Recommendations For Surgical Wounds
Recommendationsfor Surgical Wounds
Surgical Wounds Recommendationsfor Clinical CareContentsSurgical wounds - the current situation. 1Pre-Surgery Assessment and Information. 3Pre-Operative Phase (24 hours before surgery). 4Intra-Operative Phase. 5Post-Operative Phase. 7Ongoing Care after Transfer from Care of the Surgical Team. 11Appendix A: Risk Assessment Tools for SSI and SWD. 12Appendix B: Signs of Surgical Site Infection. 13Reference List. 14Please cite as:National Wound Care Strategy Programme: (2021)Recommendations for Surgical Wounds.
Surgical Wounds - Recommendations for Clinical CareSurgical Wounds the Current SituationFollowing evidence of lack of awareness of SSI ratesby frontline clinicians, the Get it Right First Time(GIRFT) SSI programme was established in 2017 tocomplement the Public Health England SSI audits.The GIRFT SSI audits seek to engage frontlineclinicians in the data collection process and explorevariation in surgical practice and outcomes for awider range of procedures and specialties. Thereare plans for GIRFT to conduct annual SSI surveysto allow comparisons to be drawn over time forprocedures and specialties. The GIRFT SSI programmewill also include procedures not currently included inthe PHE SSI surveillance programme.It is estimated that the annual cost to the NHS ofmanaging patients with wounds is between 4.5billion - 5.1 billion 1. Of the 2.2 million people witha wound, 29% have an acute wound related to anabscess, burn, surgery or trauma 1. Some chronicwounds, such as diabetic foot ulcers, pressure ulcersand some types of leg ulcer, will also require surgicalprocedures.Only 79% of acute wounds heal within 12 monthsand for the 21% that fail to heal, there is considerablepatient suffering and NHS cost. Most surgery occursin secondary care, but this only incurs 52% of thetotal annual NHS cost for acute wounds, with theremaining 48% being incurred outside hospital incommunity services and primary care 1.Despite these initiatives, it is apparent that there isstill considerable variation in practice and outcomeswhich increases care costs and extends healing times.The incidence of SSIs is also likely to be considerablyhigher than the rates reported by the PHE and GIRFTaudits since these only report on hospital data.In addition, there are challenges around accuratediagnosis of SSI and although the clinical signs andsymptoms of SSI usually present within one weekof surgery, it is estimated that 50% of SSIs becomeevident following hospital discharge 2, so hospitalaudits will not include these. There is a dearth ofliterature on the prevalence and incidence of SWD,but since SWD most commonly occurs between7 - 9 days post-surgery and thus post hospitaldischarge 3, it is unlikely to be captured in SSI audits.Delayed healing is commonly caused by surgicalsite infection (SSI). The clinical definition of SSI is an‘infectious process present at the site of surgery.Clinical signs and symptoms of infection includeheat, redness, swelling, elevated body temperatureand purulent exudate from the wound or the drain’usually within one week of surgery 2. SSI can result indehiscence (separation of the margins of a surgicallyclosed wound when wound closure materials areremoved) but surgical wound dehiscence (SWD) mayalso be caused by non-microbial aetiologies such ashaematoma, seroma or mechanical stress, obesity orpre-existing chronic disease states. Misdiagnosis ofSWD as SSI may lead to potentially severe follow-onconsequences for the patient and clinical practice.The main reason for sub-optimal management ofSSI and SWD is thought to be unwarranted variationof care with under-use of evidence-based care,over-use of therapies for which there is insufficientevidence 4 and insufficient surveillance systems formonitoring surgical site infection outside hospitalcare provision. The NWCSP has been tasked withdeveloping a set of recommendations to improvecare for patients with surgical wounds. The followingrecommendations have been developed using anevidence-based practice approach that incorporatesresearch evidence alongside clinical expertise andconsideration of healthcare costs and patient views.In 1997, the Public Health England SSI audits wereestablished by the Public Health Laboratory Service(which preceded Public Health England (PHE)). Thisnational surveillance programme aims to enhancethe quality of patient care by encouraging hospitalsto compare their SSI rates over time and againsta national benchmark. At present, there are 17surgical data categories that span general surgery,cardiothoracic, neurosurgery, gynaecology, vascular,gastroenterology and orthopaedics. Since 2004, NHSTrusts that perform orthopaedic surgery have beenmandated by the Department of Health to gathersurveillance data. Surveillance for other surgicalcategories remains voluntary.1
