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Innovation has led to an increasing number of medical
conditions being treated with surgery The Health amp
Social Care Information Centre (HSCIC) (2015) states
that surgical procedures accounted for 47 million
episodes of care in England in 2013-2014 The majorityof surgical procedures lead to a break in the protective
barrier to the skin Surgical site infection (SSI) surveillance
programmes report a decreasing incidence in the recorded
categories (Public Health England (PHE) 2014)
An SSI is defined as a superficial incisional infection that
occurs within 30 days of surgery (National Collaborating
Centre for Womenrsquos and Childrenrsquos Health 2008) However
in spite of being rare SSIs account for 16 of all health-
care associated infections in England (National Institute
for Health and Care Excellence (NICE) 2013a)mdashthat is
the third most common type of infection It is thought
that this figure may be underestimated as reporting is
voluntary with the exception of mandatory orthopaedicdata Moreover discharged patients can remain in the
community for treatment and the episode may therefore
not be disclosed
Postoperative wound sepsis carries the possibility
of high morbidity and potential mortality and leads to
unpredictable additional costs (NICE 2013a) The Under the
Knife report (CareFusion 2011) estimates the annual cost
Managing surgical wound carereview of Leukomed Control dressings
Jeanette Milne Tissue Viability Nurse Specialist Community
Health Services Clarendon South Tyneside Foundation Trust
Accepted for publication November 2015
ABSTRACT
Optimal management of surgical wounds is an important part of
postoperative recovery The aim of postoperative wound care is to facilitate
rapid wound closure while preventing complications and promoting minimal
disturbance to achieve the best functional and aesthetic results Health
professionals should seek to optimise the process of acute wound healing
observe progress and prevent wound complications Dressings that permit
extended wear time and are transparent and so allow early recognition
without the need for unnecessary changes have the potential to minimisethe effect on patients and the wider health economy This article reviews
recommendations for surgical wound care and introduces the recently
launched Leukomed Control dressing that is entirely transparent and allows
greater flexibility breathability and visualisation of the wound
Key words Surgical wound infection 992672 Cost-effectiveness 992672 Dressings
992672 Quality of life 992672 Wound healing
to be pound700 million per annum and calls for zero tolerance
It has been accepted that not all operative complications
are escapable however surveillance has shown that their
incidence can be reduced by taking appropriate measures
(PHE 2013)
This article examines surgical wound healing and
discusses preventive approaches that can be employed to
diminish postoperative complications It also introduces
evidence in support of a novel postoperative dressing
Surgical wound healingSurgical wounds are categorised as acute wounds healing is
initiated spontaneously and resolution in most cases occurs
in a predictable time frame The healing of an acute wound
requires coordinated cellular and molecular responses
(Martin and Nunan 2015) Wound healing is generally
divided into three phases inflammation proliferation and
maturation (Dealey 2005) The priority of the inflammatory
phase is to prevent further damage and prepare the site of
injury for repair Platelets are released from injured blood
vessels and vasoconstriction and coagulation occur to
initiate haemostasis (Schultz et al 2005) Concurrently
the early neutrophils that arrive signal the generationof macrophages to expedite efficient cleansing of any
devitalised tissue as well as facilitate the removal of any
bacteria that has been introduced during wounding (Dealey
2005 Martin and Nunan 2015)
Following injury histamine and prostaglandins are
released to reverse initial vasoconstriction and increase
blood vessel permeability to allow the escape of larger
neutrophils and improve blood flow to the wound This
in turn improves oxygen delivery that is required by the
cells to enable escalation in metabolism (Schultz et al
2005) Erythema and oedema occur as a result of the blood
vessels expanding and increasing blood supply (Silver 1994
Collier 1996) and this is accompanied by heat and pain(Tortora and Grabowski 1996 Dieglemann and Evans
2004)
Cells continue to release growth factors and cytokines to
enable tight regulation and coordination of events and the
wound moves into the proliferative stage of wound healing
(Hopkinson 1992 Martin and Nunan 2015) Angiogenesis
(the growth of new blood vessels) occurs to restore blood
flow and granulation tissue is generated in the form of
an extracellular matrix to fill the defect (Dealey 2005
Martin and Nunan 2015) Simultaneously the edges of
the wound contract epithelial tissue forms and it restores
the bacterial barrier function of the skin This proliferative
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stage ends when the wound is fully closed The final stage
of healing is called maturation during which time the
wound regains its tensile strength collagen fibres reorganise
the network of new blood vessel growth rationalises and
the scar loses some of its red pigmentation (Schultz 2005)
Reorganisation of tissue can take up to 18 months to be
completed (Dealey 2005)
Surgical wound healing is augmented by the surgicaltechniquemdashlarger vessels damaged during the procedure
will be ligated or cauterised to reduce blood loss The
majority of surgical wounds will have the wound edges
approximated with sutures clips or glue in an attempt
to minimise the defect (Aindow and Butcher 2005)
Approximation facilitates clotting mimics the natural
process of contraction and supports epithelial migration
from the edges to effect rapid closure thereby providing a
barrier against bacterial penetration (Roberts et al 2011)
Some surgical wounds for example the excision and
drainage of an abscess or pilonidal sinus are commonly
left open and heal by secondary intention The process of
wound healing is the same Further information in relationto managing wounds healing by secondary intention is
discussed by Schultz (2003) and Burton (2006)
Common complications of surgical woundsA common complication of surgery is the risk of patients
developing an SSI Undetected superficial wound infection
can lead to wound dehiscence (Oldfield and Burton 2009)
The latter can also occur as a result of haematoma poor
nutrition impaired blood flow and mechanical failure
which can be due to inappropriate closure technique or
patient-related factors such as obesity excess mobility
shear and friction (van Ramshorst et al 2010) Increased
pain exudate prolonged erythema unresolved oedemaand odour accompanied by pyrexia are cardinal signs and
symptoms of acute wound infection (European Wound
Management Association (EWMA) 2005) It is important
to bear in mind that the normal inflammatory phase of
wound healing leads to redness swelling heat and pain
and that this is part of the physiological process of healing
As such these symptoms alone do not equate to a wound
complication
Initial assessment may indicate the need for microbiological
analysis blood tests or imaging investigations to confirm
the diagnosis (World Union of Wound Healing Societies
(WUWHS) 2008) Yao et al (2013) recommend that
local signs of inflammation do not warrant immediateaction but should be closely monitored if these progress if
wound infection is suspected active management must be
