 21(1): 110-8

Davies P, Stephenson J, Manners C (2019) Understanding undisturbed wound healing in clinical practice — a global survey of healthcare professionals. Wounds International 10(2): 50-7

Deptuła M, Zieliński J, Wardowska A, Pikuła M (2019) Wound healing complications in oncological patients: perspectives for cellular therapy. Postepy Dermatol Alergol 36(2): 139-46

Englesbe MJ, Goss J, Patel SP (2016) Survival and graft function after transplantation of a liver from a living donor. N Engl J Med 374(21): 2014-24

Gillis C, Li C, Lee L et al (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(4): 937-47

Groenen H, Jalalzadeh H, Buis DR et al (2023) Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. eClinicalMedicine 62: 102105

Karakiewicz PI, Hutterer GC, Trinh QD et al (2007) C-reactive protein is an informative predictor of renal cell carcinoma-specific mortality: a European study of 313 patients. Cancer 109(12): 2417-23

Keeney JA, Cook JL, Clawson SW et al (2019) Incisional negative pressure wound therapy devices improve short-term wound complications, but not long-term infection rate following hip and knee arthroplasty. J Arthroplasty 34(4): 723–8

Li SS, Udelsman BV, Parikh A et al (2020) Impact of postoperative complication and completion of multimodality therapy on survival in patients undergoing gastrectomy for advanced gastric cancer. J Am Coll Surg 230(6): 912-24

Nakatsutsumi K, Endo A, Asano H et al (2022) Prophylactic effect of negative-pressure wound therapy and delayed sutures against incisional-surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study. Ann Gastroenterol Surg 7(3): 441-9

National Institute of Health and care Excellence (2020) Surgical site infections: prevention and treatment. CG74

Nausheen B, Gidron Y, Peveler R, Moss-Morris R (2009) Social support and cancer progression: a systematic review. J Psychosom Res 67(5): 403-15

Parvizi J, Gehrke T (2018) Segundo consenso internacional sobre infecciones musculoesqueléticas

Peart J (2019) A tool to assess the risk of surgical site complications and suitability for incisional negative pressure wound therapy. Wounds UK 15(1): 20-6

Pieszko K, Pieszko K, Wichtowski M et al (2023) A randomized study comparing closed-incision negative-pressure wound therapy with standard care in immediate breast reconstruction. Plast Reconstr Surg 151(6): 1123-33

Sahebally SM, McKevitt K, Stephens I et al (2018) Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. JAMA Surg 153(11): e183467

Sandy-Hodgetts, K, Morgan -Jones R, Muath Adi M et al (2022) Incision care and dressing selection in surgical wounds – Findings from a series of international meetings. Wounds International

SSERA Group (2023) Surgical patient population risk assessment: The simplified SSERA assessment model. Wounds International

Shakhar G, Ben-Eliyahu S (2003) Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol 10(8): 972-92

Stannard JP, Volgas DA, McGwin G et al (2012) Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 26(1): 37-42

Stryja J, Sandy-Hodgetts K, Collier M et al (2020) Surgical site infection: presenting and managing surgical site infection across health care sectors. J Wound Care 29(2, Suppl 2b) :S1-69

Tanaydin V, Beugels J, Andriessen A et al (2018) Randomized controlled study comparing disposable negative-pressure wound therapy with standard care in bilateral breast reduction mammoplasty evaluating surgical site complications and scar quality. Aesthetic Plast Surg 42(4): 927-35

Webster J, Liu Z, Norman G, et al (2019) Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 3(3): CD009261

Willms AG, Schwab R, von Websky MW et al (2022) Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry: Surgical technique matters. Hernia 26(1):61-73

Willy C, Agarwal A, Andersen CA et al (2017) Closed incision negative pressure therapy: international multidisciplinary consensus recommendations. Int Wound J 14(2): 385-98

World Union of Wound Healing Societies (2016) Consensus Document: Closed surgical incision management: understanding the role of NPWT. Wounds International

World Union of Wound Healing Societies (2018) Consensus Document: Surgical wound dehiscence: improving prevention and outcomes. Wounds International

Xie W, Dai L, Qi Y, Jiang X (2022) Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta-analysis. Int Wound J 19(6): 1319-28

Resources

Are incisions the forgotten wound? Rethink incision care to improve patient outcomes

Treatment with WOUND dressing spray based on St John’s wort oil and neem oil

Taking the pain out of wound healing with microcurrent electrical stimulation therapy

Autolytic continuous debridement with a focus on biofilm management: Consensus document for the APAC region

Retrospective case series: Wounds treated with 3M™ Veraflo™ Therapy

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