Surgical Wounds - Recommendations for Clinical CareIdentification, prevention, management andtreatment of SSI should be underpinned by currentantimicrobial stewardship guidance such as outlinedin these publications:The recommendations signpost to relevant clinicalguidelines or outline evidence-informed care that willimprove healing and optimise the use of healthcareresources. The recommendations provide a clinicalnavigation tool that aims to reduce the risk of woundhealing complications with swift escalation oftreatment or service provision for those who developsuch complications. These recommendations offera framework for the development of local deliveryplans that includes consideration of: Relevant research evidence (where it exists) toinform care. Configuration of services and deployment ofworkforce. Appropriate education for that workforce; and Relevant metrics to measure quality improvement. WHO Global Action Plan on AntimicrobialResistance 5. Antimicrobial stewardship in wound care:a Position Paper from the British Society forAntimicrobial Chemotherapy and European WoundManagement Association 6. Wounds UK Best Practice Statement: Antimicrobialstewardship strategies for wound management 7.The evidence base for aspects of surgical wound careis highly complex and developing rapidly so theserecommendations will be reviewed annually.These recommendations are not intended to replaceexisting evidence-informed clinical guidelines but tobring attention to such evidence, support planningfor implementation into clinical practice and provideinformation to inform other condition-specific clinicalguidance.In addition to the recommendations that follow,which are specific to the different stages of surgeryand recovery, it is recommended that cliniciansinterested in establishing wound care services shouldseek to manage wounds as a team. This processcan begin at local level by identifying relevant localservices and then seeking collaboration to develop: Referral mechanisms. Data systems with functionality to share patientdata and outcome data across different clinicalprovider organisations 2.2
Surgical Wounds - Recommendations for Clinical CarePre-Surgery Assessmentand InformationA structured approach to care should be used toimprove overall management of surgical wounds.For elective surgery, this should include preoperativeassessments to identify people with potential woundhealing problems. Enhanced education of healthcareworkers, patients and carers and sharing of clinicalexpertise is needed to support this 8.Delayed healing can be due to: Lifestyle factors:- Smoking.- Nutrition.Patients undergoing elective surgery should have apreoperative assessment to stratify risk of SSI /SWDwhich should be used to inform the consent process.Where possible, this should be done using a validatedrisk assessment tool relevant to the surgical specialityin conjunction with clinical judgement.Patients should also be provided with writteninformation specific to the type of surgery plannedand post-operative recovery.Explanatory Notes Pre-existing co-morbidities:- Diabetes.- Obesity.- Depression (and other mental health issues thatimpact on wound care).- Chronic obstructive pulmonary disease.- Peripheral arterial disease.- Immunodeficiency (side effect ofimmunosuppressant use) 3.Preoperative assessment to stratify riskof SSI /SWD is recommended to inform theconsent process and reduce the risk of SSI /SWD. However, the risk factors vary accordingto the type of surgery being planned and thereis currently a lack of evidence as to which riskassessment tools are the most valid and reliablefor different types of surgery. It is not possibleto recommend specific tools for specific typesof surgery, but a list of risk assessment toolsthat are currently in use can be found inAppendix A. Psychological and Social factors:- Learning disabilities and/or autism.- Homelessness.Cultural / ethnic / religious factors: This mayinclude physical factors such as increased riskof hypertrophic and keloid scarring as well ashealth-related beliefs in relation to medicineand surgical practices and cultural factors (e.g.language and communication, privacy issues)that may predispose towards delayed healing,access to services and follow up. Cultural and ethnicity factors 9 :- Language.- Health-related beliefs and practices.- Privacy issues.Before surgery, patients should be encouraged todiscuss the following with their health professionalsas part of a holistic assessment process, to addressany modifiable issues in advance of planned surgery. Lifestyle factors. Recent travel history. If known, current methicillin-resistantStaphylococcus aureus (MRSA) and vancomycinresistant Enterococcus (VRE) status, or if unknown,the need for screening. Current medical conditions (especially in relation todiabetes and cardiopulmonary conditions).Patient information: An example ofappropriate patient resources are the RoyalCollege of Anaesthetists’ ‘Fitter, Better, Sooner’resources 10.3
