Surgical Wound Healing Not Mines

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S34 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT

Innovation has led to an increasing number of medical

conditions being treated with surgery The Health amp

Social Care Information Centre (HSCIC) (2015) states

that surgical procedures accounted for 47 million

episodes of care in England in 2013-2014 The majorityof 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 Womenrsquos and Childrenrsquos Health 2008) However

in spite of being rare SSIs account for 16 of all health-

care associated infections in England (National Institute

for Health and Care Excellence (NICE) 2013a)mdashthat 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 orthopaedicdata 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

Managing surgical wound carereview of Leukomed Control dressings

Jeanette Milne Tissue Viability Nurse Specialist Community

Health Services Clarendon South Tyneside Foundation Trust

Accepted for publication November 2015

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 minimisethe effect on patients and the wider health economy This article reviews

recommendations for surgical wound care and introduces the recently

launched Leukomed Control dressing that is entirely transparent and allows

greater flexibility breathability and visualisation of the wound

Key words Surgical wound infection 992672 Cost-effectiveness 992672 Dressings

992672 Quality of life 992672 Wound healing

to be pound700 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 postoperative dressing

Surgical wound healingSurgical 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 generationof 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




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 surgicaltechniquemdashlarger 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 relationto managing wounds healing by secondary intention is

discussed by Schultz (2003) and Burton (2006)

Common complications of surgical woundsA 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 oedemaand 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 immediateaction 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)

Strategies for postoperativewound managementThe 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 preventsclosure 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 enhanced outcomes

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 usebenefit of doing so with an antimicrobial agent

is uncertain in terms of efficacy

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 reviewevaluated 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



British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S37

PRODUCT FOCUS

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 choosingthe most suitable dressingIn 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 patientsrsquo 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-relatedcomplications 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

that wound dressings should be chosen on the basis of cost and

specific qualitiesmanagement 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 dressingsexist A recent search of the Wound Care Handbook 2015ndash

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 painpressure 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 patient-

reported 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 postoperativelymay affect this (Milne et al 2012) Leal and Kirby (2008)

report skin damage and blister ing 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 the wound

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 movementwearer comfort with reduced

incidence of blistering

Source Roberts et al 2011

Figure 1 Description of the Leukomed Control dressing

Red strips for easier

application in line

with the Leukomed

range

Very thin and flexible

polyurethane (PU) film

the same film used

in Cutimed Siltec and

new film range

Hydropolymer-

free zones for

extra flexibility

and additional

breathability

Hydropolymer

islands for reliable

absorption and

atraumatic

removal

Soft acrylic adhesive to secure adhesion




free zones (Figure 1) 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 allowsthe 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

Case study 1Steve 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 anelective 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

lsquothrobbingrsquo 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 3 hours the

sponge wound filler was filled with 45 ml 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 thewound was closed (Figure 2a) Leukomed Control was

applied post-operatively (Figure 2b) This wound was

particularly at r isk 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 2ndash6Sharon Hunt advanced nurse practitioner South

Tees Hospital NHS Foundation Trust

The following case studies were made up of five post-

surgical wounds that attended follow-up at their registered

GP centre which deals with minor injurieswalk-ins and

has a resident wound care specialistnurse 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

exudate donate fluid andor 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 concernsCost-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 assessedin relation to evidence of efficacy in its chosen application

and its ability to meet the goal of care

Leukomed Control dressingsLeukomed 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 hydropolymer-

b) Postoperative dressing

c) One week post closure

dressing removed

a) Wound closure

d) Two weeks post closure

Figure 2 Case study 1




PRODUCT FOCUS

verbal information from the author who applied the initial

products collected the relevant data twice per week from

the patientsrsquo 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 carr ied

out in accordance with current trust policy and therefore

did not warrant ethical approval All data were collected

and stored in the patientsrsquo electronic medical file as per

normal practice Summaries of the patientsrsquo medical histories

and surgery are detailed below and results of the use of

Leukomed Control dressings are detailed in Tables 1ndash6

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

Table 1 Case study 2 Presenting date 2512016 ndash classed as day 0 Dressing size=7x10 cm

