Surgical Wound Healing Not Mines

Managing surgical wound care:
review of Leukomed Control dressings

ABSTRACT
Optimal management of surgical wounds is an important part of
postoperative recovery. The aim of postoperative wound care is to facilitate
rapid wound closure, while preventing complications and promoting minimal
disturbance, to achieve the best functional and aesthetic results. Health
professionals should seek to optimise the process of acute wound healing,
observe progress, and prevent wound complications. Dressings that permit
extended wear time, and are transparent and so allow early recognition
without the need for unnecessary changes, have the potential to minimise
the effect on patients and the wider health economy. This article reviews
recommendations for surgical wound care, and introduces the recently
launched Leukomed Controldressing that is entirely transparent and allows
greater flexibility, breathability, and visualisation of thewound.
Key words: Surgical wound infection Cost-effectiveness Dressings
Quality of life Wound healing
nnovation has led to an increasing number of medical

conditions being treated with surgery. The Health &
Social Care Information Centre (HSCIC) (2015) states
that surgical procedures accounted for 4.7 million
episodes of care in England in 2013-2014. The majority
of surgical procedures lead to a break in the protective
barrier to the skin. Surgical site infection (SSI) surveillance
programmes report a decreasing incidence in the recorded
categories (Public Health England (PHE), 2014).
An SSI is defined as a superficial incisional infection that
occurs within 30 days of surgery (National Collaborating
Centre for Womens and Childrens Health, 2008). However,
in spite of being rare, SSIs account for 16% of all healthcare associated infections in England (National Institute
for Health and Care Excellence (NICE), 2013a)that is,
the third most common type of infection. It is thought
that this figure may be underestimated, as reporting is
voluntary with the exception of mandatory orthopaedic
data. Moreover, discharged patients can remain in the
community for treatment, and the episode may therefore
not be disclosed.
Postoperative wound sepsis carries the possibility
of high morbidity and potential mortality, and leads to
unpredictable additional costs (NICE, 2013a). The Under the
Knife report (CareFusion, 2011) estimates the annual cost
Jeanette Milne, Tissue Viability Nurse Specialist, Community
Health Services Clarendon, South Tyneside Foundation Trust
Accepted for publication: November 2015
S34
to be 700 million per annum, and calls for zero tolerance.

It has been accepted that not all operative complications
are escapable; however, surveillance has shown that their
incidence can be reduced by taking appropriate measures
(PHE, 2013).
This article examines surgical wound healing, and
discusses preventive approaches that can be employed to
diminish postoperative complications. It also introduces
evidence in support of a novel postoperativedressing.
Surgical wound healing

Surgical wounds are categorised as acute wounds; healing is
initiated spontaneously and resolution, in most cases, occurs
in a predictable time frame. The healing of an acute wound
requires coordinated cellular and molecular responses
(Martin and Nunan, 2015). Wound healing is generally
divided into three phases: inflammation, proliferation, and
maturation (Dealey, 2005). The priority of the inflammatory
phase is to prevent further damage and prepare the site of
injury for repair. Platelets are released from injured blood
vessels, and vasoconstriction and coagulation occur to
initiate haemostasis (Schultz et al, 2005). Concurrently,
the early neutrophils that arrive signal the generation
of macrophages to expedite efficient cleansing of any
devitalised tissue, as well as facilitate the removal of any
bacteria that has been introduced during wounding (Dealey,
2005; Martin and Nunan, 2015).
Following injury, histamine and prostaglandins are
released to reverse initial vasoconstriction and increase
blood vessel permeability to allow the escape of larger
neutrophils and improve blood flow to the wound. This,
in turn, improves oxygen delivery that is required by the
cells to enable escalation in metabolism (Schultz et al,
2005). Erythema and oedema occur as a result of the blood
vessels expanding and increasing blood supply (Silver, 1994;
Collier, 1996), and this is accompanied by heat and pain
(Tortora and Grabowski, 1996; Dieglemann and Evans,
2004).
Cells continue to release growth factors and cytokines to
enable tight regulation and coordination of events, and the
wound moves into the proliferative stage of wound healing
(Hopkinson, 1992; Martin and Nunan, 2015). Angiogenesis
(the growth of new blood vessels) occurs to restore blood
flow, and granulation tissue is generated in the form of
an extracellular matrix to fill the defect (Dealey, 2005;
Martin and Nunan, 2015). Simultaneously, the edges of
the wound contract, epithelial tissue forms, and it restores
the bacterial barrier function of the skin. This proliferative
British Journal of Nursing 2016, Vol 25, No 6: TISSUE VIABILITY SUPPLEMENT
stage ends when the wound is fully closed. The final stage
of healing is called maturation, during which time the
wound regains its tensile strength, collagen fibres reorganise,
the network of new blood vessel growth rationalises, and
the scar loses some of its red pigmentation (Schultz, 2005).
Reorganisation of tissue can take up to 18 months to be
completed (Dealey, 2005).
Surgical wound healing is augmented by the surgical
techniquelarger vessels damaged during the procedure
will be ligated or cauterised to reduce blood loss. The
majority of surgical wounds will have the wound edges
approximated with sutures, clips, or glue in an attempt
to minimise the defect (Aindow and Butcher, 2005).
Approximation facilitates clotting, mimics the natural
process of contraction, and supports epithelial migration
from the edges to effect rapid closure, thereby providing a
barrier against bacterial penetration (Roberts et al, 2011).
Some surgical wounds, for example the excision and
drainage of an abscess or pilonidal sinus, are commonly
left open and heal by secondary intention. The process of
wound healing is the same. Further information in relation
to managing wounds healing by secondary intention is
discussed by Schultz (2003) and Burton (2006).
Common complications of surgical wounds