commenced (Keast and Swanston 2014)
Blistering of the peri-wound area is another common
complication described by Bhattacharyya et al (2005) and
Cosker et al (2005) Lifestyle and patient comorbidities can
also affect outcomes and while these are not easy to address
consideration must be given to the management of factors
such as minimising the effect of concomitant disease for
example optimising glucose control in diabetes pre- and
postoperative nutrition smoking and vascular disease as well
as the effect on perfusion to name but a few (Yao et al 2013)
Strategies for postoperativewound managementThe aim of postoperative wound care is to facilitate
rapid wound closure while preventing complications
and promoting minimal disturbance to achieve the best
functional and aesthetic results (Baxter 2003) Oldfield
and Burton (2009) suggest that patients often feel more
comfortable with their wound covered as it preventsclosure materials from catching on to clothing that may in
turn lead to trauma Baxter (2003) points out that during
initial repair in the early hours after surgery the edges of
the wound have little tensile strength and require support
from the chosen closure material until full epithelialisation
takes place Optimising wound healing in the surgical
patient requires a multidisciplinary approach involving the
patient the surgical team immediate theatre recovery staff
and postoperative caregivers irrespective of whether they
work on a ward or in the community setting (NICE 2008
2013a Milne et al 2012)
Guidance and care bundles are aimed at promoting
structured timely evidence-based interventions in the pre-intra- and postoperative management (Department of
Health (DH) 2011) This has recently been supplemented
with SSI quality standards (NICE 2013a) that can be
used to monitor organisations In addition in some areas
these have been linked to commissioning for quality and
innovation targets These enable commissioners to reward
excellence by linking a proportion of income to desired
measurable outcomes (NICE 2013b) It is hoped that
promoting adherence to the standards will improve equity
and encourage enhanced outcomes
The SSI evidence review (NICE 2013a) includes care
bundles (DH 2011) and the World Health Organization
(WHO) surgery safety checklist (WHO 2009) The NICE(2013a) review continues the three phases of clinical actions
in the pre intra and postoperative phases of care reviews
the evidence for each recommendation and gives clarity
in relation to unanswered questions suggesting areas for
research For example showering or bathing preoperatively
continues to be supported however the review suggests
that the usebenefit of doing so with an antimicrobial agent
is uncertain in terms of efficacy
Interestingly and perhaps most relevant to this article
the evidence review document (NICE 2013a) supports
recommendations from the recently published article in the
Cochrane Database of Systematic Reviews on dressings used
in surgical wound care (Dumville et al 2011) This reviewevaluated evidence from randomised control trials that studied
the incidence of SSI It concludes that there was not enough
evidence to determine if the use of wound dressings helped
to prevent SSIs in wound healing by primary intention versus
leaving the wound exposed and that no particular dressing
appeared to be better NICE (2013a) acknowledges limitations
stating that most studies had inappropriate control dressings
such as gauze or pads The studies were small and most were
either assessed as poor quality or could not be assessed because
of incomplete reporting and only four studies were published
within the last decade As a result comparison between two
modern dressings is not clear Dumville et al (2011) conclude
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PRODUCT FOCUS
Film and pad dressings have also been reported to reduce
blistering in some instances (Gupta et al 2002 Bhattacharyya
et al 2005 Cosker et al 2005) In more recent years it has
been suggested that vapour-permeable film dressings could
offer a number of advantages over non-woven dressings
(Roberts et al 2011) (Box 1)
Importance of choosingthe most suitable dressingIn a time of austerity reduced funding is compounded
by an ageing population and a corresponding increased
demand for healthcare resources Surgical wound care
is not immune to scrutiny (Dumville et al 2011)
Proposed healthcare reforms in England and across the
UK recommend addressing patientsrsquo expressed needs as
a priority Any treatment plan would need to address all
identified risk factors (NICE 2013a)
Interventions for the management of acute wounds
should centre on reducing potential wound-relatedcomplications such as SSI Part of this process is the
selection of a dressing to cover the wound most are
designed to address local factors for example absorb
that wound dressings should be chosen on the basis of cost and
specific qualitiesmanagement properties of the product itself
NICE (2008) recommends covering a wound at the
end of the procedure with an interactive dressing but
does not specify which dressing An interactive dressing
can be described as one that supports and maintains an
optimum environment for healing (Schultz et al 2003) It
is difficult to determine how many postoperative dressingsexist A recent search of the Wound Care Handbook 2015ndash
2016 (Cowan 2015) reveals that most wound products
are recommended for use on postoperative wounds
Limiting the search to those specifically designed for use
postoperatively is not easy as they are not grouped in
this way A lack of definitive evidence to support specific
choice (Dumville et al 2014) and the number of products
available today can make product selection difficult
Oldfield and Burton (2009) suggest that clinicians could
leave postoperative wounds covered and undisturbed for
48 hours Yao et al (2013) suggest that a dressing should be
removed earlier if there is excessive inflammation which
may suggest complications or an increase in wound painpressure reported by the patient that is difficult to control
with analgesia
Baxter (2003) suggests that the initial function of a
postoperative dressing is to absorb blood or haemoserous
fluid and provide protection The choice of dressing can also
be determined by the type of surgery the closure technique
anatomical location and size of the wound (Milne et al
2012) Clinicians should also look for a dressing that on
removal will minimise trauma and the degree of sensory
stimulus to the wounded area in order to reduce patient-
reported pain (Briggs and Torra i Bou 2002) In addition
careful consideration should be given to dressing orientation
and tension as well as how patient movement postoperativelymay affect this (Milne et al 2012) Leal and Kirby (2008)
report skin damage and blister ing over joints as a result
of joint articulation postoperatively with some products
Box 1 Benefits of vapour-permeable film dressings
Barrier function prevents contamination
Allows postoperative inspection of the peri-wound area and the
wound itself without removal
Allows easy removal as a result of low adhesion to the wound
Maintains a moist wound environment and prevents excessive
moisture (breathable)
Can be left in place for up to 7 days
Enables the patient to shower after 48 hours without removal
(waterproof)
Is conformable to body contours and tends to be more stretchy
allowing for postoperative movementwearer comfort with reduced
incidence of blistering
Source Roberts et al 2011
Figure 1 Description of the Leukomed Control dressing
Red strips for easier
application in line
with the Leukomed
range
Very thin and flexible
polyurethane (PU) film