Surgical Wounds - Recommendations for Clinical CarePre-Operative Phase(24 hours before surgery)Care should follow the recommendations of:e. Mechanical bowel preparation.Do not use mechanical bowel preparation routinelyto reduce the risk of surgical site infection 8.NICE Guideline: Surgical site infections: preventionand treatment (2020) 8.NICE Pathway: Preventing and Treating Surgical SiteInfection 11.f. Hand jewellery, artificial nails and nail polish.The operating team should remove hand jewellerybefore operations.WHO: Global Guidelines for the Prevention ofSurgical Site Infection 12.g. Antibiotic prophylaxis should be in line with theNICE Guideline on Surgical Site Infection 8.i. Give antibiotic prophylaxis to patients before:- clean surgery involving the placement of aprosthesis or implant,- clean-contaminated surgery,- contaminated surgery.ii. Do not use antibiotic prophylaxis routinely forclean non-prosthetic uncomplicated surgery.iii. Use the local antibiotic formulary and alwaystake into account the potential adverseeffects when choosing specific antibiotics forprophylaxis.iv. Consider giving a single dose of antibioticprophylaxis intravenously on startinganaesthesia. However, give prophylaxis earlierfor operations in which a tourniquet is used.v. Before giving antibiotic prophylaxis, take intoaccount the timing and pharmacokinetics (forexample, the serum half-life) and necessaryinfusion time of the antibiotic. Give a repeatdose of antibiotic prophylaxis when theoperation is longer than the half-life of theantibiotic given.vi. Give antibiotic treatment (in addition toprophylaxis) to patients having surgery on adirty or infected wound.vii. Inform patients before the operation, wheneverpossible, if they will need antibiotic prophylaxis,and afterwards if they have been givenantibiotics during their operation 8.The key recommendations for prevention of surgicalsite infections in the pre-operative phase are:a. Discuss and address any cultural/ethnic/ religiousfactors that may impact on care during this phaseand onwards.b. Preoperative showering.i. Advise patients to shower or have a bath (or helppatients to shower, bath or bed bath) using soap,either the day before, or on the day of, surgery 8.c. Nasal decolonisation in line with the NICEGuideline on Surgical Site Infections 8.i. Consider nasal mupirocin in combination with achlorhexidine body wash before procedures inwhich Staphylococcus aureus is a likely cause ofa surgical site infection. This should be locallydetermined and take into account:- the type of procedure,- individual patient risk factors,- the increased risk of side effects in preterminfants,- the potential impact of infection 8.ii. Maintain surveillance on antimicrobial resistanceassociated with the use of mupirocin 8 13.d. Hair removal.i. Do not use hair removal routinely to reduce therisk of surgical site infection.ii. If hair has to be removed, use electric clipperswith a single-use head on the day of surgery.Do not use razors for hair removal, because theyincrease the risk of surgical site infection 8.4
Surgical Wounds - Recommendations for Clinical CareIntra-Operative PhaseCare should follow the recommendations of:e. Sterile gowns.The operating team should wear sterile gowns inthe operating theatre during the operation 8.NICE Guideline: Surgical site infections: preventionand treatment (2020) 8.NICE Pathway: Preventing and Treating Surgical SiteInfection 11.f. Gloves.Consider wearing 2 pairs of sterile gloves whenthere is a high risk of glove perforation and theconsequences of contamination may be serious 8.WHO: Global Guidelines for the Prevention ofSurgical Site Infection 12.WHO Surgical Safety Checklist 14.g. Staff leaving the operating area.Staff wearing non-sterile theatre wear should keeptheir movements in and out of the operating areato a minimum 8.The Association for Perioperative Practice: InfectionControl 15.The key recommendations for prevention of surgicalsite infections in the intra-operative phase are:h. Antiseptic skin preparation.i. Prepare the skin at the surgical site immediatelybefore incision using an antiseptic preparation.ii. Be aware of the risks of using skin antisepticsin babies, in particular the risk of severechemical injuries with the use of chlorhexidine(both alcohol-based and aqueous solutions) inpreterm babies.iii. When deciding which antiseptic skinpreparation to use, consider the advice in theNICE Guideline (Table 1).iv. If diathermy is to be carried out, useevaporation to dry antiseptic skin preparationsand avoid pooling of alcohol-basedpreparations 8.a. Patient theatre wear.Give patients specific theatre wear that isappropriate for the procedure and clinical settingand that provides easy access to the operative siteand areas for placing devices, such as intravenouscannulas. Take into account the patient’s comfortand dignity 8.b. Staff theatre wear.All staff should wear specific non-steriletheatre wear in all areas where operations areundertaken 8.c. Hand decontamination.i. The operating team should wash their hands priorto the first operation on the list using an aqueousantiseptic surgical solution, with a single-use brushor pick for the nails and ensure that hands andnails are visibly clean.ii. Before subsequent