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Are incisions the forgotten wound? Rethink incision care to improve patient outcomes

Sara Carvalhal, Daniel Chaverri
20 February 2024
This report summarises the findings of several studies into the efficacy and implementation of undisturbed wound healing (UWH) in a series of surgical and post-surgical settings. Particular focus is given to surgical oncology and the care of incision wounds during and after orthopaedic surgery. UWH is a principle that reduces patient mortality, improves recovery time, increases patients’ quality of life and reduces costs.

It is generally accepted that a moist environment provides the optimal setting for wound healing, both in acute and chronic wounds. In recent years, a new concept has emerged in the field of surgical wound care: ‘undisturbed wound healing (UWH)’. This concept advocates allowing the healing process to progress uninterrupted, not disturbing the wound unless absolutely necessary (Brindle et al, 2019; Davies et al, 2019). It is based on maintaining a constant temperature, an optimal moist environment and keeping the wound free of external agents in order to facilitate the normal wound healing process. 

When is the best time to start surgical wound care?
The simple answer is: in the operating theatre, a sterile environment where the wound is fresh and clean.

There is consensus in the literature that dressings applied in the operating theatre should remain on the wound for at least 48 hours after surgery, and it is strongly recommended to leave them in place for up to four days, unless bleeding or wound exudate necessitates an early change. In these first four days, the wound has the highest risk of surgical wound infection (especially during the first 48 hours; Stryja et al, 2020). With this evidence in mind, it therefore makes no sense to change the dressing frequently – something often done out of habit or routine – unless deemed absolutely necessary. 

Why is simple gauze not enough?
To facilitate UWH, there is a need for advanced dressings. This means dressings with a gentle adhesive that avoid blisters and peri-wound injuries, dressings with good exudate management and that allow the patient to shower and experience a free range of motion (Stryja et al, 2020).

What are the cost benefits of UWH?
Although advanced surgical dressings have a higher initial price than conventional ones, the lower number of dressing changes, reduced time spent by healthcare practitioners and reduction of complications make these advanced dressings an important tool, demonstrably saving overall healthcare costs. Furthermore, evidence clearly recommends their use as best practice (Stryja et al, 2020; Clin Guidel, 2020; Parvizi and Gehrke, 2018).

Finally, fewer dressing changes – or even potentially none – will enable the wound to heal, reduce dressing-related costs and dramatically decrease the amount of dressing-related medical waste. For example, comparing the usual 5—7 changes of a conventional dressing (including the consumables required to change those sterile or aseptically) with a dressing having the capacity to remain undisturbed for a much longer period of time in line with best practices.

Download the full supplement below.

Disclaimer: This report is supported by an educational grant from Mölnlycke Healthcare.
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