Date Length Width Depth Exudate Infected

2512016 20 18 10 Low No

2812016 15 15 05 Low No

3112016 10 08 02 None No

322016 0 0 0 None No

No

722016 0 0 0 None No

Date Pain score 010

peri (on application

and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

25116 810 310 P=2 N=2 P=3 N=3 None

28116 210 010 P=2 N=2 P=3 N=3 None

31116 010 010 P=2 N=2 P=3 N=3 None

3216 010 010 P=2 N=2 P=3 N=3 None

7216 010 010 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 2512016 ndash classed as day 0 Dressing size 10x35 cm


2512016 35 2 8 Low No

2812016 33 2 8 Low No

3112016 28 18 6 Low No

322016 28 18 6 Low No

722016 25 15 5 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2512016 410 410 P=2 N=2 P=2 N=3 None

2812016 210 210 P=2 N=2 P=2 N=3 None

3112016 010 010 P=2 N=2 P=2 N=3 None

322016 010 010 P=2 N=2 P=2 (patient needed

help to apply due to

dressing size) N=3

None

722016 010 010 P=2 N=2 P=2 N=3 None







2612016 3 08 25 Low No

2912016 28 05 25 Low No

122016 25 03 20 Low No

422016 15 02 10 Low No

822016 10 02 03 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2612016 210 010 P=3 N=3 P=3 N=3 None

2912016 010 010 P=3 N=3 P=3 N=3 None

122016 010 010 P=3 N=3 P=3 N=3 None

422016 010 010 P=3 N=3 P=3 N=3 None

822016 010 010 P=3 N=3 P=3 N=3 None




2712016 1 32 08 Low No

3012016 1 32 08 Low No

222016 1 30 05 None No

522016 1 30 05 None No

922016 1 25 04 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 010 010 P=3 N=3 P=3 N=3 None

3012016 010 010 P=3 N=3 P=3 N=3 None

222016 010 010 P=3 N=3 P=3 N=3 None

522016 010 010 P=3 N=3 P=3 N=3 None

922016 010 010 P=3 N=3 P=3 N=3 None


a) Peri-intervention c) Day 10 healedb) Post-intervention with product

applied





PRODUCT FOCUS

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

dressingrsquos use are in Table 1

Case study 3

This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history

includes hypercholesterolemia for which she is on

medication no allergies and fully mobile She is prescribed

simvastatin 20 mg 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 (10 cm x 30 cm) was in situ on

attendance Leukomed Control was applied by the author

and details of the dressingrsquos 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 20 mg once per day and flucloxacillin

500 mg four times a day for one week

This patient presented to surgery with a postoperative

surgically debrided abscess on the r ight midaxillary for his

first wound review and dressing application A Softpore




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 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin

20 mg once a day and flucloxacillin 500 mg 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 (Moumllnlycke Health Care) (7 cm x 75 cm)



2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None

522016 010 010 P=2 (pulled a little

when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10





was in situ on attendance Leukomed Control was applied by

the author and details of the dressingrsquos 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 noallergies 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 lsquogrindingrsquo sensation

especially at the end of the day and on long walks A

Softpore adhesive surgical dressing (10 cm x 35 cm) was in

situ on attendance Leukomed Control was applied by the

author and details of the dressingrsquos 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 onhairy 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 long-

length 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 useand found the transparency when in situ useful she felts it

was a good alternative to dressings traditionally used

ConclusionThis 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

patientrsquos quality of life and minimise any associated costs

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

acute wounds BJN

Declaration of interest this article was supported by BSN medical

Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20

Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective

clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4

Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17

Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)

CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke

Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52

Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9

Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon

Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford

Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)

Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9

Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev

(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document

Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)

Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3

Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)

Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50

Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18

Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7

Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954

Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4

National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)

National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)

National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)

National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)

Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)

