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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 Tips

  • 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 Tips

  • 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

A working understanding of the fundamentals of the wound healing process, as well as available wound dressings, is critical for the primary care practitioner embarking on performing skin procedures. Acute wounds are created with every surgical procedure, and what patients are interested in the most—outcomes—are generally dependent not only on the care and skill of the individual practitioner, but on the natural wound healing process as well.

The healing process is highly dependent on a patient’s underlying health status, and complications such as surgical site infections, chronic wound development, and keloid scarring are common. In the United States, over 70 million surgeries are performed a year, with an estimated 38 million ...

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