Treatment of surgical wound dehiscence

Surgical exploration of cavities, sinuses, and specific antibiotic therapy are fundamental for the control fo cutaneous infection. Topical treatment will vary based on evaluation of the lesion, experience of the health care team, and the environment.     

The newer surgical dressings and wound healing

In summary, there are a variety of new synthetic surgical dressing materials available today. Although individual physician preferences and differences in the type of injury may determine which of these membranes is utilized in a given clinical situation, they all serve to speed the rate of epithelialization, to decrease motion within the healing wound, to decrease postoperative pain, and to minimize the potential for bleeding and infection. For all of these reasons, a complete knowledge of these dressings and their uses will greatly enhance the surgeon's ability to care more satisfactorily for the patient with a cutaneous wound.     

Improved scar formation after using a medical surgical zipper for wound closure under tension

BACKGROUND AND OBJECTIVE: The objective of the study was to evaluate the use of a medical surgical zipper (Medizip) for wound closure under tension in comparison to conventional cutaneous sutures. The surgical zipper is supposed to reduce wound tension by approximating of the wound edges via epidermal traction. PATIENTS/METHODS: This prospective study included patients with a wound diameter of more than 1 cm. 45 patients were treated with the surgical zipper, 38 were randomized into a control group with conventional wound closure. Scars were assessed after 6-18 months focusing on aesthetic and functional aspects. RESULTS: The average length of the scars in both groups was 9 cm, but after a observation time of at least 6 month, there were differences in the width of the scars. The group with the surgical zipper showed significantly thinner scars (2.74 mm versus 4.24 mm, p=0.0008). Only 17% of the Medizip patients developed unaesthetic rope ladder-like scars versus 65% in the control group. This observation was statistically significant (p<0.0001). CONCLUSIONS: Wound stabilization by approximation of the wound edges via surgical zipper results in improved scar formation in wounds with moderate tension. Using the Medizip trade mark in wounds under heavy tension is not recommended because of the possible development of to tension bullae under the zipper.     

Cardiac device interrogation for safer care of surgical wound patients

Although most clinicians would agree comprehensive assessment of a wound patient is important, not all know the importance of including cardiac device interrogation as part of the standard preoperative evaluation. Using clinical exemplars, the authors highlight key concepts to raise awareness among wound colleagues of this important patient safety concern.     

The effect of surveillance on surgical wound infection rates.

The clean wound infection rate is the most valuable reflection of surgical care in any hospital. Wound infection rates are seen as indicators of quality in terms of negative outcome measures. A nurse was appointed by Hairmyres and Stonehouse Hospitals NHS Trust for the purpose of surveillance of the clean surgical wound infection rate. The surveillance is based on a previous study in the USA showing that feedback of infection rates to surgeons can lead to a reduction in these rates. The specifications for surveillance were that all clean surgery would be followed up for 30 days post-operatively and that wounds with implants, i.e. vascular grafts, would be followed up for 1 year post-operatively to produce infection rates for the surgeons, wards, theatres and the infection control team. Data collection commenced in October 1995 and so far 1851 clean surgical cases have been followed up for 30 days post-operatively. All patients were monitored until discharge, then at 30 days post-operatively, and the wound scored for signs of infection. Day cases were seen within week 1 and at day 30. General practitioner and district nurse liaison enabled detection of problems at other times. The patients were given a telephone number they could use to report problems after surgery. The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It has enabled the early identification of problem areas in practice. The audit has also been used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the extrinsic risk factors for wound infection. As a result of the surveillance, there has been a significant reduction (P < 0.05) in the clean wound infection rate.     

Healing of the surgical wound: I. Basic considerations

Part I of this review explores the basic process by which surgical wounds heal. The relationship of innate physiologic mechanisms of regeneration and repair will be related in part II to the various factors influencing the healing process.     

Unusual size,topography, and surgical resolution of an acquired fibrokeratoma

Acquired fibrokeratoma is a rare benign skin tumor that usually manifests as a slow-growing solitary nodular lesion of the digits. We report a case of plantar acquired fibrokeratoma evidencing its atypical size and topography, in addition to the treatment with simple surgical excision followed by healing by second intention. Nondigital fibrokeratomas may occur in 18% of cases and rarely affect the palmoplantar region. These lesions are usually asymptomatic and show ≥ 3cm in size at the time of diagnosis due to delayed diagnosis. Complete surgical excision is the treatment of choice, which is usually curative. In general, primary closure is chosen; however healing by second intention becomes an option in regions of difficult approach.