Public Health England (2013) Protocol for the Surveillance of Surgical Site

KEY POINTS

992672 Surgical site infections account for 16 of all healthcare-associated

infections in England

992672 Increased knowledge and use of guidelines clinical standards and care

bundles will ensure early recognition of signs and symptoms of wound

complications

992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound

992672 Being completely transparent Leukomed Control allows clinicians to

easily inspect the wound without the need to remove the dressing




PRODUCT FOCUS

Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS

hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative

wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21

Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11

Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of

its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)

Silver IA (1994) The physiology of wound healing J Wound Care 3(2)

106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology

Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal

wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y

World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)

World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)

Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70

The best wound care videos from the web all together in one place

Including educational channels fromthe industryrsquos leading companies

wwwwoundcaretvcom

Assessment | Infection | Leg Ulcers Pressure Ulcers

Diabetic Foot Ulcers | Management Dressings

Management Therapeutic Techniques New Developments



C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s

c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e

c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l

a r t i c l e s f o r i n d i v i d u a l u s e




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 surgicaltechniquemdashlarger 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 relationto managing wounds healing by secondary intention is

discussed by Schultz (2003) and Burton (2006)

Common complications of surgical woundsA 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 oedemaand 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 immediateaction 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)

Strategies for postoperativewound managementThe 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 preventsclosure 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 enhanced outcomes

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 usebenefit of doing so with an antimicrobial agent

is uncertain in terms of efficacy

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 reviewevaluated 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







































with analgesia























(waterproof)







application in line

with the Leukomed

range



the same film used


new film range

Hydropolymer-

free zones for

extra flexibility

and additional

breathability

Hydropolymer


absorption and

atraumatic

removal
































pain






















































dressing removed

a) Wound closure






PRODUCT FOCUS


























2512016 20 18 10 Low No

2812016 15 15 05 Low No

3112016 10 08 02 None No

322016 0 0 0 None No

No

722016 0 0 0 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

25116 810 310 P=2 N=2 P=3 N=3 None

28116 210 010 P=2 N=2 P=3 N=3 None

31116 010 010 P=2 N=2 P=3 N=3 None

3216 010 010 P=2 N=2 P=3 N=3 None

7216 010 010 P=2 N=2 P=3 N=3 None




2512016 35 2 8 Low No

2812016 33 2 8 Low No

3112016 28 18 6 Low No

322016 28 18 6 Low No

722016 25 15 5 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2512016 410 410 P=2 N=2 P=2 N=3 None

2812016 210 210 P=2 N=2 P=2 N=3 None

3112016 010 010 P=2 N=2 P=2 N=3 None



dressing size) N=3

None

722016 010 010 P=2 N=2 P=2 N=3 None







2612016 3 08 25 Low No

2912016 28 05 25 Low No

122016 25 03 20 Low No

422016 15 02 10 Low No

822016 10 02 03 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2612016 210 010 P=3 N=3 P=3 N=3 None

2912016 010 010 P=3 N=3 P=3 N=3 None

122016 010 010 P=3 N=3 P=3 N=3 None

422016 010 010 P=3 N=3 P=3 N=3 None

822016 010 010 P=3 N=3 P=3 N=3 None




2712016 1 32 08 Low No

3012016 1 32 08 Low No

222016 1 30 05 None No

522016 1 30 05 None No

922016 1 25 04 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 010 010 P=3 N=3 P=3 N=3 None

3012016 010 010 P=3 N=3 P=3 N=3 None

222016 010 010 P=3 N=3 P=3 N=3 None

522016 010 010 P=3 N=3 P=3 N=3 None

922016 010 010 P=3 N=3 P=3 N=3 None



applied





PRODUCT FOCUS







Case study 3
























Case study 5



















2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None


when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10







Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom













PRODUCT FOCUS







































with analgesia























(waterproof)







application in line

with the Leukomed

range



the same film used


new film range

Hydropolymer-

free zones for

extra flexibility

and additional

breathability

Hydropolymer


absorption and

atraumatic

removal
































pain






















































dressing removed

a) Wound closure






PRODUCT FOCUS


























2512016 20 18 10 Low No

2812016 15 15 05 Low No

3112016 10 08 02 None No

322016 0 0 0 None No

No

722016 0 0 0 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

25116 810 310 P=2 N=2 P=3 N=3 None

28116 210 010 P=2 N=2 P=3 N=3 None

31116 010 010 P=2 N=2 P=3 N=3 None

3216 010 010 P=2 N=2 P=3 N=3 None

7216 010 010 P=2 N=2 P=3 N=3 None




2512016 35 2 8 Low No

2812016 33 2 8 Low No

3112016 28 18 6 Low No

322016 28 18 6 Low No

722016 25 15 5 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2512016 410 410 P=2 N=2 P=2 N=3 None