A common complication of surgery is the risk of patients
developing an SSI. Undetected superficial wound infection
can lead to wound dehiscence (Oldfield and Burton, 2009).
The latter can also occur as a result of haematoma, poor
nutrition, impaired blood flow, and mechanical failure,
which can be due to inappropriate closure technique or
patient-related factors, such as obesity, excess mobility,
shear, and friction (van Ramshorst et al, 2010). Increased
pain, exudate, prolonged erythema, unresolved oedema,
and odour accompanied by pyrexia, are cardinal signs and
symptoms of acute wound infection (European Wound
Management Association (EWMA), 2005). It is important
to bear in mind that the normal inflammatory phase of
wound healing leads to redness, swelling, heat, and pain,
and that this is part of the physiological process of healing.
As such, these symptoms alone do not equate to a wound
complication.
Initial assessment may indicate the need for microbiological
analysis, blood tests, or imaging investigations to confirm
the diagnosis (World Union of Wound Healing Societies
(WUWHS), 2008).Yao et al (2013) recommend that
local signs of inflammation do not warrant immediate
action but should be closely monitored if these progress; if
wound infection is suspected, active management must be
commenced (Keast and Swanston, 2014).
Blistering of the peri-wound area is another common
complication described by Bhattacharyya et al (2005) and
Cosker et al (2005). Lifestyle and patient comorbidities can
also affect outcomes, and while these are not easy to address,
consideration must be given to the management of factors
such as minimising the effect of concomitant disease, for
example, optimising glucose control in diabetes, pre- and
postoperative nutrition, smoking, and vascular disease, as well
as the effect on perfusion, to name but a few (Yao et al, 2013).
S36
Strategies for postoperative

