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WOUND DRESSING

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SUMMARY

  • Acute postsurgical wounds follow an orderly progression in healing, from hemostasis/inflammation to proliferation, and on to maturation and remodeling.

  • Minimizing tension during primary wound closure will help limit the proliferative phase of wound healing and decrease chances of keloid formation.

  • Simple wound dressings, such as polymer films, are generally adequate for most postoperative wounds.

image Beginner Pearls

  • Avoid dressing a wound with gauze directly adjacent to the wound bed, as it has a tendency to become incorporated into the wound.

  • An ounce of prevention truly is worth a pound of cure; pay attention to meticulous suturing and wound closure, and dressing choice will be far less important.

  • Be sure to affix the pressure dressing to the surrounding skin and not to the polymer film, or when the pressure dressing is removed the film will be as well.

image Expert Pearls

  • While polymer films, such as Tegaderm, may work well for wounds closed with buried sutures alone, nylon sutures that will require removal in under a week may be best dressed with nonadherent pads.

image Don’t Forget!

  • When using a polymer film dressing, some moisture under the dressing is desirable, but excess serous drainage may lead to maceration.

  • Most surgical wounds do not require topical antibiotic dressings or ointments.

image Pitfalls and Cautions

  • Wound debridement is of vital importance, but can be painful. In general, the removal of necrotic tissue is fairly painless, though pretreatment with local anesthetics may be desirable.

  • Expensive wound dressings and devices generally add little (other than expense) to the healing of well-sutured operative wounds.

image Patient Education Points

  • When using clear polymer films, advise patients that they will likely see some serous drainage or even frank bleeding under the dressing. A small amount of eschar present under the film is not concerning.

  • Patient education regarding leg elevation and compression after lower leg procedures is of vital importance.

image Billing Pearls

  • While wound dressings are incorporated as part of any surgical procedure, debridement may be separately billable using the debridement codes (11042 series). Wound debridement performed during the postoperative global period, however, cannot be billed separately.

INTRODUCTION

Acute wounds are created with every surgical procedure, and outcomes are generally dependent on the wound-healing process. As dermatologic surgery frequently involves cosmetically sensitive areas such as the face, wound healing is of particular importance; even on the trunk and extremities, however, most patients tend to judge the success of their dermatologic surgery procedure more on the basis of the final scar appearance than on the low rate of recurrence.

The healing process is highly dependent on a patient’s underlying health status, and complications such as surgical-site infections (SSIs), chronic wound development, and keloid scarring are common. In the United States, over 70 million surgeries are performed a year, with an estimated ...

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