2812016 210 210 P=2 N=2 P=2 N=3 None

3112016 010 010 P=2 N=2 P=2 N=3 None



dressing size) N=3

None

722016 010 010 P=2 N=2 P=2 N=3 None







2612016 3 08 25 Low No

2912016 28 05 25 Low No

122016 25 03 20 Low No

422016 15 02 10 Low No

822016 10 02 03 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2612016 210 010 P=3 N=3 P=3 N=3 None

2912016 010 010 P=3 N=3 P=3 N=3 None

122016 010 010 P=3 N=3 P=3 N=3 None

422016 010 010 P=3 N=3 P=3 N=3 None

822016 010 010 P=3 N=3 P=3 N=3 None




2712016 1 32 08 Low No

3012016 1 32 08 Low No

222016 1 30 05 None No

522016 1 30 05 None No

922016 1 25 04 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 010 010 P=3 N=3 P=3 N=3 None

3012016 010 010 P=3 N=3 P=3 N=3 None

222016 010 010 P=3 N=3 P=3 N=3 None

522016 010 010 P=3 N=3 P=3 N=3 None

922016 010 010 P=3 N=3 P=3 N=3 None



applied





PRODUCT FOCUS







Case study 3
























Case study 5



















2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None


when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10







Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom








































pain






















































dressing removed

a) Wound closure






PRODUCT FOCUS


























2512016 20 18 10 Low No

2812016 15 15 05 Low No

3112016 10 08 02 None No

322016 0 0 0 None No

No

722016 0 0 0 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

25116 810 310 P=2 N=2 P=3 N=3 None

28116 210 010 P=2 N=2 P=3 N=3 None

31116 010 010 P=2 N=2 P=3 N=3 None

3216 010 010 P=2 N=2 P=3 N=3 None

7216 010 010 P=2 N=2 P=3 N=3 None




2512016 35 2 8 Low No

2812016 33 2 8 Low No

3112016 28 18 6 Low No

322016 28 18 6 Low No

722016 25 15 5 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2512016 410 410 P=2 N=2 P=2 N=3 None

2812016 210 210 P=2 N=2 P=2 N=3 None

3112016 010 010 P=2 N=2 P=2 N=3 None



dressing size) N=3

None

722016 010 010 P=2 N=2 P=2 N=3 None







2612016 3 08 25 Low No

2912016 28 05 25 Low No

122016 25 03 20 Low No

422016 15 02 10 Low No

822016 10 02 03 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2612016 210 010 P=3 N=3 P=3 N=3 None

2912016 010 010 P=3 N=3 P=3 N=3 None

122016 010 010 P=3 N=3 P=3 N=3 None

422016 010 010 P=3 N=3 P=3 N=3 None

822016 010 010 P=3 N=3 P=3 N=3 None




2712016 1 32 08 Low No

3012016 1 32 08 Low No

222016 1 30 05 None No

522016 1 30 05 None No

922016 1 25 04 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 010 010 P=3 N=3 P=3 N=3 None