wound management
The aim of postoperative wound care is to facilitate

rapid wound closure while preventing complications
and promoting minimal disturbance to achieve the best
functional and aesthetic results (Baxter, 2003). Oldfield
and Burton (2009) suggest that patients often feel more
comfortable with their wound covered, as it prevents
closure materials from catching on to clothing that may in
turn lead to trauma. Baxter (2003) points out that during
initial repair in the early hours after surgery, the edges of
the wound have little tensile strength and require support
from the chosen closure material until full epithelialisation
takes place. Optimising wound healing in the surgical
patient requires a multidisciplinary approach, involving the
patient, the surgical team, immediate theatre recovery staff,
and postoperative caregivers, irrespective of whether they
work on a ward or in the community setting (NICE, 2008;
2013a; Milne et al, 2012).
Guidance and care bundles are aimed at promoting
structured, timely, evidence-based interventions in the pre-,
intra-, and postoperative management (Department of
Health (DH), 2011). This has recently been supplemented
with SSI quality standards (NICE, 2013a) that can be
used to monitor organisations. In addition, in some areas,
these have been linked to commissioning for quality and
innovation targets. These enable commissioners to reward
excellence by linking a proportion of income to desired
measurable outcomes (NICE, 2013b). It is hoped that
promoting adherence to the standards will improve equity
and encourage enhancedoutcomes.
The SSI evidence review (NICE, 2013a) includes care
bundles (DH, 2011) and the World Health Organization
(WHO) surgery safety checklist (WHO, 2009). The NICE
(2013a) review continues the three phases of clinical actions
in the pre, intra, and postoperative phases of care, reviews
the evidence for each recommendation, and gives clarity
in relation to unanswered questions, suggesting areas for
research. For example, showering or bathing preoperatively
continues to be supported; however, the review suggests
that the use/benefit of doing so with an antimicrobial agent
is uncertain in terms ofefficacy.
Interestingly, and perhaps most relevant to this article,
the evidence review document (NICE, 2013a) supports
recommendations from the recently published article in the
Cochrane Database of Systematic Reviews on dressings used
in surgical wound care (Dumville et al, 2011). This review
evaluated evidence from randomised control trials that studied
the incidence of SSI. It concludes that there was not enough
evidence to determine if the use of wound dressings helped
to prevent SSIs in wound healing by primary intention versus
leaving the wound exposed, and that no particular dressing
appeared to be better. NICE (2013a) acknowledges limitations,
stating that most studies had inappropriate control dressings,
such as gauze or pads. The studies were small, and most were
either assessed as poor quality or could not be assessed because
of incomplete reporting, and only four studies were published
within the last decade. As a result, comparison between two
modern dressings is not clear. Dumville et al (2011) conclude
PRODUCT FOCUS
that wound dressings should be chosen on the basis of cost and
specific qualities/management properties of the product itself.
NICE (2008) recommends covering a wound at the
end of the procedure with an interactive dressing, but
does not specify which dressing. An interactive dressing
can be described as one that supports and maintains an
optimum environment for healing (Schultz et al, 2003). It
is difficult to determine how many postoperative dressings
exist. A recent search of the Wound Care Handbook 2015
2016 (Cowan, 2015) reveals that most wound products
are recommended for use on postoperative wounds.
Limiting the search to those specifically designed for use
postoperatively is not easy, as they are not grouped in
this way. A lack of definitive evidence to support specific
choice (Dumville et al, 2014) and the number of products
available today can make product selection difficult.
Oldfield and Burton (2009) suggest that clinicians could
leave postoperative wounds covered and undisturbed for
48 hours.Yao et al (2013) suggest that a dressing should be
removed earlier if there is excessive inflammation, which
may suggest complications or an increase in wound pain/
pressure reported by the patient that is difficult to control
with analgesia.
Baxter (2003) suggests that the initial function of a
postoperative dressing is to absorb blood or haemoserous
fluid and provide protection. The choice of dressing can also
be determined by the type of surgery, the closure technique,
anatomical location, and size of the wound (Milne et al,
2012). Clinicians should also look for a dressing that, on
removal, will minimise trauma and the degree of sensory
stimulus to the wounded area in order to reduce patientreported pain (Briggs and Torra i Bou, 2002). In addition,
careful consideration should be given to dressing orientation
and tension, as well as how patient movement postoperatively
may affect this (Milne et al, 2012). Leal and Kirby (2008)
report skin damage and blistering over joints as a result
of joint articulation postoperatively with some products.
Box 1. Benefits of vapour-permeable film dressings

Barrier function prevents contamination
Allows postoperative inspection of the peri-wound area and the
wound itself without removal
Allows easy removal as a result of low adhesion to thewound
Maintains a moist wound environment and prevents excessive
moisture (breathable)
Can be left in place for up to 7 days
Enables the patient to shower after 48 hours without removal
(waterproof)
Is conformable to body contours and tends to be more stretchy,
allowing for postoperative movement/wearer comfort with reduced
incidence of blistering
Source: Roberts et al, 2011
Film and pad dressings have also been reported to reduce

blistering in some instances (Gupta et al, 2002; Bhattacharyya
et al, 2005; Cosker et al, 2005). In more recent years, it has
been suggested that vapour-permeable film dressings could
offer a number of advantages over non-woven dressings
(Roberts et al, 2011) (Box 1).
Importance of choosing
the most suitabledressing
In a time of austerity, reduced funding is compounded
by an ageing population and a corresponding increased
demand for healthcare resources. Surgical wound care
is not immune to scrutiny (Dumville et al, 2011).
Proposed healthcare reforms in England and across the
UK recommend addressing patients expressed needs as
a priority. Any treatment plan would need to address all
identified risk factors (NICE, 2013a).
Interventions for the management of acute wounds
should centre on reducing potential wound-related
complications such as SSI. Part of this process is the
selection of a dressing to cover the wound; most are
designed to address local factors, for example, absorb
Red strips for easier
application in line
with the Leukomed
range
Hydropolymer
islands for reliable
absorption and
atraumatic
removal
Very thin and flexible

polyurethane (PU) film;
the same film used
in Cutimed Siltec and
new film range
Hydropolymerfree zones for

extra flexibility
and additional
breathability
Soft, acrylic adhesive to secure adhesion
Figure 1. Description of the Leukomed Control dressing