the same film used
in Cutimed Siltec and
new film range
Hydropolymer-
free zones for
extra flexibility
and additional
breathability
Hydropolymer
islands for reliable
absorption and
atraumatic
removal
Soft acrylic adhesive to secure adhesion
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S38 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
free zones (Figure 1) that allow greater flexibility
breathability and visualisation of the wound
The dressings have a soft acrylic adhesive at the margins
that allow secure adhesion while the hydropolymer islands
that cover the incision are non-adhesive This facilitates
moist wound healing while absorbing excess exudate and
minimising pain and trauma to the incision on removal
The entire hydropolymer pad is transparent which allowsthe clinician to easily inspect the wound without the need
to remove the dressing Consequently this helps to lengthen
the wear time and prevent external contamination and
trauma associated with early removal
Case study 1Steve Jeffrey Professor Wound Study Birmingham
City University and consultant plastic surgeon
A 36-year-old man sustained a fractured tibia while
parachuting abroad The fracture was plated abroad and
unfortunately it did not heal and the patient developed
osteomyelitis of the tibia He also developed complex
regional pain syndrome and after much discussion anelective above-knee amputation was performed About 6
weeks following the amputation he developed an abscess
in the end of the stump The stump was very painful and
lsquothrobbingrsquo The patient was admitted and underwent
opening up of the stump A wound irrigation system using
the KCI VAC-Ulta device was placed in theatre using
octenilin Wound Irrigation Solution Every 3 hours the
sponge wound filler was filled with 45 ml of the irrigation
solution and held for 15 minutes Postoperatively the
patient immediately reported a complete reduction in his
pain
The dressings were changed at day 3 on the ward and
at day 6 the patient was taken back to theatre where thewound was closed (Figure 2a) Leukomed Control was
applied post-operatively (Figure 2b) This wound was
particularly at r isk of developing further infection and the
ability to see any redness in the postoperative wound was
the reason that this dressing was chosen The patient was
reviewed at 1 week when the dressing was removed (Figure
2c ) A further Leukomed control dressing was applied At 2
weeks the wound was completely healed (Figure 2d )
The use of the Leukomed Control dressing allowed for
inspection of this at-risk wound without removal of the
dressing The patient found the dressing to be comfortable
Case studies 2ndash6Sharon Hunt advanced nurse practitioner South
Tees Hospital NHS Foundation Trust
The following case studies were made up of five post-
surgical wounds that attended follow-up at their registered
GP centre which deals with minor injurieswalk-ins and
has a resident wound care specialistnurse practitioner (the
author) on rota The patients all attended for their first
postoperative dressing change and follow-up care Three
patients attended postoperatively from the acute sector and
two from the walk-in centre (in-house intervention) All five
patients gave verbal consent for product application following
exudate donate fluid andor reduce bioburden Dressings
help to manage the symptoms of the wound and
manipulate the environment in which healing takes place
Optimisation of the wound environment can improve
patient outcomes accompanied with transparency which
allows inspection without removal will help to alleviate and
address patient-related concernsCost-effectiveness in surgical care relates to overall
treatment costs and is balanced with an ability to
maintain or improve patient outcomes In surgery the
resultant injury to the skin is a necessary by-product of
the intervention The relative cost associated with the
treatment of the wound is minimal when compared to that
of the procedure itself This of course assumes that none
of the above-mentioned complications occur because
costs escalate with complications such as SSIs These
complications commonly lead to increased length of stay
and the need for more interventions such as an increased
frequency of dressing changes debridement or further
surgery As such the cost of the dressing should be assessedin relation to evidence of efficacy in its chosen application
and its ability to meet the goal of care
Leukomed Control dressingsLeukomed Control dressings (BSN medical) are made of a
very thin flexible polyurethane film that is used in the new
Leukomed range of film and postoperative dressings The
backing of the dressing provides stability for application and
has red strips on the edges that enable easier visualisation
and application with aids The dressing has been designed
with hydropolymer islands that allow reliable absorption
and facilitate atraumatic removal There are hydropolymer-
b) Postoperative dressing
c) One week post closure
dressing removed
a) Wound closure
d) Two weeks post closure
Figure 2 Case study 1
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PRODUCT FOCUS
verbal information from the author who applied the initial
products collected the relevant data twice per week from
the patientsrsquo electronic records and compiled the background
case study information Those that gave permission for
photos have been used in this article Following the first
application by the author all five patients then carried out
their own dressing application as part of their care plan with
twice-weekly visits for wound assessment measurement and
verbal support and reassurance Pain score was obtained at
dressing change and between visits All wounds had low to
moderate exudate levels The evaluation process was carr ied
out in accordance with current trust policy and therefore
did not warrant ethical approval All data were collected
and stored in the patientsrsquo electronic medical file as per
normal practice Summaries of the patientsrsquo medical histories
and surgery are detailed below and results of the use of
Leukomed Control dressings are detailed in Tables 1ndash6
Case study 2 (Figure 3)
This patient is a 45-year old male who works as a manager
for a large UK firm dealing with computer and service
provision He is normally fit and well with no allergies
medical history or illnesses He had not taken any
medication when he presented to surgery with recurrence
Table 1 Case study 2 Presenting date 2512016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2512016 20 18 10 Low No
2812016 15 15 05 Low No
3112016 10 08 02 None No
322016 0 0 0 None No
No
722016 0 0 0 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
25116 810 310 P=2 N=2 P=3 N=3 None
28116 210 010 P=2 N=2 P=3 N=3 None
31116 010 010 P=2 N=2 P=3 N=3 None
3216 010 010 P=2 N=2 P=3 N=3 None
7216 010 010 P=2 N=2 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 2 Case study 3 presenting date 2512016 ndash classed as day 0 Dressing size 10x35 cm
Date Length Width Depth Exudate Infected
2512016 35 2 8 Low No
2812016 33 2 8 Low No
3112016 28 18 6 Low No
322016 28 18 6 Low No
722016 25 15 5 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2512016 410 410 P=2 N=2 P=2 N=3 None
2812016 210 210 P=2 N=2 P=2 N=3 None
3112016 010 010 P=2 N=2 P=2 N=3 None
322016 010 010 P=2 N=2 P=2 (patient needed
help to apply due to
dressing size) N=3
None
722016 010 010 P=2 N=2 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
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S40 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
Table 3 Case study 4 Presenting date 2612016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2612016 3 08 25 Low No
