Beyond the Incision: Surgical Wound Complications

Case Story of Patient Developing Surgical Wound Infection

Mr. K is a 56-year-old man with long-standing rheumatoid arthritis, who had knee replacement surgery. While the surgery initially went well, Mr K faced problems afterwards. He experienced swelling, redness, and fluid leaking from his wound. Despite doctors keeping a close eye on him and giving him medicine, his condition got worse. Eventually, he developed a serious infection in his wound, which required a long hospital stay and intense treatment.

This case highlights how important it is to closely watch patients after surgery and to get help right away if something doesn’t seem right.

History of Wound Care

One of the oldest medical manuscripts known to man is a clay tablet that dates back to 2200 BC. This tablet describes, perhaps for the first time, the “three healing gestures”—washing the wounds, making the plasters, and bandaging the wound.

Later in ancient civilizations, people used things like honey, grease, and clean water to clean wounds and promote healing. As time went on, people learned more about how wounds heal and how to keep them from getting infected.

Over time, nursing pioneer Florence Nightingale emphasized cleanliness and nutrition for wound healing.

In the late 1800s, Dr. Joseph Lister introduced antiseptics to prevent infection in wounds. Since then, advancements in medicine and technology have led to more effective wound care treatments.

As time went on, doctors and nurses learned more and more about how to treat wounds. But the fundamental principles remain the same: cleanliness, infection prevention, and supporting the body’s natural healing process.

What is Surgical Wound Complication?

Surgical procedures are common medical interventions aimed at treating various conditions and improving patient health. While many surgeries proceed smoothly without complications, surgical wounds can sometimes develop complications, posing challenges to patient recovery and well-being.

Most surgical wounds heal rapidly without complications. A minority of surgical wounds are complicated by infection. This occurs when germs (micro-organisms such as bacteria) enter the incision (cut) that the surgeon makes through your skin to carry out the operation.

When Do These Infections Develop?

A surgical wound infection can develop at any time from 2 to 3 days after surgery until the wound has healed (usually 2 to 3 weeks after the operation). Very occasionally, an infection can occur several months after an operation.

Surgical wound infections are uncommon. Most surgical wound infections are limited to the skin but can occasionally spread to deeper tissues. Infections are more likely to occur after surgery on parts of the body that harbour lots of germs, such as the gut.

Types of Surgical Wound Complications

Following are types of Surgical Wound Complications:

Surgical Site Infections (SSI)

SSIs are one of the most prevalent complications following surgery. They occur when bacteria or other pathogens infect the surgical site, leading to inflammation, pain, redness, and sometimes discharge or fever.

Delayed Wound Healing

Some wounds may exhibit delayed healing, characterized by slow progression through the stages of wound repair. Factors such as poor blood supply, underlying health conditions (e.g., diabetes), malnutrition, and certain medications can contribute to delayed healing.

Wound Dehiscence

Wound dehiscence refers to the partial or complete separation of wound edges, often accompanied by the exposure of underlying tissues or organs. This complication increases the risk of infection and may necessitate surgical intervention to reapproximate the wound edges.

Hematoma and Seroma Formation

Hematomas occur when blood accumulates in the surgical site, while seromas involve the accumulation of serous fluid. These fluid collections can exert pressure on surrounding tissues, impair wound healing, and increase the risk of infection.

Scar Formation and Hypertrophic Scarring

Surgical wounds may heal with excessive scar tissue, leading to hypertrophic scars or keloids. These scars can be cosmetically undesirable and may cause itching, pain, or restricted movement.

Fistula Formation

A fistula is an abnormal connection between two epithelial surfaces, which can occur as a complication of surgery. Fistulas may lead to persistent drainage, infection, and discomfort.

Wound Classification

Class I/Clean	Uninfected operative wound without inflammation, not entering respiratory, alimentary, genital, or urinary tract.
Class II/Clean-Contaminated	Operative wound entering respiratory, alimentary, genital, or urinary tract under controlled conditions, without unusual contamination.
Class III/Contaminated	Uninfected operative wound without inflammation, not entering the respiratory, alimentary, genital, or urinary tract.
Class IV/Dirty-Infected	Incision during operation with visceral perforation, encounter with acute inflammation and pus, or existing contamination and devitalized tissue.

Prevention is Better than Cure

Preventing surgical wound complications is better than cure. This involves steps before, during, and after surgery:

1. Before surgery, we check and improve the patient’s health, manage any existing health problems, and help them quit habits like smoking.
2. During surgery, we keep everything clean, ensure good blood flow to tissues, minimize damage, and stop bleeding carefully.
3. Giving antibiotics before surgery helps prevent infections.
4. We close wounds properly using the right techniques and materials to help them heal well.
5. After surgery, we teach patients how to care for their wounds, watch for any problems, and act fast if we notice signs of trouble. These steps help patients recover smoothly without complications.

Treatment of Surgical Wound Complications

The management of surgical wound complications varies depending on the nature and severity of the issue:

Antimicrobial Therapy

In cases of surgical site infections, appropriate antimicrobial therapy targeting the causative pathogens is essential. 

Wound Debridement

Debridement of necrotic tissue, foreign material, or nonviable tissue is often necessary to promote wound healing and prevent further infection.

Drainage

Hematomas, seromas, or abscesses may require percutaneous or surgical drainage to evacuate fluid collections and relieve pressure on surrounding tissues.

Advanced Wound Care

Utilizing advanced wound care modalities such as negative pressure wound therapy, wound dressings with antimicrobial properties, or biological skin substitutes may facilitate healing in complex or non-healing wounds.

Surgical Revision

In cases of extensive wound dehiscence, fistula formation, or severe tissue necrosis, surgical revision may be indicated to reconstruct the wound and promote healing.

Scar Management

Various interventions, including scar massage, silicone gel sheets, corticosteroid injections, laser therapy, or surgical revision, can help improve the appearance and symptoms associated with hypertrophic scars or keloids.

Conclusion

Surgical wound problems can make it harder for patients to heal, causing infections, slow healing, and scars. But we can prevent a lot of these issues by taking good care of wounds, giving antibiotics when needed, and teaching patients how to look after themselves. If we spot any problems early and treat them quickly, we can help patients feel better sooner. Moreover, with advancements in medical knowledge and technology, healthcare providers can strive towards safer surgical outcomes and improved patient well-being.

Reference 

1. Surgical infection. (2023b, March 3). MDDUS. https://www.mddus.com/resources/publications/publications-library/fyi/issue-18/case-study-surgical-infection
2. History of wound care | WoundSource. (n.d.-b). https://www.woundsource.com/blog/wound-care-then-and-now-brief-history-evolution-wound-care
3. Surgical wound complications | WoundSource. (n.d.). https://www.woundsource.com/blog/surgical-wound-complications
4. Admin. (2022, December 14). Surgical wounds – Sherman Oaks Hospital. https://shermanoakshospital.org/surgical-wounds/
5. Evolution, W. (2023, January 20). Surgical wound complications. Wound Evolution. https://www.woundevolution.com/wound-care/wound-types/surgical-wound-complications/
6. Monitoring Surgical Wound Complications Leaflet UKHSA