S37
free zones (Figure1) that allow greater flexibility,

breathability, and visualisation of the wound.
The dressings have a soft acrylic adhesive at the margins
that allow secure adhesion, while the hydropolymer islands
that cover the incision are non-adhesive. This facilitates
moist wound healing while absorbing excess exudate and
minimising pain and trauma to the incision on removal.
The entire hydropolymer pad is transparent, which allows
the clinician to easily inspect the wound without the need
to remove the dressing. Consequently, this helps to lengthen
the wear time and prevent external contamination and
trauma associated with early removal.
Figure 2. Case study 1
a) Wound closure
c) One week post closure,

dressing removed
b) Postoperative dressing
d) Two weeks post closure
exudate, donate fluid, and/or reduce bioburden. Dressings

help to manage the symptoms of the wound and
manipulate the environment in which healing takes place.
Optimisation of the wound environment can improve
patient outcomes, accompanied with transparency, which
allows inspection without removal, will help to alleviate and
address patient-related concerns.
Cost-effectiveness in surgical care relates to overall
treatment costs and is balanced with an ability to
maintain or improve patient outcomes. In surgery, the
resultant injury to the skin is a necessary by-product of
the intervention. The relative cost associated with the
treatment of the wound is minimal when compared to that
of the procedure itself. This of course assumes that none
of the above-mentioned complications occur, because
costs escalate with complications such as SSIs. These
complications commonly lead to increased length of stay
and the need for more interventions, such as an increased
frequency of dressing changes, debridement, or further
surgery. As such, the cost of the dressing should be assessed
in relation to evidence of efficacy in its chosen application
and its ability to meet the goal of care.
Leukomed Control dressings

Leukomed Control dressings (BSN medical) are made of a
very thin, flexible, polyurethane film that is used in the new
Leukomed range of film and postoperative dressings. The
backing of the dressing provides stability for application and
has red strips on the edges that enable easier visualisation
and application with aids. The dressing has been designed
with hydropolymer islands that allow reliable absorption
and facilitate atraumatic removal. There are hydropolymerS38
Case study 1
Steve Jeffrey, Professor, Wound Study, Birmingham

City University, and consultant plastic surgeon
A 36-year-old man sustained a fractured tibia while
parachuting abroad. The fracture was plated abroad and,
unfortunately, it did not heal and the patient developed
osteomyelitis of the tibia. He also developed complex
regional pain syndrome, and after much discussion an
elective above-knee amputation was performed. About 6
weeks following the amputation, he developed an abscess
in the end of the stump. The stump was very painful and
throbbing. The patient was admitted and underwent
opening up of the stump. A wound irrigation system using
the KCI VAC-Ulta device was placed in theatre, using
octenilin Wound Irrigation Solution. Every 3hours the
sponge wound filler was filled with 45ml of the irrigation
solution and held for 15 minutes. Postoperatively, the
patient immediately reported a complete reduction in his
pain.
The dressings were changed at day 3 on the ward and
at day 6 the patient was taken back to theatre where the
wound was closed (Figure 2a). Leukomed Control was
applied post-operatively (Figure 2b). This wound was
particularly at risk of developing further infection and the
ability to see any redness in the postoperative wound was
the reason that this dressing was chosen. The patient was
reviewed at 1 week when the dressing was removed (Figure
2c). A further Leukomed control dressing was applied. At 2
weeks the wound was completely healed (Figure 2d).
The use of the Leukomed Control dressing allowed for
inspection of this at-risk wound without removal of the
dressing. The patient found the dressing to be comfortable.
Case studies 26
Sharon Hunt, advanced nurse practitioner, South