3012016 010 010 P=3 N=3 P=3 N=3 None

222016 010 010 P=3 N=3 P=3 N=3 None

522016 010 010 P=3 N=3 P=3 N=3 None

922016 010 010 P=3 N=3 P=3 N=3 None



applied





PRODUCT FOCUS







Case study 3
























Case study 5



















2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None


when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10







Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom













PRODUCT FOCUS


























2512016 20 18 10 Low No

2812016 15 15 05 Low No

3112016 10 08 02 None No

322016 0 0 0 None No

No

722016 0 0 0 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

25116 810 310 P=2 N=2 P=3 N=3 None

28116 210 010 P=2 N=2 P=3 N=3 None

31116 010 010 P=2 N=2 P=3 N=3 None

3216 010 010 P=2 N=2 P=3 N=3 None

7216 010 010 P=2 N=2 P=3 N=3 None




2512016 35 2 8 Low No

2812016 33 2 8 Low No

3112016 28 18 6 Low No

322016 28 18 6 Low No

722016 25 15 5 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2512016 410 410 P=2 N=2 P=2 N=3 None

2812016 210 210 P=2 N=2 P=2 N=3 None

3112016 010 010 P=2 N=2 P=2 N=3 None



dressing size) N=3

None

722016 010 010 P=2 N=2 P=2 N=3 None







2612016 3 08 25 Low No

2912016 28 05 25 Low No

122016 25 03 20 Low No

422016 15 02 10 Low No

822016 10 02 03 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2612016 210 010 P=3 N=3 P=3 N=3 None

2912016 010 010 P=3 N=3 P=3 N=3 None

122016 010 010 P=3 N=3 P=3 N=3 None

422016 010 010 P=3 N=3 P=3 N=3 None

822016 010 010 P=3 N=3 P=3 N=3 None




2712016 1 32 08 Low No

3012016 1 32 08 Low No

222016 1 30 05 None No

522016 1 30 05 None No

922016 1 25 04 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 010 010 P=3 N=3 P=3 N=3 None

3012016 010 010 P=3 N=3 P=3 N=3 None

222016 010 010 P=3 N=3 P=3 N=3 None

522016 010 010 P=3 N=3 P=3 N=3 None

922016 010 010 P=3 N=3 P=3 N=3 None



applied





PRODUCT FOCUS







Case study 3
























Case study 5



















2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None


when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10







Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom















2612016 3 08 25 Low No

2912016 28 05 25 Low No

122016 25 03 20 Low No

422016 15 02 10 Low No

822016 10 02 03 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2612016 210 010 P=3 N=3 P=3 N=3 None

2912016 010 010 P=3 N=3 P=3 N=3 None

122016 010 010 P=3 N=3 P=3 N=3 None

422016 010 010 P=3 N=3 P=3 N=3 None

822016 010 010 P=3 N=3 P=3 N=3 None




2712016 1 32 08 Low No

3012016 1 32 08 Low No

222016 1 30 05 None No

522016 1 30 05 None No

922016 1 25 04 None No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 010 010 P=3 N=3 P=3 N=3 None

3012016 010 010 P=3 N=3 P=3 N=3 None

222016 010 010 P=3 N=3 P=3 N=3 None

522016 010 010 P=3 N=3 P=3 N=3 None

922016 010 010 P=3 N=3 P=3 N=3 None



applied





PRODUCT FOCUS







Case study 3
























Case study 5



















2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None


when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10







Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom













PRODUCT FOCUS







Case study 3
























Case study 5



















2712016 15 29 3 Med No

3012016 15 27 3 Low No

222016 1 22 28 Low No

522016 1 22 25 Low No

922016 1 20 2 Low No

Date Pain score 010


and removal)

Pain score 010

post (in between

dressing changes)

Dressing

satisfaction (nurse

N) (patient P) 03

Self-application

satisfaction (nurse

N) (patient P) 03

Adverse events

2712016 410 010 P=2 N=2 P=2 N=3 None

3012016 210 010 P=2 N=2 P=2 N=3 None

222016 010 010 P=2 N=2 P=2 N=3 None


when bending knee)

N=2

P=2 N=3 None

922016 010 010 P=3 N=3 P=2 N=3 None


a) Day 0 b) Day 10







Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom















Case study 6











































acute wounds BJN






























KEY POINTS





complications







PRODUCT FOCUS
















wwwwoundcaretvcom













PRODUCT FOCUS
















wwwwoundcaretvcom
















Documents

Surgical Wound Healing Not Mines