Management of Complex Surgical Wounds

Let us hear from Prof Eu Kong Weng on the topic of Management of complex surgical wounds. For other articles by Prof Eu Kong Weng on GetDoc Says, check this link. 

Colon surgery is a means of treatment for various conditions affecting the large intestines such as ulcerative colitis, familial adenomatous polyposis and colon cancer. The affected segments of the colon are removed through surgery both to improve symptoms and prevent worsening of the patient’s general condition. This can be achieved through various surgical techniques like minimally-invasive laparoscopic surgery or conventional open-abdomen surgery (laparotomy).

A key concern to patients undergoing such procedures is the formation of cosmetically unacceptable scars, especially in younger patients. Depending on the surgical technique used, a scar will be formed at different locations. Conventional laparotomy will result in a long, midline scar traversing the umbilicus while scars resulting from laparoscopy and robotic surgery are smaller and usually located on the sides of the abdomen.

Scarring

Scarring is the result of tissue repair and is a normal bodily reaction in response to tissue damage. The process and end-result of scar formation is influenced by various factors such as wound closure and postsurgery infections. A wound that is properly closed by appropriate suturing techniques allows for healing by primary intention, resulting in a more cosmetically pleasing scar. On the other hand, an infected wound will complicate the healing process, causing a delayed and painful experience and a scar that is potentially less presentable. The issue of scarring is particularly important in colon surgery because of a mandatory incision for the removal of the resected segment of colon even in laparoscopic or robotic surgery. Furthermore, the fact that the removed specimen contains faecal
matter adds to the risk of developing post-surgery infection as the resected colon may contaminate the wound while being removed through the incision. As such, all colon operations could potentially result in wound infection.

Besides the formation of cosmetically unacceptable scars, an infected wound can present with pain, discomfort, purulent discharge (pus), skin irritation and constant wetting of clothing. This will require a higher frequency of dressing changes, causing an increased burden to the patient and caregivers.

Vacuum Assisted Closure Dressing

Medical advancement now allows us to manage such complicated infected wounds with a negative pressure wound therapy device known as VA C or Vacuum Assisted Closure dressing. VAC is a feasible and effective option of managing such infected wounds following colon surgery. It can be applied onto the infected wound area and attached to a negative pressure device which continuously removes wound fluids, preventing leakage and making for easy wound care. The dressing also comes with an airtight seal which prevents faecal contamination especially if a stoma (colostomy) is nearby, which in turn speeds up the healing process.
This routine reduces the total number of dressing changes, minimising patient discomfort and the workload of caregivers. VA C is also portable, allowing the patient to be ambulant and decreasing the need for prolonged hospital stay which comes with a range of complications associated with being bed-bound, such as pressure ulcers and pneumonia.

Wound Healing

Surgical wound infections managed conservatively take a long time to heal and requires repeated dressing changes which may lead to the formation of cosmetically unacceptable scars. With VA C, patients can now experience a significantly shortened recovery downtime and increased comfort. Once the wound of a patient on the VA C routine appears clean enough, it can be quickly re-sutured and the resulting scars can still be cosmetically pleasing.
Patients undergoing colon operations should be informed that wounds can be potentially infected, giving rise to some discomfort, pain and prolonged hospital stay. The resulting scar may also be not as cosmetically pleasing as one would have preferred. However, although wound infection cannot be absolutely prevented, VAC is an effective method available to minimise the symptoms and improve healing.

This article was written by Prof Eu Kong Weng, Colorectal Surgeon at Colorectal Surgeons Inc., Mount Elizabeth Novena Specialist Centre and was published in This Quarterly magazine. For queries and consultation with Prof Eu Kong Weng, head to GetDoc.

Tags

• colorectal surgery
• management
• surgical wounds