Tees Hospital NHS Foundation Trust
The following case studies were made up of five postsurgical wounds that attended follow-up at their registered
GP centre, which deals with minor injuries/walk-ins and
has a resident wound care specialist/nurse practitioner (the
author) on rota. The patients all attended for their first
postoperative dressing change and follow-up care. Three
patients attended postoperatively from the acute sector and
two from the walk-in centre (in-house intervention). All five
patients gave verbal consent for product application following
PRODUCT FOCUS
Table 1. Case study 2: Presenting date 25/1/2016 classed as day 0
Dressing size=7x10cm
Date
Length
Width
Depth
Exudate
Infected
25/1/2016
2.0
1.8
1.0
Low
No
28/1/2016
1.5
1.5
0.5
Low
No
31/1/2016
1.0
0.8
0.2
None
No
3/2/2016
None
No
No
7/2/2016
None
No
Date
Pain score 0/10

peri (on application
and removal)
Pain score 0/10

post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 0/3
Self-application
satisfaction (nurse
N) (patient P) 0/3
Adverse events
25/1/16
8/10
3/10
P=2, N=2
P=3, N=3
None
28/1/16
2/10
0/10
P=2, N=2
P=3, N=3
None
31/1/16
0/10
0/10
P=2, N=2
P=3, N=3
None
3/2/16
0/10
0/10
P=2, N=2
P=3, N=3
None
7/2/16
0/10
0/10
P=2, N=2
P=3, N=3
None
Dressing satisfaction = 1, poor; 2, good; 3, excellent. Self-application satisfaction = 1, poor; 2, manageable; 3, excellent
Table 2. Case study 3: presenting date 25/1/2016 classed as day 0
Dressing size 10x35cm
Date
Length
Width
Depth
Exudate
Infected
25/1/2016
35
Low
No
28/1/2016
33
Low
No
31/1/2016
28
1.8
Low
No
3/2/2016
28
1.8
Low
No
7/2/2016
25
1.5
Low
No
Date
Pain score 0/10

and removal)
Pain score 0/10

post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 0/3
Self-application
satisfaction (nurse
N) (patient P) 0/3
Adverse events
25/1/2016
4/10
4/10
P=2, N=2
P=2, N=3
None
28/1/2016
2/10
2/10
P=2, N=2
P=2, N=3
None
31/1/2016
0/10
0/10
P=2, N=2
P=2, N=3
None
3/2/2016
0/10
0/10
P=2, N=2
P=2 (patient needed

help to apply due to
dressing size), N=3
None
7/2/2016
0/10
0/10
P=2, N=2
P=2, N=3
None
verbal information from the author who applied the initial

products, collected the relevant data twice per week from
the patients electronic records and compiled the background
case study information. Those that gave permission for
photos have been used in this article. Following the first
application by the author, all five patients then carried out
their own dressing application as part of their care plan with
twice-weekly visits for wound assessment, measurement and
verbal support and reassurance. Pain score was obtained at
dressing change and between visits. All wounds had low to
moderate exudate levels. The evaluation process was carried
out in accordance with current trust policy and therefore
did not warrant ethical approval. All data were collected

and stored in the patients electronic medical file as per
normal practice. Summaries of the patients medical histories
and surgery are detailed below, and results of the use of
Leukomed Control dressings are detailed in Tables 16.
Case study 2 (Figure 3)
This patient is a 45-year old male who works as a manager
for a large UK firm dealing with computer and service
provision. He is normally fit and well with no allergies,
medical history or illnesses. He had not taken any
medication when he presented to surgery with recurrence
S39
b) Post-intervention with product

applied
a) Peri-intervention
c) Day 10: healed
Date
Length
Width
Depth
Exudate
Infected
26/1/2016
0.8
2.5
Low
No
29/1/2016
2.8
0.5
2.5
Low
No
1/2/2016
2.5
0.3
2.0
Low
No
4/2/2016
1.5
0.2
1.0
Low
No
8/2/2016
1.0
0.2
0.3
Low
No
Date
Pain score 0/10

and removal)
Pain score 0/10

post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 0/3
Self-application
satisfaction (nurse
N) (patient P) 0/3
Adverse events
26/1/2016
2/10
0/10
P=3, N=3
P=3, N=3
None
29/1/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
1/2/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
4/2/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
8/2/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
Date
Length
Width
Depth
Exudate
Infected
27/1/2016
3.2
0.8
Low
No
30/1/2016
3.2
0.8
Low
No
2/2/2016
3.0
0.5
None
No
5/2/2016
3.0
0.5
None
No
9/2/2016
2.5
0.4
None
No
Date
Pain score 0/10