2912016 28 05 25 Low No
122016 25 03 20 Low No
422016 15 02 10 Low No
822016 10 02 03 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2612016 210 010 P=3 N=3 P=3 N=3 None
2912016 010 010 P=3 N=3 P=3 N=3 None
122016 010 010 P=3 N=3 P=3 N=3 None
422016 010 010 P=3 N=3 P=3 N=3 None
822016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 4 Case study 5 Presenting date 2512016 ndash classed as day 0 Dressing size=8x15 cm
Date Length Width Depth Exudate Infected
2712016 1 32 08 Low No
3012016 1 32 08 Low No
222016 1 30 05 None No
522016 1 30 05 None No
922016 1 25 04 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 010 010 P=3 N=3 P=3 N=3 None
3012016 010 010 P=3 N=3 P=3 N=3 None
222016 010 010 P=3 N=3 P=3 N=3 None
522016 010 010 P=3 N=3 P=3 N=3 None
922016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Peri-intervention c) Day 10 healedb) Post-intervention with product
applied
Figure 3 Case study 2
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PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
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S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
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C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
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S36 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
stage ends when the wound is fully closed The final stage
of healing is called maturation during which time the
wound regains its tensile strength collagen fibres reorganise
the network of new blood vessel growth rationalises and
the scar loses some of its red pigmentation (Schultz 2005)
Reorganisation of tissue can take up to 18 months to be
completed (Dealey 2005)
Surgical wound healing is augmented by the surgicaltechniquemdashlarger vessels damaged during the procedure
will be ligated or cauterised to reduce blood loss The
majority of surgical wounds will have the wound edges
approximated with sutures clips or glue in an attempt
to minimise the defect (Aindow and Butcher 2005)
Approximation facilitates clotting mimics the natural
process of contraction and supports epithelial migration
from the edges to effect rapid closure thereby providing a
barrier against bacterial penetration (Roberts et al 2011)
Some surgical wounds for example the excision and
drainage of an abscess or pilonidal sinus are commonly
left open and heal by secondary intention The process of
wound healing is the same Further information in relationto managing wounds healing by secondary intention is
discussed by Schultz (2003) and Burton (2006)
Common complications of surgical woundsA common complication of surgery is the risk of patients
developing an SSI Undetected superficial wound infection
can lead to wound dehiscence (Oldfield and Burton 2009)
The latter can also occur as a result of haematoma poor
nutrition impaired blood flow and mechanical failure
which can be due to inappropriate closure technique or
patient-related factors such as obesity excess mobility
shear and friction (van Ramshorst et al 2010) Increased
pain exudate prolonged erythema unresolved oedemaand odour accompanied by pyrexia are cardinal signs and
symptoms of acute wound infection (European Wound
Management Association (EWMA) 2005) It is important
to bear in mind that the normal inflammatory phase of
wound healing leads to redness swelling heat and pain
and that this is part of the physiological process of healing
As such these symptoms alone do not equate to a wound
complication
Initial assessment may indicate the need for microbiological
analysis blood tests or imaging investigations to confirm
the diagnosis (World Union of Wound Healing Societies
(WUWHS) 2008) Yao et al (2013) recommend that
local signs of inflammation do not warrant immediateaction but should be closely monitored if these progress if
wound infection is suspected active management must be
commenced (Keast and Swanston 2014)
Blistering of the peri-wound area is another common
complication described by Bhattacharyya et al (2005) and
Cosker et al (2005) Lifestyle and patient comorbidities can
also affect outcomes and while these are not easy to address
consideration must be given to the management of factors
such as minimising the effect of concomitant disease for
example optimising glucose control in diabetes pre- and
postoperative nutrition smoking and vascular disease as well
as the effect on perfusion to name but a few (Yao et al 2013)
Strategies for postoperativewound managementThe aim of postoperative wound care is to facilitate
rapid wound closure while preventing complications
and promoting minimal disturbance to achieve the best
functional and aesthetic results (Baxter 2003) Oldfield
and Burton (2009) suggest that patients often feel more
comfortable with their wound covered as it preventsclosure materials from catching on to clothing that may in
turn lead to trauma Baxter (2003) points out that during
initial repair in the early hours after surgery the edges of
the wound have little tensile strength and require support
from the chosen closure material until full epithelialisation
takes place Optimising wound healing in the surgical
patient requires a multidisciplinary approach involving the
patient the surgical team immediate theatre recovery staff
and postoperative caregivers irrespective of whether they
work on a ward or in the community setting (NICE 2008
2013a Milne et al 2012)
Guidance and care bundles are aimed at promoting
structured timely evidence-based interventions in the pre-intra- and postoperative management (Department of
Health (DH) 2011) This has recently been supplemented
with SSI quality standards (NICE 2013a) that can be
used to monitor organisations In addition in some areas
these have been linked to commissioning for quality and
innovation targets These enable commissioners to reward
excellence by linking a proportion of income to desired
measurable outcomes (NICE 2013b) It is hoped that
promoting adherence to the standards will improve equity
and encourage enhanced outcomes
The SSI evidence review (NICE 2013a) includes care
bundles (DH 2011) and the World Health Organization
(WHO) surgery safety checklist (WHO 2009) The NICE(2013a) review continues the three phases of clinical actions
in the pre intra and postoperative phases of care reviews
the evidence for each recommendation and gives clarity
in relation to unanswered questions suggesting areas for
research For example showering or bathing preoperatively
continues to be supported however the review suggests
that the usebenefit of doing so with an antimicrobial agent
is uncertain in terms of efficacy
Interestingly and perhaps most relevant to this article
the evidence review document (NICE 2013a) supports
recommendations from the recently published article in the
Cochrane Database of Systematic Reviews on dressings used
in surgical wound care (Dumville et al 2011) This reviewevaluated evidence from randomised control trials that studied
the incidence of SSI It concludes that there was not enough
evidence to determine if the use of wound dressings helped
to prevent SSIs in wound healing by primary intention versus
leaving the wound exposed and that no particular dressing
appeared to be better NICE (2013a) acknowledges limitations
stating that most studies had inappropriate control dressings
such as gauze or pads The studies were small and most were
either assessed as poor quality or could not be assessed because
of incomplete reporting and only four studies were published
within the last decade As a result comparison between two
modern dressings is not clear Dumville et al (2011) conclude