operations, hands shouldbe washed using either an alcoholic hand rubor an antiseptic surgical solution. If hands aresoiled, then they should be washed again with anantiseptic surgical solution 8.i. Diathermy.Do not use diathermy for surgical incision toreduce the risk of surgical site infection 8.j. Maintaining patient homeostasis.i. Maintain patient temperature in line with NICE’sguideline on hypothermia: prevention andmanagement in adults having surgery.ii. Maintain optimal oxygenation during surgery. Inparticular, give patients sufficient oxygen duringmajor surgery and in the recovery period toensure that a haemoglobin saturation of morethan 95% is maintained.iii. Maintain adequate perfusion during surgery.See additional recommendations on intravenousfluids and cardiac monitoring for adults inNICE’s guideline on perioperative care in adults.d. Incise drapes.i. Do not use non-iodophor-impregnated incisedrapes routinely for surgery as they may increasethe risk of surgical site infection.ii. If an incise drape is required, use an iodophorimpregnated drape unless the patient has aniodine allergy 8.5
Surgical Wounds - Recommendations for Clinical Careiv. Do not give insulin routinely to patients whodo not have diabetes to optimise blood glucosepostoperatively as a means of reducing the riskof surgical site infection. See the additionalrecommendation on blood glucose control foradults in NICE’s guideline on perioperative carein adults.Explanatory NotesWound irrigation and intracavity lavage:Although the NICE Guideline for Surgical SiteInfection advises against wound irrigation,the Cochrane Review of Intracavity lavage andwound irrigation for prevention of surgical siteinfection 17 suggests that further high qualityresearch is needed to look at the potential fordifferent types of intraoperative irrigation toreduce SSI in closed surgical wounds.k. Wound irrigation and intracavity lavage.i. Do not use wound irrigation to reduce the riskof surgical site infection.ii. Do not use intracavity lavage to reduce the riskof surgical site infection 8.l. Antiseptics and antibiotics before wound closure.i. Only apply an antiseptic or antibiotic to thewound before closure as part of a clinicalresearch trial.ii. Consider using gentamicin-collagen implants incardiac surgery 8.m. Closure methods.i. When deciding on closure methods, considerNICE guidance 16.ii. When using sutures, consider usingantimicrobial triclosan-coated sutures, especiallyfor paediatric surgery, to reduce the risk ofsurgical site infection.iii. Consider using sutures rather than staples toclose the skin after caesarean section to reducethe risk of superficial wound dehiscence 8.n. Wound dressings.i. Before dressing the wound, consider capturinga digital image of the wound using NHScompliant digital technology and upload theimage to the patient’s clinical record.ii. Cover surgical incisions with an appropriateinteractive dressing at the end of theoperation 8 11.6
Surgical Wounds - Recommendations for Clinical CarePost-Operative Phasee. Dressings for wound healing by secondaryintention.i. Do not use Eusol and gauze, moist cottongauze or mercuric antiseptic solutions tomanage surgical wounds that are healing bysecondary intention.ii. Use an appropriate interactive dressing tomanage surgical wounds that are healing bysecondary intention 8.iii. Ask a tissue viability nurse (or anotherhealthcare professional with wound careexpertise) for advice on appropriate dressingsfor the management of surgical wounds thatare healing by secondary intention 8.Care should follow the recommendations of:NICE Guideline: Surgical site infections: preventionand treatment (2020) 8.NICE Pathway: Preventing and Treating Surgical SiteInfection 11.WHO: Global Guidelines for the Prevention ofSurgical Site Infection 12.NICE Guideline for Sepsis: Recognition, Diagnosis andEarly Management 18.The key recommendations for prevention of surgicalsite infections and treatment of infected wounds andthose healing by secondary intention in the postoperative phase are:f. Treatment of surgical site infection (SSI) / surgicalwound dehiscence (SWD).i. Monitor for signs of SSI (See Appendix B).ii. When surgical site infection is suspected by thepresence of cellulitis, either by a new infectionor an infection caused by treatment failure.i. Obtain relevant samples for culture andsensitivity testing.ii. Give the patient an antibiotic that covers thelikely causative organisms.Consider local resistance patterns and theresults of microbiological tests in choosing anantibiotic 8 13.i. Do not use Eusol and gauze, or dextranomer orenzymatic treatments for debridement in themanagement of surgical site infection 8 11.ii. Patients should be monitored for signs of sepsis 18.a. Changing dressings.i. Use an aseptic non-touch technique forchanging or removing surgical wounddressings 8.ii. Monitor pain and offer appropriate analgesia.b. Wound Assessment.i. Wounds assessment should use the minimumdata criteria 19 as the basis for woundassessment.ii. Care providers that