and removal)
Pain score 0/10

post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 0/3
Self-application
satisfaction (nurse
N) (patient P) 0/3
Adverse events
27/1/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
30/1/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
2/2/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
5/2/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
9/2/2016
0/10
0/10
P=3, N=3
P=3, N=3
None
S40
PRODUCT FOCUS
Date
Length
Width
Depth
Exudate
Infected
27/1/2016
1.5
29
Med
No
30/1/2016
1.5
27
Low
No
2/2/2016
22
2.8
Low
No
5/2/2016
22
2.5
Low
No
9/2/2016
20
Low
No
Date
Pain score 0/10

and removal)
Pain score 0/10

post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 0/3
Self-application
satisfaction (nurse
N) (patient P) 0/3
Adverse events
27/1/2016
4/10
0/10
P=2, N=2
P=2, N=3
None
30/1/2016
2/10
0/10
P=2, N=2
P=2, N=3
None
2/2/2016
0/10
0/10
P=2, N=2
P=2, N=3
None
5/2/2016
0/10
0/10
P=2 (pulled a little

when bending knee),
N=2
P=2, N=3
None
9/2/2016
0/10
0/10
P=3, N=3
P=2, N=3
None
of a raised subcutaneous cyst to his left radial region of the

wrist. This was affecting his working role (using computers),
due to its position and resulting pressure and pain. The
patient consented to debridement of the mass. Leukomed
Control was applied by the author and details of the
dressings use are in Table 1.
Case study 3
This patient is an 82-year-old female who is a retired
teacher, independent and lives alone. Her medical history
includes hypercholesterolemia for which she is on
medication, no allergies and fully mobile. She is prescribed
simvastatin 20mg once per day.
She presented to surgery for first dressing change
following a right hip replacement. Before this, she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur. A Softpore (Richardsons)
adhesive surgical dressing (10cm x 30cm) was in situ on
attendance. Leukomed Control was applied by the author
and details of the dressings use are in Table 2.
Case study 4 (Figure 4)
This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS. He
suffers from frequent abscess formation, folliculitis and
depressive illness, and feels well with no allergies. He is
taking sertraline 20mg once per day and flucloxacillin
500mg four times a day for one week.
This patient presented to surgery with a postoperative
surgically debrided abscess on the right midaxillary for his
first wound review and dressing application. A Softpore
adhesive surgical dressing (6cm x 7cm) was in situ on
attendance. Leukomed Control was applied by the author
and details of the dressings use are in Table 3.
Case study 5
This patient was an unemployed 48-year-old father of
two, who cares at home for his young children alone. His
medical history includes diabetes mellitus, for which he
takes medication, HBA1c 8%, SINBAD (diabetic foot
classification) level 3, diagnosed neuropathy and peripheral
vascular disease, hypertension, hypercholesterolemia, obesity
and heavy smoker (30 cigarettes a day). He is currently
taking metformin 500mg in the morning; metformin
1000mg in the evening, and ramipril 10mg; simvastatin
20mg once a day; and flucloxacillin 500mg four times a
day for a 10-day period. He wears an offloading diabetic
shoe (Procare) as directed.
This patient presented to surgery for first dressing change
following a left great toe amputation. Before this, he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot. A Mepilex Border
adhesive dressing (Mlnlycke Health Care) (7cm x 7.5cm)
a) Day 0
b) Day 10
S41
KEY POINTS
Surgical site infections account for 16% of all healthcare-associated

infections in England
Increased knowledge and use of guidelines, clinical standards, and care

bundles will ensure early recognition of signs and symptoms of wound
complications
Leukomed Control dressings contain hydropolymer-free zones that allow

greater flexibility, breathability, and visualisation of thewound
Being completely transparent, Leukomed Control allows clinicians to

easily inspect the wound without the need to remove the dressing
was in situ on attendance. Leukomed Control was applied by

the author and details of the dressings use are in Table 4.
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day.) She is normally fit and well with no
allergies, medical history or illnesses. No medications were
being taken at presentation.
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella.
Before this, she had chronic pain and a grinding sensation,
especially at the end of the day and on long walks. A
Softpore adhesive surgical dressing (10cm x 35cm) was in
situ on attendance. Leukomed Control was applied by the
author and details of the dressings use are in Table 5.
Summary of case studies 2-6
While using the product, the author noticed the following:
Reduced adhesion to skin that is hairy and pulls on
hairy skin; suggest hair removed before application
Only applied to none, low or moderate serous/
haemoserous exudate in this evaluation
One older patient needed some assistance with longlength dressing application.
The author received positive feedback from the patients,
who in the main applied the dressing independently
with no problems, thus promoting self-care and reducing
the need for extra dressing visits. The patients found
the dressing to be light, comfortable and atraumatic in
application and removal. They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible. The author found the product easy to use
and found the transparency when in situ useful; she felts it
was a good alternative to dressings traditionally used.
Conclusion
This article provides a general overview of surgical
wound healing and potential complications, including SSI.
Care bundles, NICE guidance, and quality standards are
considered and should be used to direct care to minimise
complications. It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will, in turn, reduce the adverse effect on a
patients quality of life and minimise any associated costs.
S42
The limited evidence for the selection of postoperative

