Care of Surgical Wounds and Choice of Dressings − Main Findings of the Latest International Expert Consensus

Introduction

Surgical wounds are susceptible to infections, so the use of modern dressings can play a key role in the healing process and in preventing complications. The term surgical wound complication includes infection, wound dehiscence, excessive granulation tissue formation, maceration of the surrounding skin, scarring, and damage to the skin from adhesive materials. The actual incidence of these complications may be underestimated due to insufficient follow-up after hospital discharge. Surgical wound infections are associated with longer hospital stays, may necessitate further surgery, require intensive care, increase healthcare costs, morbidity, and mortality. Therefore, the goal of healthcare providers caring for operated patients should be to reduce the risk of infection and complications of surgical wounds.

International expert groups (in various geographic areas: London, Northern Europe, Eastern Europe, Asia-Pacific, Middle East, and Africa) reached a consensus on what the requirements for surgical wound dressings should be, how long the dressing should stay on, and how frequently it should be changed.

Requirements for Surgical Wound Dressings

The purpose of a surgical wound dressing is to absorb and retain exudate, create ideal conditions for healing, and protect the wound until it heals. After the surgical wound is closed with minimal risk of infection, it is advisable to use a dressing that protects the wound from contamination, maintains a moist environment, minimizes the risk of skin damage, and stays in place until stitches or staples are removed. In cases of wounds with a moderate risk of infection and after surgeries where longer hospital stays are expected, expert panel members suggested using dressings that absorb and retain large volumes of fluid and exudate and allow for monitoring of the skin's appearance, so frequent changes are not necessary.

The first international consensus defined 6 basic requirements for an ideal surgical wound dressing, and 2 additional requirements were added:

• It is flexible and elastic − it does not restrict patient movement and does not create tension on the skin.
• It adheres well to the skin even shortly after applying disinfectant.
• It has absorbent properties and retains exudate.
• It protects the skin − does not cause irritation or blistering and is not excessively adhesive.
• It is waterproof − it seals well and allows the patient to shower and maintain hygiene.
• It does not create dead space.
• It has transparent edges that allow inspection of the surrounding skin.
• It is cost-effective.

Duration of Dressing

Opinions on dressing duration varied across different meetings. The common stance was that the duration of the dressing should depend on the wound's condition, the type of surgery, and the patient's level of cooperation. Differing opinions on the duration included options of 14 days, 7 days, 4 days, until patient discharge, usually 2-4 days, 48 hours, or depending on the individual risk of the patient. Other considerations included changing the dressing only if soaked or there is suspect wound infection, using glue for clean wounds in healthy patients, and leaving the wound uncovered.

Dressing Change Frequency

Panelists noted that often dressings are changed based more on established practices of the facility rather than the individual needs of the patient. There is increasing emphasis on so-called undisturbed wound healing today, where dressings are not changed unless there is a specific reason. The benefits include reducing the risk of contamination and potential infection, saving materials, and healthcare workers' time. Indicators that dressing change is necessary or appropriate include:

• soaking of the dressing
• leakage of fluid through the dressing
• excessive bleeding
• suspected local/systemic infection (wound pain, swelling, redness)
• potential dehiscence of wound edges
• dressing not staying in place

Conclusion

Although surgical wound care may differ in various parts of the world, international expert groups agreed on the need for consistency and standardization of procedures along with individualized optimization of surgical wound care. Education and training of staff are also essential. To ensure quality surgical wound care, it is necessary to choose appropriate dressings that meet the basic established requirements and change them individually based on clinical need with the goal of ensuring undisturbed wound healing.

(zza)

Source: Sandy-Hodgetts K., Morgan-Jones R. Incision care and dressing selection in surgical wounds: findings from a series of international meetings. Wounds International, 2022 Dec 14.