A skin break after trauma or a skin incision after surgery creates a wound. The wound does not heal completely within the prescribed time, which is called delayed wound healing in medicine.
In China, incision healing is divided into three levels.
Type I incision: Grade A healing was excellent, no adverse reactions.
Class II incision: inflammation at the healing site of Class B healing, such as redness, swelling, induration, hematoma, effusion, etc., but no suppuration.
Class III incision; Grade C healing incision suppuration, requiring incision and drainage.
Systemic factors in delayed postoperative wound healing
Age: Old Age
Nutritional status: protein deficiency, obesity, vitamin deficiency
Chronic diseases: diabetes, chronic liver, kidney disease
The use of drugs: such as chemotherapy drugs, steroid drugs
Coagulation disorders: generally should be corrected before surgery
Hypovolemic shock or severe anemia
Impaired state of the immune system
Chronic underlying factors or habits: Smoking, alcohol
Local factors of delayed wound healing after operation
Inoperative operation: improper incision protection, mechanical pulling, extrusion, etc.
Operation of electric knife: electric knife cutting causes wound burning, cell degeneration and necrosis, local tissue ischemia and hypertonic state, which will delay wound healing.
Excessive use of electrotome hemostatic cutting for the fat layer is easy to cause fat liquefaction.
Delayed healing of the abdominal postoperative incision caused by electrotome cutting and electrocoagulation was reported in 17.71 and 18.97 percent, compared with 4.35 percent in the control group, a highly significant difference in results.
Postoperative fat liquefaction: refers to the aseptic necrosis of fat cells, the outflow of lipid droplets after rupture, the formation of liquid fat and local aseptic inflammatory reaction in the incision
Foreign body reaction: A patient’s immune response to sutures, gas patches, or other implants.
Local tension: improper suture, local tension is too high.
Infection SSI: superficial incision infection, deep surgical infection, organ or space infection.
Surgical site: There is a high incidence of infection in specific sites, such as perineal incisions.
Identification and Diagnosis of Postoperative Delayed Wound Healing
After 1-3 days should be closely observed incision and the patient’s body, in order to find poor wound healing as soon as possible.
If systemic symptoms are caused by infection, the following signs and symptoms may occur
Trapathy, fever, loss of appetite, tachycardia, shortness of breath, septic shock
Local symptoms of incision are as follows: local symptoms appear three days after operation
More common in the early stage: bleeding, local fever, abnormal exudate (viscous, peculiar smell), increased volume, abnormal pain or tenderness.
More common in late stages: Edema/hard joints, localized or disseminated erythema (cellulitis) More common in late stages are purulent or purulent exudates, abscesses, malodors, crepitations (bursting sensation or sound on palpation due to gas in soft tissues), dehiscence.
Treatment
Systemic
Active treatment of concomitant diseases such as diabetes, coagulation disorders, immune system diseases, etc. Strengthen nutrition and correct malnutrition. Evaluate the extent, location, and nature of pain, and apply analgesics correctly. Severe infection and accompanied by systemic symptoms, according to the results of wound bacterial culture can choose antibiotic treatment.
Locality
In case of infection or severe colonization, povidone iodine can be used for cleaning, and then physiological saline can be used to clean the wound. Deactivated tissue should be removed and fully drained. Drainage strips can be applied locally for wounds with more exudates (such as alginate dressing strips to drain from suture gaps); If there is infection, silver ion dressing is used. If necessary, remove part of the suture, observe whether the incision is through the abdominal cavity, and carefully check the bottom of the incision (wound bed) for further processing. Depending on the assessment of the local wound, the method of wound management is selected. According to the TIME principle, modern suitable soft silicone foam dressing can be selected for treatment.