dressing products is also addressed. Guidance to choose a
product on the basis of cost, features, and benefits matched
to the wound type support the introduction of Leukomed
Control dressings. The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acutewounds. BJN
Declaration of interest: this article was supported by BSNmedical.
Aindow D, Butcher M (2005) Films or fabrics: is it time to re-appraise
postoperative dressings? Br J Nursing 14(19): S15-20
Baxter H (2003) Management of surgical wounds. Nurs Times 99(13): 66-8
Bhattacharyya M, Bradley H, Holder S, Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopy
wounds. Wounds UK 1(1): 304
Briggs M, Torra i Bou JE (2002) Pain at wound dressing changes: a guide
to management. In: EWMA Position Document Pain At Wound Dressing
Changes. http://tinyurl.com/z9jsw8r (accessed 17 March 2016): 1217
Burton F (2006) Best practice overview: surgical and trauma wounds.
Wound Essentials 1: 98107. http://tinyurl.com/ze9nfvv (accessed 3
March 2016)
CareFusion (2011) Under the Knife: Taking a Zero Tolerance Approach
to Preventable Surgical Site Infections in UK Hospitals. CareFusion,
Basingstoke
Collier M (1996) The principles of optimum wound management. Nurs
Stand 10(43): 47-52
Cosker T, Elsayed S, Gupta S, Mendonca AD, Tayton KJ (2005) Choice
of dressing has a major impact on blistering and healing outcomes in
orthopaedic patients. J Wound Care 14(1): 27-9
Cowan T, ed (2015) Wound Care Handbook 201516. MA Healthcare Ltd,
London
Dealey C (2005) The Care of Wounds. A Guide for Nurses. 3rd edn. Blackwell
Publishing, Oxford
Department of Health (2011) High Impact Intervention Care Bundle
to Prevent Surgical Site Infection. http://bit.ly/11kifVJ (accessed 12
November 2015)
Diegelmann RF, Evans MC (2004) Wound healing: an overview of acute,
fibrotic and delayed healing. Front Biosci 9: 2839
Dumville JC, Walter CJ, Sharp CA, Page T (2014) Dressings for the
prevention of surgical site infection. Cochrane Database Syst Rev
(7):CD003091. doi:10.1002/14651858.CD003091.pub2
European Wound Management Association (2005) Position Document:
Identifying Criteria for Wound Infection. http://tinyurl.com/blzjrc
(accessed 16 March 2016)
Gupta SK, Lee S, Moseley LG (2002) Postoperative wound blistering: is
there a link with dressing usage? J Wound Care 11(7): 2713
Health & Social Care Information Centre (2015) Hospital Episode
Statistics. Admitted Patient Care, England 2013-14. http://bit.
ly/1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix. J Wound Care
1(2): 4750
Keast D, Swanston T (2014) Ten top tips: managing surgical site infections.
Wounds International 5(3): 1318
Leal A, Kirby P (2008) Blister formation on primary wound closure sites: a
comparison of two dressings. Wounds UK 4(2): 317
Martin P, Nunan R (2015) Cellular and molecular mechanisms of repair
in acute and chronic wound healing. Br J Dermatol 173(2): 370-8.
doi:10.1111/bjd.13954
Milne J,Vowden P, Fumarola S Leaper D (2012) Post-operative incision
management. Wounds UK 8(4): 14
National Collaborating Centre for Womens and Childrens Health (2008)
Surgical Site Infection: Prevention and Treatment of Surgical Site Infection.
http://tinyurl.com/gsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines
[CG74] Surgical Site Infections: Prevention and Treatment. www.nice.
org.uk/guidance/cg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical Site
Infection. Evidence Update June 2013. http://tinyurl.com/zm4nkbb
National Institute for Health and Care Excellence (2013b) NICE Support
for Commissioning for Surgical Site Infection. http://tinyurl.com/hvv3yqx
Oldfield A, Burton F (2009) Surgical wounds: why do they dehisce?
Wound Essentials. http://tinyurl.com/hkepkdx (accessed 16 March
2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service. PHE, London
Public Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England, 2013/14. PHE, London
Roberts N, Sorrell J, Bielby A, Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing national
guidelines. Wounds UK 7(4): 1221
Schultz GS, Sibbald RG, Falanga V et al (2003) Wound bed preparation: a
systematic approach to wound management. Wound Repair Regen 11
Suppl 1: S128
Schultz GS, Ladwig G, Wysoki A (2005) Extracellular matrix: review of
its roles in acute and chronic wounds. World Wide Wounds. http://bit.
ly/1kQPfPl (accessed 12November 2015)
Silver IA (1994) The physiology of wound healing. J Wound Care 3(2):
1069
Tortora GJ, Grabowski SR (1996) Principles of Anatomy and Physiology.
Harper Collins Publications, New York
van Ramshorst GH, Nieuwenhuizen J, Hop WC et al (2010) Abdominal
wound dehiscence in adults: development and validation of a risk
model. World J Surg 34(1): 207. doi:10.1007/s00268-009-0277-y
World Health Organization (2009) Safe Surgery. http://tinyurl.
com/56y97w (accessed 12 November 2015)
World Union of Wound Healing Societies (2008) Principles of Best Practice:
Wound Infection in Clinical Practice. An International Consensus. http://
tinyurl.com/oglcy8c (accessed 16 March 2016)
Yao K, Bae L,Yew WP (2013) Post-operative wound management. Aust
Fam Physician 42(12): 86770
The best wound care videos from the web all together in one place
ww
Including educational channels from