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S37
PRODUCT FOCUS
Film and pad dressings have also been reported to reduce
blistering in some instances (Gupta et al 2002 Bhattacharyya
et al 2005 Cosker et al 2005) In more recent years it has
been suggested that vapour-permeable film dressings could
offer a number of advantages over non-woven dressings
(Roberts et al 2011) (Box 1)
Importance of choosingthe most suitable dressingIn a time of austerity reduced funding is compounded
by an ageing population and a corresponding increased
demand for healthcare resources Surgical wound care
is not immune to scrutiny (Dumville et al 2011)
Proposed healthcare reforms in England and across the
UK recommend addressing patientsrsquo expressed needs as
a priority Any treatment plan would need to address all
identified risk factors (NICE 2013a)
Interventions for the management of acute wounds
should centre on reducing potential wound-relatedcomplications such as SSI Part of this process is the
selection of a dressing to cover the wound most are
designed to address local factors for example absorb
that wound dressings should be chosen on the basis of cost and
specific qualitiesmanagement properties of the product itself
NICE (2008) recommends covering a wound at the
end of the procedure with an interactive dressing but
does not specify which dressing An interactive dressing
can be described as one that supports and maintains an
optimum environment for healing (Schultz et al 2003) It
is difficult to determine how many postoperative dressingsexist A recent search of the Wound Care Handbook 2015ndash
2016 (Cowan 2015) reveals that most wound products
are recommended for use on postoperative wounds
Limiting the search to those specifically designed for use
postoperatively is not easy as they are not grouped in
this way A lack of definitive evidence to support specific
choice (Dumville et al 2014) and the number of products
available today can make product selection difficult
Oldfield and Burton (2009) suggest that clinicians could
leave postoperative wounds covered and undisturbed for
48 hours Yao et al (2013) suggest that a dressing should be
removed earlier if there is excessive inflammation which
may suggest complications or an increase in wound painpressure reported by the patient that is difficult to control
with analgesia
Baxter (2003) suggests that the initial function of a
postoperative dressing is to absorb blood or haemoserous
fluid and provide protection The choice of dressing can also
be determined by the type of surgery the closure technique
anatomical location and size of the wound (Milne et al
2012) Clinicians should also look for a dressing that on
removal will minimise trauma and the degree of sensory
stimulus to the wounded area in order to reduce patient-
reported pain (Briggs and Torra i Bou 2002) In addition
careful consideration should be given to dressing orientation
and tension as well as how patient movement postoperativelymay affect this (Milne et al 2012) Leal and Kirby (2008)
report skin damage and blister ing over joints as a result
of joint articulation postoperatively with some products
Box 1 Benefits of vapour-permeable film dressings
Barrier function prevents contamination
Allows postoperative inspection of the peri-wound area and the
wound itself without removal
Allows easy removal as a result of low adhesion to the wound
Maintains a moist wound environment and prevents excessive
moisture (breathable)
Can be left in place for up to 7 days
Enables the patient to shower after 48 hours without removal
(waterproof)
Is conformable to body contours and tends to be more stretchy
allowing for postoperative movementwearer comfort with reduced
incidence of blistering
Source Roberts et al 2011
Figure 1 Description of the Leukomed Control dressing
Red strips for easier
application in line
with the Leukomed
range
Very thin and flexible
polyurethane (PU) film
the same film used
in Cutimed Siltec and
new film range
Hydropolymer-
free zones for
extra flexibility
and additional
breathability
Hydropolymer
islands for reliable
absorption and
atraumatic
removal
Soft acrylic adhesive to secure adhesion
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S38 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
free zones (Figure 1) that allow greater flexibility
breathability and visualisation of the wound
The dressings have a soft acrylic adhesive at the margins
that allow secure adhesion while the hydropolymer islands
that cover the incision are non-adhesive This facilitates
moist wound healing while absorbing excess exudate and
minimising pain and trauma to the incision on removal
The entire hydropolymer pad is transparent which allowsthe clinician to easily inspect the wound without the need
to remove the dressing Consequently this helps to lengthen
the wear time and prevent external contamination and
trauma associated with early removal
Case study 1Steve Jeffrey Professor Wound Study Birmingham
City University and consultant plastic surgeon
A 36-year-old man sustained a fractured tibia while
parachuting abroad The fracture was plated abroad and
unfortunately it did not heal and the patient developed
osteomyelitis of the tibia He also developed complex
regional pain syndrome and after much discussion anelective above-knee amputation was performed About 6
weeks following the amputation he developed an abscess
in the end of the stump The stump was very painful and
lsquothrobbingrsquo The patient was admitted and underwent
opening up of the stump A wound irrigation system using
the KCI VAC-Ulta device was placed in theatre using
octenilin Wound Irrigation Solution Every 3 hours the
sponge wound filler was filled with 45 ml of the irrigation
solution and held for 15 minutes Postoperatively the
patient immediately reported a complete reduction in his
pain
The dressings were changed at day 3 on the ward and
at day 6 the patient was taken back to theatre where thewound was closed (Figure 2a) Leukomed Control was
applied post-operatively (Figure 2b) This wound was
particularly at r isk of developing further infection and the
ability to see any redness in the postoperative wound was
the reason that this dressing was chosen The patient was
reviewed at 1 week when the dressing was removed (Figure
2c ) A further Leukomed control dressing was applied At 2
weeks the wound was completely healed (Figure 2d )
The use of the Leukomed Control dressing allowed for
inspection of this at-risk wound without removal of the
dressing The patient found the dressing to be comfortable
Case studies 2ndash6Sharon Hunt advanced nurse practitioner South
Tees Hospital NHS Foundation Trust
The following case studies were made up of five post-
surgical wounds that attended follow-up at their registered
GP centre which deals with minor injurieswalk-ins and
has a resident wound care specialistnurse practitioner (the
author) on rota The patients all attended for their first
postoperative dressing change and follow-up care Three
patients attended postoperatively from the acute sector and
two from the walk-in centre (in-house intervention) All five
patients gave verbal consent for product application following
exudate donate fluid andor reduce bioburden Dressings
help to manage the symptoms of the wound and
manipulate the environment in which healing takes place
Optimisation of the wound environment can improve
patient outcomes accompanied with transparency which
allows inspection without removal will help to alleviate and
address patient-related concernsCost-effectiveness in surgical care relates to overall
treatment costs and is balanced with an ability to
maintain or improve patient outcomes In surgery the