undertake wound careshould be able to capture a digital image of thewound using NHS compliant digital technologyand upload the image to the patient’s clinicalrecord.c. Postoperative wound cleansing.i. Use sterile saline for wound cleansing up to48 hours after surgery.ii. Advise patients that they may shower safely48 hours after surgery.iii. Use potable tap water for wound cleansingafter 48 hours if the surgical wound hasseparated or has been surgically opened todrain pus 8.g. Specialist wound care services.Use a structured approach to care to improveoverall management of surgical wounds. Thisshould include preoperative assessments toidentify people with potential wound healingproblems. Enhanced education of healthcareworkers, patients and carers and sharing of clinicalexpertise is needed to support this 8.d. Topical antimicrobial agents for wound healing byprimary intention.Do not use topical antimicrobial agents for surgicalwounds that are healing by primary intention toreduce the risk of surgical site infection 8.7
Surgical Wounds - Recommendations for Clinical Careh. Patient Information and discharge planning.i. Advise patients that they may shower safely48 hours after surgery 8.ii. Patients and the health care providers whowill be responsible for ongoing care should beprovided with written information 2 about:- The surgical intervention.- Details of any antibiotics administered.- Material and type of any implant.- Closure materials and plans for removal.- Ongoing care, including pain management,proposed dressing regime and opportunitiesfor shared care.- When to seek advice and specific information(including names and phone numbers) aboutwho to contact from the surgical team.Written information should be sensitive todifferent cultural needs.iii. If a digital image of the wound has beencaptured, this image should be shared with thepatient (if the patient wishes) and the healthcare provider responsible for ongoing careusing NHS compliant digital technology.iv. Patients / carers should also be provided withcomprehensible written information about:- Signs of infection.- Hygiene (including hand hygiene).- Shared care of wound. This may includeadvice on dressing changes and taking adigital image of their own wound to monitorhealing.v. Prior to transfer to another healthcare provider(which may involve shared care/ supported selfcare), patients should be provided with enoughdressings to care for their wound for one week.vi. Following transfer to another healthcareprovider, patients should be informed of thename of the clinician in that organisationresponsible for overseeing their care and howto contact the new organisation.i. Surveillance for Surgical Site Infection (SSI) andSurgical Wound Dehiscence (SWD).i. As a minimum, surveillance should be in linewith the NICE Quality Standard 20 advice onsurveillance.ii. Surveillance systems for monitoring SSI shouldbe expanded to include SWD.iii. SSI surveillance should monitor patients for upto 30 days after surgery (or up to 90 days aftersurgery in patients receiving implants) 21.iv. SWD surveillance may need to monitor for morethan 30 days 22.v. Surveillance should monitor post-surgicalpatients across acute, primary and communityhealth care providers 2.8
Surgical Wounds - Recommendations for Clinical CareExplanatory NotesPost Operative Wound CleansingIf tap water is to be used for wound cleansing, itshould be at room temperature or warmed andpotable (safe to drink).The recommendations regarding showering areintended as guidance as some closure materialsallow earlier showering and some wound sitesalso benefit from earlier cleansing (e.g. open analwounds after defaecation).Wound Dressings and Management Systems:There is no definitive evidence for the use of anyparticular type of modern interactive wounddressing to prevent SSI or to manage woundshealing by primary or secondary intention.Negative pressure wound therapy (NPWT), iscurrently used in closed wounds with high riskof infection to prevent surgical site infection, inopen surgical wounds with the aim of managingexudate and promoting healing, and in graftsurgery to prepare graft sites to promote grafttake and with the aim of healing of skin grafts byimproving adherence.The evidence base for NPWT is highly complexand developing rapidly. Open surgical wounds to promote healingThe Cochrane review of evidence for NPWTfor open surgical sites 24 has not been updatedsince 2015. Trials have been published sincethen but the NWCSP lacks the resources to doan updated review of the evidence. Althoughthe NWCSP has been unable to identify anyrobust evidence of effectiveness for promotinghealing, NPWT is self-evidently effective forcontaining heavy exudate. Preparation of graft sitesThe Cochrane review of evidence for NPWTin graft sites was included in the earlier 2014version of the Cochrane systematic review forsurgical wounds healing by primary closure 19but subsequently excluded in later versions. Itis possible that trials may have been publishedsince.In light of the complexity of