the industrys leading companies
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management: Dressings
Management: Therapeutic Techniques New Developments
www.woundcaretv.com
S43
Copyright of British Journal of Nursing is the property of Mark Allen Publishing Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.

Surgical Wound Healing Not Mines

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Surgical Wound Healing Not Mines

Încărcat de

Drepturi de autor:

Formate disponibile

Managing surgical wound care:

review of Leukomed Control dressings

nnovation has led to an increasing number of medical

to be 700 million per annum, and calls for zero tolerance.

Surgical wound healing

Common complications of surgical wounds

Strategies for postoperative

The aim of postoperative wound care is to facilitate

Box 1. Benefits of vapour-permeable film dressings

Film and pad dressings have also been reported to reduce

Very thin and flexible

Hydropolymerfree zones for

Soft, acrylic adhesive to secure adhesion

Figure 1. Description of the Leukomed Control dressing

free zones (Figure1) that allow greater flexibility,

Figure 2. Case study 1

c) One week post closure,

d) Two weeks post closure

exudate, donate fluid, and/or reduce bioburden. Dressings

Leukomed Control dressings

Steve Jeffrey, Professor, Wound Study, Birmingham

Sharon Hunt, advanced nurse practitioner, South

Table 1. Case study 2: Presenting date 25/1/2016 classed as day 0

Pain score 0/10

Pain score 0/10

Table 2. Case study 3: presenting date 25/1/2016 classed as day 0

Dressing size 10x35cm

Pain score 0/10

Pain score 0/10

P=2 (patient needed

verbal information from the author who applied the initial

did not warrant ethical approval. All data were collected

Figure 3. Case study 2

b) Post-intervention with product

c) Day 10: healed

Table 3. Case study 4: Presenting date 26/1/2016 classed as day 0

Pain score 0/10

Pain score 0/10

Table 4. Case study 5: Presenting date 25/1/2016 classed as day 0

Pain score 0/10

Pain score 0/10

British Journal of Nursing 2016, Vol 25, No 6: TISSUE VIABILITY SUPPLEMENT

Table 5. Case study 6: Presenting date 25/1/2016 classed as day 0

Pain score 0/10

Pain score 0/10

P=2 (pulled a little

of a raised subcutaneous cyst to his left radial region of the

Surgical site infections account for 16% of all healthcare-associated

Increased knowledge and use of guidelines, clinical standards, and care

Leukomed Control dressings contain hydropolymer-free zones that allow

Being completely transparent, Leukomed Control allows clinicians to

was in situ on attendance. Leukomed Control was applied by

The limited evidence for the selection of postoperative

Including educational channels from

S-ar putea să vă placă și