Managing surgical wounds – the importance of appropriate wound closure and aftercare

Posted: 17/04/2023

When a patient undergoes an operation, an incision of the skin/tissue will often need to be made. Consequently, patients will usually have a wound that requires a form of closure, and in some cases, aftercare. This article explains more about how wounds are closed, the range of aftercare they may require, and why this is important in a patient’s recovery – particularly to avoid any complications that can arise from poor wound management in the immediate aftermath of surgery, or later on down the road.

How are surgical wounds closed?

At the end of an operation, the surgeon will usually close the patient’s wound, unless it is so small that it can be left to heal by itself. Wound closure can be done in a number of different ways:

skin glue, which is usually used for smaller wounds;
adhesive strips, which stick to the skin;
stitches, including Vicryl, which may be dissolvable; or
staples (metal clips).

The type of closure that the surgeon will use will depend on where the wound is, the type of surgery that took place, the size of the wound, and specific factors such as any patient allergies.

What care should a surgical wound have?

The main risks that patients will want to avoid following surgery are poor wound closure, and the wound getting infected.

If you have recently had surgery, you should be given detailed advice before you are discharged from hospital about how to look after the wound. This may include how to keep dressings clean and dry, how often to change dressings, how to clean the wound (if appropriate), how much you can move about during the early stages of recovery, and what activities to avoid while the wound heals.

If non-dissolvable stitches or staples have been used, these will need to be removed and you should be informed about where and when this will be done. Other types of wound closures can be left to heal themselves, although you may still be asked to attend follow up appointments to check that this is proceeding as planned.

You should also be given advice on the warning signs that something is wrong. Our recent article on post-operative management provides a list of the red flags to look out for following surgery, including wound infection.

Why is wound care important?

Most of the time, surgical wounds will heal within a few weeks, depending on the size and nature of the wound. Where wound closure is not performed correctly, or if the wound is not looked after properly, this can increase the risk that the wound will dehisce (open up).

In some cases, this can be very dangerous because it can lead to bacteria getting into the wound, resulting in a serious infection, and may require emergency readmission to have the wound washed out and closed again. A hospital admission may also be required in this situation, for appropriate observation and for antibiotics to be administered.

There can often be underlying reasons why a wound is not healing properly, such as an internal collection forming (for example – a collection of blood known as a haematoma or a collection of fluid known as a seroma) and so early medical attention is imperative to spot any signs of such complications to ensure that things do not get worse.

In some cases, poor wound management/healing can lead to further complications down the line, such as worsened appearance of the scarring or distortion of the surrounding tissue/skin; it can also result in hernia formation in the future.

It is therefore important that closure of the wound is carried out by the surgeon with appropriate care and skill, that suitable follow-up in terms of wound care is organised, and furthermore, that patients are provided with full, detailed information before they are discharged from hospital to make sure they understand how to look after their wound, and what to do if they are concerned about it.

Penningtons Manches Cooper has a specialist team of surgical negligence solicitors who deal with the full spectrum of surgery related medical negligence claims. If you think you may have a surgical claim, even if the type of claim has not been mentioned above, please do not hesitate to get in touch with a member of the team for an initial discussion.