Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

and normally follows distinct bodily reactions: the

inflammatory response Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecu ...

, the proliferation of cells and tissues that initiate

healing With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells i ...

, and the final

remodeling Renovation (also called remodeling) is the process of improving broken, damaged, or outdated structures. Renovations are typically done on either commercial or residential buildings. Additionally, renovation can refer to making something new, ...

. Postoperative wounds are different from other

wounds A wound is a rapid onset of injury that involves lacerated or punctured skin (an ''open'' wound), or a contusion (a ''closed'' wound) from blunt force trauma or compression. In pathology, a ''wound'' is an acute injury that damages the epider ...

in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.

Healing sequence

The body responds to postoperative wounds in the same manner as it does to tissue damage acquired in other circumstances. The

is designed to create

homeostasis In biology, homeostasis (British English, British also homoeostasis) Help:IPA/English, (/hɒmɪə(ʊ)ˈsteɪsɪs/) is the state of steady internal, physics, physical, and chemistry, chemical conditions maintained by organism, living systems. Thi ...

. This first step is called the inflammatory stage. The next stage and wound healing is the infiltration of

leukocyte White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mult ...

s and release of

cytokine Cytokines are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrin ...

s into the tissue. The inflammatory response and the infiltration of leukocytes occur simultaneously. The final stage of postoperative wound healing is called remodeling. Remodeling restores the structure of the tissue and that tissues ability to regain its function.

Diagnosis

Surgical wounds can begin to open between three and five days after surgery. The wound usually appears red and can be accompanied by drainage. Clinicians delay re-opening the wound unless it is necessary due to the potential of other complications. If the surgical wound worsens, or if a rupture of the digestive system is suspected the decision may be to investigate the source of the drainage or infection.

Complications

Wound dehiscence

The rates of a surgical wound opening after surgery has remained constant. When a wound opens after surgery, the hospital stay becomes longer and the medical care becomes more intensive if a surgical wound opens after surgery.

Infection

Infection will complicate healing of surgical wounds and is commonly observed. Most infections are present within the first 30 days after surgery. Surgical wounds can become infected by bacteria, regardless if the bacteria is already present on the patient's skin or if the bacteria is spread to the patient due to contact with infected individuals. Wound infections can be superficial (skin only), deep (muscle and tissue), or spread to the organ or space where the surgery occurred. Recent studies have established that

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

after surgery can occur after several years post surgery, and these infection rates are not recorded due to loss in patient follow up, hard to access record of previous surgery, visiting a new surgeon, lack of requirement from national registries etc.

Fascia dehiscence

The surgical site or wound may allow the passage of air into the body. This most often occurs after abdominal and pelvic surgery. Treatment at this point becomes more complex depending upon the extent of the opening, where it occurs and if contents of the

digestive system The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). Digestion involves the breakdown of food into smaller and smaller compone ...

have entered the body.

Risks

The risk of complications of the surgical wound is greater for those greater than 65-years-old, or who have pulmonary disease,

nutritional deficiencies Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...

overweight Being overweight or fat is having more body fat than is optimally healthy. Being overweight is especially common where food supplies are plentiful and lifestyles are sedentary. , excess weight reached epidemic proportions globally, with mo ...

, other illnesses and

high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...

Prevention

Complications of postsurgical wounds can be reduced before, during and after surgery. Some measures such as antibiotic prophylaxis before

caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

and

hernia A hernia is the abnormal exit of tissue or an organ (anatomy), organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the gr ...

l repair are useful in reducing surgical site infection. Intravenous prophylactic antibiotics are recommended, to be administered within one hour from the beginning of the surgical procedure. In addition to i.v. prophylaxis, oral antibiotic prophylaxis has been demonstrated to be beneficial in reducing surgical site infections after elective large bowel surgery. Adding a mechanical bowel cleansing in these patients might not be beneficial after colonic resection, but is still used and recommended by many before rectal resection (ideally in combination with oral antibiotics) However, some options include antibiotic coated sutures, antibiotic impregnated cement or locally administered paste or gel. Of note, a recent randomised controlled trial performed in low- and middle-income countries did not report any reduction in surgical site infection after abdominal surgery with antiseptic (triclosan-coated) sutures. There is also evidence that adhesive tapes increase infection risks. Before surgery, clinicians can treat the patient to reduce

hemoglobin A1c Glycated hemoglobin, also known as HbA1c, glycohemoglobin, hemoglobin A1c, A1C, is a form of hemoglobin (Hb) that is chemically linked to a sugar. Most monosaccharides, including glucose, galactose and fructose, spontaneously (i.e. non-enzymat ...

levels to less than 7%. Those anticipating surgery can reduce their risk of complications by stopping smoking thirty days prior to surgery. The patient's skin can be evaluated for the presence of ''

Staphylococcus aureus ''Staphylococcus aureus'' is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive ...

'' prior to surgery since this bacterium causes wound infections in postoperative wounds. Treating any other infections prior to surgery also reduces the risks of a postoperative wound infection. Examples of these pre-existing infections are

urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...

or lower reproductive system infection. Removing the hair where the skin will be cut helps to reduce the risk of complications, though shaving is not considered to be appropriate and instead depilatories are used. Those who come in contact with the person who is receiving the surgery clean and disinfect their own skin surfaces. The patient's skin is also cleaned, scrubbed and treated with antiseptics. Patients undergoing surgery often receive antibiotics before surgery. During the surgery, there are several precautions that can be taken to reduce the risk of postoperative wound complications. These are: minimizing traffic in the operating room, providing adequate ventilation, not closing wounds that are infected, minimize tissue handling, re-administer prophylactic antibiotics if large amounts of fluid are lost during surgery, and keeping the patient warm. Lately, studies have highlighted new preventative measures of avoiding repeated reprocessing and intraoperatively guarding the implants in the sterile-field, for surgeries implanting single-use devices such as orthopedic and spine surgeries. The risk of complications after surgery can be reduced by: maintaining blood glucose levels in the normal range and constant evaluation of surgical site infection. There is insufficient evidence to show that whether applying cyanoacrylate microbial sealants on the wound site before operation is effective in reducing surgical site infection post surgery. There is no evidence that one type of hand antisepsis is better than the other in preventing surgical site infection. There is no evidence that plastic adhesive tapes reduces surgical site infections.

References

{{Digestive system surgical procedures Skin physiology Surgical procedures and techniques