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Introduction
CHAPTER 2 Wound Healing and
Surgical Wound Dressings
Amy Vandiver Luis Garza
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.
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.
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.
Donโt 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.
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.
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.
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.
CHAPTER 2 Wound Healing and