VOL: 99, ISSUE: 13, PAGE NO: 66
Helena Baxter, MSc, BSc, RGN, is independent nurse consultant, tissue viability and elective care redesign facilitator, Hinchingbrooke Health Care NHS Trust, Cambridgeshire
Most surgical wounds are categorised as acute wounds, healing without complication in an expected time frame (Bale and Jones, 1997). However, like all wounds, healing is affected by intrinsic and extrinsic factors that may result in complications.
Whichever method of healing is chosen, the aims of treatment are to disturb the wound as little as possible to allow healing and prevent bacterial invasion. Patient factors such as comfort, maintaining function and being given adequate information are also a priority.
Many factors are associated with surgical dehiscence. Age, malnutrition, being male and long-term steroid use are thought to influence the incidence of abdominal dehiscence (Poole, 1985), while smoking, diabetes and rheumatoid arthritis can impair healing by affecting the microcirculation. While malnutrition affects healing, obesity can influence wound breakdown due to reduced tissue oxygenation, increased subcutaneous dead space rendering the patient more susceptible to haematoma and seroma formation and increased incidence of infection (Armstrong, 1998).