Surgical wounds are premeditated wounds, reducing risks of complication. Surgical wounds typically encountered are muscle and skin grafts, wound dehiscence and wounds that have been surgically debrided and left to close by secondary intention (28). Surgical wounds include lacerations, caused when trauma exceeds intrinsic tissue strength e.g. skin torn by blunt injury over a bony prominence such as the scalp. Tissue damage may not be extensive, and primary suturing may be possible. Sterile skin closure strips may be appropriate in some circumstances like pretibial laceration, as suturing causes increased tissue tension, with the swelling of early healing and inflammation leading to more tissue loss (28).

 

Dehisced Surgical Wounds

Dehiscence is a complication in which a wound ruptures along a surgical suture, due to excess tension across the wound edges. Vitamins deficiencies may decrease wound tensile strength, increasing the probability of occurrence. Healing will be enhanced by correcting these deficiencies. Surgical dehiscence may also occur due to underlying infection and abscess formation. If so, the wound is likely to present with classic signs of infection, with a necrotic or slough-covered base. It’s possible for the infection to be confined superficially within suture layer, or spread to tissue layers beyond the level of the procedure before becoming clinically evident (24).

 

Local wound management would consist of wound irrigation and debridement. Due to infection, moisture retentive dressings should be avoided. Modalities like pulsed lavage with suction, electrical stimulation and ultrasound are contraindicated in surgical wounds involving body cavities (24).

 

Surgically Debrided Wounds

Wounds that have been surgically debrided and allowed to close by secondary intention should be almost 100% granular after surgery. Interventions are therefore directed at enhancing granulation tissue formation, wound contraction and epithelialisation. In the absence of infection, a moisture retentive dressing may facilitate wound closure. Other therapies e.g. electrical stimulation and negative pressure wound therapy, may be beneficial (24). 

 

Surgical Site Infections

Despite vast improvements in standards of asepsis, postsurgical wound infections still occur (28). In hospitalised patients, surgical site infections (SSIs) are the third most frequently reported infection and often account for 12-16% of all nosocomial infections. Staphylococcus aureus is most frequently found in SSIs, with antibiotic resistant strains such as methicillin-resistant staphylococci aureus, vancomycin resistant enterococci and extended spectrum beta-lactamase gram negative bacteria becoming serious concerns. It has been estimated that 40–60% of SSIs are preventable and effective control relies on interventions like clinical monitoring, antimicrobial prophylaxis, infection control programmes and education. Other strategies to reduce wound infection include the development of vaccines for orthopaedic patients, phage therapy and negative pressure wound therapy (30).

 

Methods of Wound Closure

Primary closure: Skin may be closed with simple or mattress sutures using interrupted or continuous techniques. Knots should be loose, to allow swelling due to inflammation and to prevent necrosis at the skin edge. Mattress sutures ensure optimal eversion at the skin edge and appose deeper tissue, reducing the risk of formation of haematoma or seroma. The subcuticular suture is the most widely favoured technique for closing surgical skin wounds. It has good cosmetic results (31).