the currentevidence base, wound product selectionshould seek to match wound symptoms withthe characteristics of wound dressings ormanagement systems, while remaining mindfulof patient comfort and dignity, clinician timeand the cost of alternative products. Decisionsabout the use of negative pressure woundtherapy selection should be informed by anorganisational protocol or pathway of care. Wounds healing by primary closure(closed wounds)A recent update of a Cochrane systematicreview for surgical wounds healing by primaryclosure 23 included 15 new trials and 3 neweconomic evaluations and identified a largenumber of ongoing trials. The evidence iscurrently dominated by studies in particularsurgical indications (caesarean section, fracturesurgery, knee and hip arthroplasties andabdominal surgery) so the findings are moredirectly relevant to some surgical interventionsthan others. Studies also vary as to the type ofSSI (superficial vs deep/organ space) assessed.The review currently concludes that NPWTprobably reduces the incidence of SSI insurgical wounds healing by primary intention,is probably cost-effective for caesarean sectionwounds in obese women and not cost-effectivefor fracture surgery wounds (and unclear forother types of surgery). However, it is likely thatthe results of ongoing trials will affect theseconclusions.Wound Assessment: Accurate woundassessment is essential for monitoring woundhealing. Wound size and wound bed statusform the baseline against which all subsequenttreatment effectiveness will be measured.Digital imaging that can be uploaded to thepatient’s clinical record should be incorporatedinto wound assessment and regarded as part ofstandard practice. NHS compliant mobile datatechnology with this functionality is now availableand in use by health care providers.Continued overleaf 9
Surgical Wounds - Recommendations for Clinical CareSurveillance: Sustained surveillance and feedbackof data on rates of SSI has been associatedwith reductions in rates of infection. Accuratediagnosis of SSI can be challenging as the classicsigns such as pain, swelling and inflammation arealso present in normal wound healing, exudatecan be mistaken for pus and fever may notpresent except in advanced cases of infection.SWD can occur both in the presence of infectionand without infection but in both cases, has asignificant impact on both patient well-being andhealthcare costs. Including both SSI and SWD inpost-operative surveillance systems will increasethe capture of clinically relevant information.Most SSI occur within 7 days of surgery and SWDwithin 9 days. The Center for Disease Controlreporting definition for surgical site infectionsurveillance 21 defines SSI infections occurringup to 30 days after surgery (or within 90 daysof surgery in patients receiving implants) andaffecting either the incision or deep tissue at theoperation site. As many patients are transferredfrom acute care to another care provider before7 days after surgery, surveillance systemsshould include data collection from primary andcommunity health care providers, up to 30 daysafter surgery, and for up to 90 days for implantsurgery.Any SSI or SWD that requires clinical input (e.g.surgical review, antibiotic therapy, or nursing care)should be reported.Continued overleaf 10
Surgical Wounds - Recommendations for Clinical CareOngoing Care after Transfer fromCare of the Surgical Teamb. Wound Healing.Monitoring of incision site healing.a. RED FLAGS If the incision site is healing by primary intentionand:- Fails to heal (epithelialise) as normal; or- Dehisces with visible subcutaneous tissue,arrange review by health professional with surgicalwound expertise 2 such as the general practitioner,tissue viability specialist nurse, stoma care nurse,or podiatrist who can escalate directly to surgicalteam as needed. If the incision site is healing by secondaryintention:- Review progress weekly to monitor healing andevaluate effectiveness of treatment plan. If the wound deteriorates or fails to progress,arrange review by health professional withsurgical wound expertise 2 such as generalpractitioner, tissue viability specialist nurse,stoma care nurse, or podiatrist who can escalatedirectly to surgical team as needed. If post-operative wound infection is suspectedbut there are no red flag symptoms:- Wound sw
Surgical Wounds - Recommendations for Clinical Care Pre-Operative Phase (24 hours before surgery) Care should follow the recommendations of: NICE Guideline: Surgical site infections: prevention and treatment (2020) 8. NICE Pathway: Preventing and Treating Surgical Site Infection11. WHO: Global Guidelines for the Prevention of Surgical Site .
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from hard-to-heal wounds. All wounds were located on lower limbs, as per the study’s inclusion criteria. The wounds’ characteristics are listed in Table 3. Overall, 31 wounds were treated with a mean dressing change every 3 days. During the 8-week follow-up, nine
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