resultant injury to the skin is a necessary by-product of
the intervention The relative cost associated with the
treatment of the wound is minimal when compared to that
of the procedure itself This of course assumes that none
of the above-mentioned complications occur because
costs escalate with complications such as SSIs These
complications commonly lead to increased length of stay
and the need for more interventions such as an increased
frequency of dressing changes debridement or further
surgery As such the cost of the dressing should be assessedin relation to evidence of efficacy in its chosen application
and its ability to meet the goal of care
Leukomed Control dressingsLeukomed Control dressings (BSN medical) are made of a
very thin flexible polyurethane film that is used in the new
Leukomed range of film and postoperative dressings The
backing of the dressing provides stability for application and
has red strips on the edges that enable easier visualisation
and application with aids The dressing has been designed
with hydropolymer islands that allow reliable absorption
and facilitate atraumatic removal There are hydropolymer-
b) Postoperative dressing
c) One week post closure
dressing removed
a) Wound closure
d) Two weeks post closure
Figure 2 Case study 1
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S39
PRODUCT FOCUS
verbal information from the author who applied the initial
products collected the relevant data twice per week from
the patientsrsquo electronic records and compiled the background
case study information Those that gave permission for
photos have been used in this article Following the first
application by the author all five patients then carried out
their own dressing application as part of their care plan with
twice-weekly visits for wound assessment measurement and
verbal support and reassurance Pain score was obtained at
dressing change and between visits All wounds had low to
moderate exudate levels The evaluation process was carr ied
out in accordance with current trust policy and therefore
did not warrant ethical approval All data were collected
and stored in the patientsrsquo electronic medical file as per
normal practice Summaries of the patientsrsquo medical histories
and surgery are detailed below and results of the use of
Leukomed Control dressings are detailed in Tables 1ndash6
Case study 2 (Figure 3)
This patient is a 45-year old male who works as a manager
for a large UK firm dealing with computer and service
provision He is normally fit and well with no allergies
medical history or illnesses He had not taken any
medication when he presented to surgery with recurrence
Table 1 Case study 2 Presenting date 2512016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2512016 20 18 10 Low No
2812016 15 15 05 Low No
3112016 10 08 02 None No
322016 0 0 0 None No
No
722016 0 0 0 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
25116 810 310 P=2 N=2 P=3 N=3 None
28116 210 010 P=2 N=2 P=3 N=3 None
31116 010 010 P=2 N=2 P=3 N=3 None
3216 010 010 P=2 N=2 P=3 N=3 None
7216 010 010 P=2 N=2 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 2 Case study 3 presenting date 2512016 ndash classed as day 0 Dressing size 10x35 cm
Date Length Width Depth Exudate Infected
2512016 35 2 8 Low No
2812016 33 2 8 Low No
3112016 28 18 6 Low No
322016 28 18 6 Low No
722016 25 15 5 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2512016 410 410 P=2 N=2 P=2 N=3 None
2812016 210 210 P=2 N=2 P=2 N=3 None
3112016 010 010 P=2 N=2 P=2 N=3 None
322016 010 010 P=2 N=2 P=2 (patient needed
help to apply due to
dressing size) N=3
None
722016 010 010 P=2 N=2 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
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S40 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
Table 3 Case study 4 Presenting date 2612016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2612016 3 08 25 Low No
2912016 28 05 25 Low No
122016 25 03 20 Low No
422016 15 02 10 Low No
822016 10 02 03 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2612016 210 010 P=3 N=3 P=3 N=3 None
2912016 010 010 P=3 N=3 P=3 N=3 None
122016 010 010 P=3 N=3 P=3 N=3 None
422016 010 010 P=3 N=3 P=3 N=3 None
822016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 4 Case study 5 Presenting date 2512016 ndash classed as day 0 Dressing size=8x15 cm
Date Length Width Depth Exudate Infected
2712016 1 32 08 Low No
3012016 1 32 08 Low No
222016 1 30 05 None No
522016 1 30 05 None No
922016 1 25 04 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 010 010 P=3 N=3 P=3 N=3 None
3012016 010 010 P=3 N=3 P=3 N=3 None
222016 010 010 P=3 N=3 P=3 N=3 None
522016 010 010 P=3 N=3 P=3 N=3 None
922016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Peri-intervention c) Day 10 healedb) Post-intervention with product
applied
Figure 3 Case study 2
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S41
PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
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S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
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C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S37
PRODUCT FOCUS
Film and pad dressings have also been reported to reduce
blistering in some instances (Gupta et al 2002 Bhattacharyya
et al 2005 Cosker et al 2005) In more recent years it has
been suggested that vapour-permeable film dressings could
offer a number of advantages over non-woven dressings
(Roberts et al 2011) (Box 1)
Importance of choosingthe most suitable dressingIn a time of austerity reduced funding is compounded
by an ageing population and a corresponding increased
demand for healthcare resources Surgical wound care
is not immune to scrutiny (Dumville et al 2011)
Proposed healthcare reforms in England and across the
UK recommend addressing patientsrsquo expressed needs as
a priority Any treatment plan would need to address all
identified risk factors (NICE 2013a)
Interventions for the management of acute wounds
should centre on reducing potential wound-relatedcomplications such as SSI Part of this process is the
selection of a dressing to cover the wound most are
designed to address local factors for example absorb
that wound dressings should be chosen on the basis of cost and
specific qualitiesmanagement properties of the product itself
NICE (2008) recommends covering a wound at the
end of the procedure with an interactive dressing but
does not specify which dressing An interactive dressing
can be described as one that supports and maintains an
optimum environment for healing (Schultz et al 2003) It
is difficult to determine how many postoperative dressingsexist A recent search of the Wound Care Handbook 2015ndash
2016 (Cowan 2015) reveals that most wound products
are recommended for use on postoperative wounds
Limiting the search to those specifically designed for use
postoperatively is not easy as they are not grouped in
this way A lack of definitive evidence to support specific
choice (Dumville et al 2014) and the number of products
available today can make product selection difficult
Oldfield and Burton (2009) suggest that clinicians could
leave postoperative wounds covered and undisturbed for
48 hours Yao et al (2013) suggest that a dressing should be
removed earlier if there is excessive inflammation which
may suggest complications or an increase in wound painpressure reported by the patient that is difficult to control
with analgesia
Baxter (2003) suggests that the initial function of a
postoperative dressing is to absorb blood or haemoserous
fluid and provide protection The choice of dressing can also
be determined by the type of surgery the closure technique
