Patient care after surgery: suture care and wound care process
Background. A wound is a defect of skin and underlying tissues that can be caused by many factors. Wound care is more than just changing dressings. Different wounds require different approaches and care. Optimal wound care supports the natural healing process in an effective but gentle way. Wounds are classified into acute and chronic, as well as cut, scalped, chopped, stabbed, bruised, torn, bitten, gunshot, and surgical. Surgical wounds are distinguished by the fact that they are applied specifically, for medical or diagnostic purposes, in special aseptic conditions, with minimal tissue trauma, in conditions of anesthesia, with thorough hemostasis and joining of separated anatomical structures with sutures.
Objective. To describe the modern approach to wound care.
Materials and methods. Analysis of literature data on this topic.
Results and discussion. Types of wound healing include primary tension healing, delayed primary tension healing, secondary tension healing, and scab healing. When caring for surgical wounds, primary protection against microorganisms is important. In this case, sterile dressings play an important role, for example, a medical surgical patch with an absorbent pad (Yu-Fix, “Yuria-Pharm”). The pad is characterized by high hygroscopicity, does not stick to the wound and does not leave fibers in the wound. The frequency of dressings changing depends on the healing process and the amount of exudate released from the wound. For festering wounds, the dressing should be changed daily and sometimes more often. Hands and gloves should be worn before bandaging. After removing the gloves, the hands are also treated with an antiseptic (Gorosten, “Yuria-Pharm”, a decamethoxine-based antiseptic). The use of Gorosten in medical institutions for prophylactic purposes is indicated for disinfection of staff hands in order to prevent the spread of transient microflora. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. However, in this period there are still wound channels from the threads, so after that it is necessary to treat the wound several times with antiseptic (Dekasan, “Yuria-Pharm”). Signs of local infection of the wound are redness, excess exudate, sometimes – with the addition of pus, odor, pain in the area of injury, fever, edema. Sometimes postsurgical wound suppuration occurs even with proper care due to weak immunity or rejection of surgical suture material. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. Unlike 2 % povidone-iodine, which causes severe inhibition of granulation in an open wound, Dekasan does not damage granulation tissue. Surgical treatment, lavage, drainage, antibiotics, laser or ultrasound may also be required. After removing the signs of local inflammation, secondary sutures are applied to the wound or the edges of the wound are connected with the help of adhesive plaster. Before starting the wound care procedure, it is necessary to assess the condition of the wound bed, the nature of the exudate, the condition of the tissues around the wound, pain, wound size. Wound management should involve a multidisciplinary approach. For example, an endocrinologist, a diabetic foot specialist, a purulent surgery surgeon, a vascular surgeon, and a nurse are involved in the treatment of ulcerative defects in patients with diabetes. In the treatment of wounds it is necessary to maintain a humid environment in the wound, maintain a constant temperature without hypothermia, provide adequate drainage and not too tight tamponade, use additional means of healing (eg, unloading the foot in the treatment of foot ulcers in patients with diabetes).
Conclusions. 1. Optimal wound care supports the natural healing process in an effective but gentle way. 2. When caring for surgical wounds, primary protection against the effects of microorganisms is important. 3. Sutures from the surgical wound are removed after the onset of epithelialization, when the wound is covered with a thin protective film. 4. If there is suppuration, it is advisable to switch to dressings with Dekasan and hyperosmolar antibacterial ointments. 5. Wound management should involve a multidisciplinary approach.
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