Wound Closure - Techniques, Complications, and Prevention

Introduction

Wound complications are one of the most serious complications of surgeries which causes disruption in rehabilitation, a longer hospital stay, higher costs, decreased satisfaction, and increased morbidity. Wound closure is strongly linked to wound complications and may result in deep infection. The complications of wound closure emphasize the significance of the closure technique. Wound closure is a critical step in the process of wound healing. It involves bringing the edges of the wound together and securing them to promote healing and prevent infection. While wound closure is a routine procedure, there are certain complications that can arise during or after the procedure. This article will go over a number of complications of wound closure and their management.

What Is Wound Closure?

Wound closure is a process in which the edges of a wound are brought together and secured in order to promote healing and prevent infection. The purpose of wound closure is to minimize the risk of infection and facilitate the formation of new tissue at the site of injury. Wound closure can be achieved through a variety of methods, including suturing, stapling, adhesive strips, and tissue glue. The method used to close a wound depends on the location and severity of the injury, as well as the preference of the healthcare provider.

What Are the Methods for Wound Closure?

It is important to note that not all wounds require closure. A few wounds might be left untreated to heal on their own, a process known as healing by secondary intention. The healthcare provider will assess the wound and determine the best method of closure based on the factors mentioned above.

The method used to close a wound depends on several factors, including the type and location of the wound, the extent of the injury, and the overall health of the patient. Here are a few of the most popular techniques used to close wounds:

• Sutures: Sutures, also known as stitches, are commonly used to close wounds. The healthcare provider uses a needle and thread to sew the edges of the wound together. Sutures are typically used for deeper wounds or wounds that are at high risk of infection.

• Staples: Staples is another method used to close wounds. A staple gun is used to place metal clips over the edges of the wound to hold them together. Staples are often used for wounds that are longer or wider than those that can be closed with sutures.

• Adhesive Strips: Adhesive strips, also known as butterfly strips, are small strips of adhesive tape that are placed over the wound to hold the edges together. Adhesive strips are often used for small, superficial wounds.

• Tissue Glue: Tissue glue is a medical adhesive that is used to seal the edges of a wound together. The glue is applied to the edges of the wound and allowed to dry, creating a waterproof seal. Tissue glue is often used for small wounds or incisions.

What Are Complications of Wound Closure?

The following are the complications of wound closure:

• Hemorrhage: Hemorrhage or excessive bleeding is a common complication of wound closure. It can occur due to injury to blood vessels during the closure procedure or due to underlying bleeding disorders. The bleeding can be controlled by applying direct pressure, using a tourniquet or ligature, or by performing a blood transfusion in severe cases.

• Infection: Infection is a serious complication of wound closure. It can occur due to contamination of the wound during closure or due to poor wound hygiene. Symptoms of infection include redness, swelling, fever, and pus formation. Infections are treated with antibiotics and sometimes require wound debridement.

• Dehiscence: Dehiscence refers to the opening of a previously closed wound. It can occur due to excessive tension on the wound, poor wound closure technique, or underlying medical conditions such as diabetes or obesity. Dehiscence can be managed by suturing the wound again or by leaving it open to heal by secondary intention.

• Keloids: Keloids are raised, thickened scars that develop after wound closure. They develop as a result of excessive collagen production during the wound-healing process. Keloids can be unsightly and cause discomfort. They are managed with corticosteroid injections, cryotherapy, or surgical excision.

• Adhesions: Adhesions refer to the formation of scar tissue between two adjacent surfaces. They occur due to excessive scar tissue formation during wound healing. Adhesions can cause pain, restricted movement, and organ dysfunction. They are managed with surgery to release the scar tissue.

• Delayed Healing: Delayed healing is a common complication of wound closure. It can occur due to underlying medical conditions such as malnutrition, smoking, or diabetes. Delayed healing can be managed by treating the underlying condition, improving wound hygiene, and using advanced wound care products such as growth factors or skin substitutes.

What Are Postoperative Management for Wound Closure?

The following are the postoperative management for wound closure:

• Cotton dressing is applied to all wounds.

• Postoperative wound dressings are changed every two days.

• Drains are removed one day after surgery.

• Each patient received the standard protocol of postoperative interventions, which included postoperative antibiotic use for 24 hours, deep vein thrombosis prophylaxis, and rehabilitation.

• On the thirty-first postoperative day, patients have a routine follow-up that include wound inspection and radiographic evaluation.

How to Prevent Complications of Wound Closure?

The complications of wound closure can be prevented through the following ways:

• Proper Preparation: Before wound closure, cleaning and preparing the area around the wound is important to prevent any potential infection. This can be done by washing the area with soap and water or an antiseptic solution.

• Careful Handling of Tissues: During wound closure, tissues must be handled with care to avoid any additional trauma or damage. This can be achieved by using surgical instruments carefully and gently.

• Use of Sterile Materials: All materials used in wound closure should be sterile to avoid any contamination or infection. This includes surgical instruments, gloves, and dressings.

• Proper Suturing Technique: The suturing technique used in wound closure should be appropriate for the type of wound and the patient's condition. Proper technique includes using the correct type of suture material, ensuring the knots are tied tightly, and placing sutures at the correct tension.

Conclusion

Wound closure is a routine procedure that can lead to various complications. Hemorrhage, infection, dehiscence, keloids, adhesions, and delayed healing are some of the common complications of wound closure. The management of these complications requires prompt recognition and intervention to prevent further complications and promote wound healing. Proper wound closure technique, good wound hygiene, and appropriate use of advanced wound care products can help minimize the risk of complications.