anatomical location and size of the wound (Milne et al
2012) Clinicians should also look for a dressing that on
removal will minimise trauma and the degree of sensory
stimulus to the wounded area in order to reduce patient-
reported pain (Briggs and Torra i Bou 2002) In addition
careful consideration should be given to dressing orientation
and tension as well as how patient movement postoperativelymay affect this (Milne et al 2012) Leal and Kirby (2008)
report skin damage and blister ing over joints as a result
of joint articulation postoperatively with some products
Box 1 Benefits of vapour-permeable film dressings
Barrier function prevents contamination
Allows postoperative inspection of the peri-wound area and the
wound itself without removal
Allows easy removal as a result of low adhesion to the wound
Maintains a moist wound environment and prevents excessive
moisture (breathable)
Can be left in place for up to 7 days
Enables the patient to shower after 48 hours without removal
(waterproof)
Is conformable to body contours and tends to be more stretchy
allowing for postoperative movementwearer comfort with reduced
incidence of blistering
Source Roberts et al 2011
Figure 1 Description of the Leukomed Control dressing
Red strips for easier
application in line
with the Leukomed
range
Very thin and flexible
polyurethane (PU) film
the same film used
in Cutimed Siltec and
new film range
Hydropolymer-
free zones for
extra flexibility
and additional
breathability
Hydropolymer
islands for reliable
absorption and
atraumatic
removal
Soft acrylic adhesive to secure adhesion
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S38 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
free zones (Figure 1) that allow greater flexibility
breathability and visualisation of the wound
The dressings have a soft acrylic adhesive at the margins
that allow secure adhesion while the hydropolymer islands
that cover the incision are non-adhesive This facilitates
moist wound healing while absorbing excess exudate and
minimising pain and trauma to the incision on removal
The entire hydropolymer pad is transparent which allowsthe clinician to easily inspect the wound without the need
to remove the dressing Consequently this helps to lengthen
the wear time and prevent external contamination and
trauma associated with early removal
Case study 1Steve Jeffrey Professor Wound Study Birmingham
City University and consultant plastic surgeon
A 36-year-old man sustained a fractured tibia while
parachuting abroad The fracture was plated abroad and
unfortunately it did not heal and the patient developed
osteomyelitis of the tibia He also developed complex
regional pain syndrome and after much discussion anelective above-knee amputation was performed About 6
weeks following the amputation he developed an abscess
in the end of the stump The stump was very painful and
lsquothrobbingrsquo The patient was admitted and underwent
opening up of the stump A wound irrigation system using
the KCI VAC-Ulta device was placed in theatre using
octenilin Wound Irrigation Solution Every 3 hours the
sponge wound filler was filled with 45 ml of the irrigation
solution and held for 15 minutes Postoperatively the
patient immediately reported a complete reduction in his
pain
The dressings were changed at day 3 on the ward and
at day 6 the patient was taken back to theatre where thewound was closed (Figure 2a) Leukomed Control was
applied post-operatively (Figure 2b) This wound was
particularly at r isk of developing further infection and the
ability to see any redness in the postoperative wound was
the reason that this dressing was chosen The patient was
reviewed at 1 week when the dressing was removed (Figure
2c ) A further Leukomed control dressing was applied At 2
weeks the wound was completely healed (Figure 2d )
The use of the Leukomed Control dressing allowed for
inspection of this at-risk wound without removal of the
dressing The patient found the dressing to be comfortable
Case studies 2ndash6Sharon Hunt advanced nurse practitioner South
Tees Hospital NHS Foundation Trust
The following case studies were made up of five post-
surgical wounds that attended follow-up at their registered
GP centre which deals with minor injurieswalk-ins and
has a resident wound care specialistnurse practitioner (the
author) on rota The patients all attended for their first
postoperative dressing change and follow-up care Three
patients attended postoperatively from the acute sector and
two from the walk-in centre (in-house intervention) All five
patients gave verbal consent for product application following
exudate donate fluid andor reduce bioburden Dressings
help to manage the symptoms of the wound and
manipulate the environment in which healing takes place
Optimisation of the wound environment can improve
patient outcomes accompanied with transparency which
allows inspection without removal will help to alleviate and
address patient-related concernsCost-effectiveness in surgical care relates to overall
treatment costs and is balanced with an ability to
maintain or improve patient outcomes In surgery the
resultant injury to the skin is a necessary by-product of
the intervention The relative cost associated with the
treatment of the wound is minimal when compared to that
of the procedure itself This of course assumes that none
of the above-mentioned complications occur because
costs escalate with complications such as SSIs These
complications commonly lead to increased length of stay
and the need for more interventions such as an increased
frequency of dressing changes debridement or further
surgery As such the cost of the dressing should be assessedin relation to evidence of efficacy in its chosen application
and its ability to meet the goal of care
Leukomed Control dressingsLeukomed Control dressings (BSN medical) are made of a
very thin flexible polyurethane film that is used in the new
Leukomed range of film and postoperative dressings The
backing of the dressing provides stability for application and
has red strips on the edges that enable easier visualisation
and application with aids The dressing has been designed
with hydropolymer islands that allow reliable absorption
and facilitate atraumatic removal There are hydropolymer-
b) Postoperative dressing
c) One week post closure
dressing removed
a) Wound closure
d) Two weeks post closure
Figure 2 Case study 1
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S39
PRODUCT FOCUS
verbal information from the author who applied the initial
products collected the relevant data twice per week from
the patientsrsquo electronic records and compiled the background
case study information Those that gave permission for
photos have been used in this article Following the first
application by the author all five patients then carried out
their own dressing application as part of their care plan with
twice-weekly visits for wound assessment measurement and
verbal support and reassurance Pain score was obtained at
dressing change and between visits All wounds had low to
moderate exudate levels The evaluation process was carr ied
out in accordance with current trust policy and therefore
did not warrant ethical approval All data were collected
and stored in the patientsrsquo electronic medical file as per
normal practice Summaries of the patientsrsquo medical histories
and surgery are detailed below and results of the use of
Leukomed Control dressings are detailed in Tables 1ndash6
Case study 2 (Figure 3)
This patient is a 45-year old male who works as a manager
for a large UK firm dealing with computer and service
provision He is normally fit and well with no allergies
