Wound Closure

There are many different ways to close a surgical wound. In a lot of cases, you will have a combination of wound closure techniques and will depend upon your surgeon’s preference and the type and location of the incision. The three main materials to close wounds are: -

Sutures

•      SILK
•      SYNTHETIC NONABSORBABLE SUTURES
•      SYNTHETIC ABSORBABLE SUTURES
  

STAINLESS STEEL CLIPS / WIRE

TAPES

The ideal closure of small wounds in healthy patients is with fine interrupted sutures placed loosely and close to the wounds edge.

Unfortunately, surgeons often must operate on patients who have impaired wound-healing capacity. In these cases, sutures must be strong enough to avoid the wound coming apart. Reasons for slower healing can include medical problems such as diabetes, people who need to take daily steroids for other conditions, and those people whose immune system may be compromised.

Additionally sutures placed too tightly and too close together, can obstruct blood supply to the wound, causing tissues to not heal in these areas.

Your surgical wound will be closed in multiple layers. The surgeon will first close your muscle layer and then your skin layer. The amount of sutures or staples will depend upon the depth and length of the wound.

All wounds heal in three stages:

•  Inflammatory Stage, occurring during the first few days. The wounded area attempts to restore its normal state by constricting blood vessels to control bleeding. Platelets make a clot. Inflammation (redness, heat, swelling) also occurs and is a visible indicator of the immune response. White blood cells clean the wound of debris and bacteria. 
 
• Proliferative Stage, lasting about 3 weeks (or longer, depending on the severity of the wound). Granulation occurs, which means that special cells called fibroblasts make collagen to fill in the wound. New blood vessels form. The wound gradually contracts and is covered by a layer of skin. 
 
•  Maturation and Remodeling Stage, lasting up to 2 years. New collagen forms, changing the shape of the wound and increasing strength of tissue in the area. Scar tissue, however, is only about 80% as strong as the original tissue.

Problems with Scar Formation

Occasionally issues arise with scar formation.  Scar tissue can form around joints, causing a loss of movement. Abdominal surgery invariably leads to adhesions between the intestines and mechanical obstruction can result. Stricture (narrowing) can occur at sites such as the bowel, blood vessels, trachea, ureter, or bile duct causing dysfunction.

Wound Care

Your wound will have a dressing over it for the first few days whilst you are in hospital. The nursing staff will change the dressing as per your surgeon’s protocols.

A few days after your surgery you may notice some itching near your surgical wound. Most people say that is a sign of healing but it may also be a result of the Steri-Strips or other tapes that have been used causing irritation. Do not pick or scratch at the wound as this will delay healing and could introduce infection.

What to look out for

When you go home from the hospital you should check your wound or dressing on a daily basis. It is normal to have some fullness in your wound. This is a result of swelling or haematoma. A haematoma is an accumulation of blood that has occurred during and after your wound was closed. In most cases, your body will absorb this fluid with no additional concern.

Your doctor or nurse will tell you when you are able to get the wound wet. It is generally alright to shower earlier than it is to bathe. This is because wounds and dressings are more water resistant and there is also an increased risk of infection with soaking a wound (particularly in swimming pools, spa’s and the ocean)

It is common to have a little leakage from your wound in the first day or so. There should be no discharge from your wound after this. Other signs of concern will be increasing redness and heat around the wound. If the swelling is increasing, the wound becomes red / inflamed or you notice drainage, you should contact your surgeon or nurse for additional instructions.

Your wound will be healed within two weeks from your surgery unless there has been some reason to delay that healing. If you have questions about the time it will take for your wound to heal, discuss this with your surgeon.

Wound Management

Patients should observe the following precautions about general cleanliness and personal habits:

• wash hands carefully after using the toilet and after touching or handling trash or garbage; pets and pet equipment; dirty linen or soiled incision dressings; and anything else that is dirty or has been used outdoors,
• ask family members, close friends, and others who touch the patient to wash their hands first,
• avoid contact with family members and others who are sick or recovering from a contagious illness,
• stop smoking (smoking slows down the healing process).