medical history or illnesses He had not taken any
medication when he presented to surgery with recurrence
Table 1 Case study 2 Presenting date 2512016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2512016 20 18 10 Low No
2812016 15 15 05 Low No
3112016 10 08 02 None No
322016 0 0 0 None No
No
722016 0 0 0 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
25116 810 310 P=2 N=2 P=3 N=3 None
28116 210 010 P=2 N=2 P=3 N=3 None
31116 010 010 P=2 N=2 P=3 N=3 None
3216 010 010 P=2 N=2 P=3 N=3 None
7216 010 010 P=2 N=2 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 2 Case study 3 presenting date 2512016 ndash classed as day 0 Dressing size 10x35 cm
Date Length Width Depth Exudate Infected
2512016 35 2 8 Low No
2812016 33 2 8 Low No
3112016 28 18 6 Low No
322016 28 18 6 Low No
722016 25 15 5 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2512016 410 410 P=2 N=2 P=2 N=3 None
2812016 210 210 P=2 N=2 P=2 N=3 None
3112016 010 010 P=2 N=2 P=2 N=3 None
322016 010 010 P=2 N=2 P=2 (patient needed
help to apply due to
dressing size) N=3
None
722016 010 010 P=2 N=2 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
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S40 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
Table 3 Case study 4 Presenting date 2612016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2612016 3 08 25 Low No
2912016 28 05 25 Low No
122016 25 03 20 Low No
422016 15 02 10 Low No
822016 10 02 03 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2612016 210 010 P=3 N=3 P=3 N=3 None
2912016 010 010 P=3 N=3 P=3 N=3 None
122016 010 010 P=3 N=3 P=3 N=3 None
422016 010 010 P=3 N=3 P=3 N=3 None
822016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 4 Case study 5 Presenting date 2512016 ndash classed as day 0 Dressing size=8x15 cm
Date Length Width Depth Exudate Infected
2712016 1 32 08 Low No
3012016 1 32 08 Low No
222016 1 30 05 None No
522016 1 30 05 None No
922016 1 25 04 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 010 010 P=3 N=3 P=3 N=3 None
3012016 010 010 P=3 N=3 P=3 N=3 None
222016 010 010 P=3 N=3 P=3 N=3 None
522016 010 010 P=3 N=3 P=3 N=3 None
922016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Peri-intervention c) Day 10 healedb) Post-intervention with product
applied
Figure 3 Case study 2
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S41
PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
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S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 1010
C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
8162019 Surgical Wound Healing Not Mines
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S38 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
free zones (Figure 1) that allow greater flexibility
breathability and visualisation of the wound
The dressings have a soft acrylic adhesive at the margins
that allow secure adhesion while the hydropolymer islands
that cover the incision are non-adhesive This facilitates
moist wound healing while absorbing excess exudate and
minimising pain and trauma to the incision on removal
The entire hydropolymer pad is transparent which allowsthe clinician to easily inspect the wound without the need
to remove the dressing Consequently this helps to lengthen
the wear time and prevent external contamination and
trauma associated with early removal
Case study 1Steve Jeffrey Professor Wound Study Birmingham
City University and consultant plastic surgeon
A 36-year-old man sustained a fractured tibia while
parachuting abroad The fracture was plated abroad and
unfortunately it did not heal and the patient developed
osteomyelitis of the tibia He also developed complex
regional pain syndrome and after much discussion anelective above-knee amputation was performed About 6
weeks following the amputation he developed an abscess
in the end of the stump The stump was very painful and
lsquothrobbingrsquo The patient was admitted and underwent
opening up of the stump A wound irrigation system using
the KCI VAC-Ulta device was placed in theatre using
octenilin Wound Irrigation Solution Every 3 hours the
sponge wound filler was filled with 45 ml of the irrigation
solution and held for 15 minutes Postoperatively the
patient immediately reported a complete reduction in his
pain
The dressings were changed at day 3 on the ward and
at day 6 the patient was taken back to theatre where thewound was closed (Figure 2a) Leukomed Control was
applied post-operatively (Figure 2b) This wound was
particularly at r isk of developing further infection and the
ability to see any redness in the postoperative wound was
the reason that this dressing was chosen The patient was
reviewed at 1 week when the dressing was removed (Figure
2c ) A further Leukomed control dressing was applied At 2
weeks the wound was completely healed (Figure 2d )
The use of the Leukomed Control dressing allowed for
inspection of this at-risk wound without removal of the
dressing The patient found the dressing to be comfortable
Case studies 2ndash6Sharon Hunt advanced nurse practitioner South
Tees Hospital NHS Foundation Trust
The following case studies were made up of five post-
surgical wounds that attended follow-up at their registered
GP centre which deals with minor injurieswalk-ins and
has a resident wound care specialistnurse practitioner (the
author) on rota The patients all attended for their first
postoperative dressing change and follow-up care Three
patients attended postoperatively from the acute sector and
two from the walk-in centre (in-house intervention) All five
patients gave verbal consent for product application following
exudate donate fluid andor reduce bioburden Dressings
help to manage the symptoms of the wound and
manipulate the environment in which healing takes place
Optimisation of the wound environment can improve
patient outcomes accompanied with transparency which
allows inspection without removal will help to alleviate and
address patient-related concernsCost-effectiveness in surgical care relates to overall
treatment costs and is balanced with an ability to
maintain or improve patient outcomes In surgery the
resultant injury to the skin is a necessary by-product of
the intervention The relative cost associated with the
treatment of the wound is minimal when compared to that
of the procedure itself This of course assumes that none
of the above-mentioned complications occur because
costs escalate with complications such as SSIs These
complications commonly lead to increased length of stay
and the need for more interventions such as an increased
frequency of dressing changes debridement or further
surgery As such the cost of the dressing should be assessedin relation to evidence of efficacy in its chosen application
and its ability to meet the goal of care
Leukomed Control dressingsLeukomed Control dressings (BSN medical) are made of a
very thin flexible polyurethane film that is used in the new
Leukomed range of film and postoperative dressings The
backing of the dressing provides stability for application and
has red strips on the edges that enable easier visualisation
and application with aids The dressing has been designed
with hydropolymer islands that allow reliable absorption
and facilitate atraumatic removal There are hydropolymer-
b) Postoperative dressing
c) One week post closure
dressing removed
a) Wound closure
d) Two weeks post closure
Figure 2 Case study 1
8162019 Surgical Wound Healing Not Mines
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S39
PRODUCT FOCUS
verbal information from the author who applied the initial
products collected the relevant data twice per week from
the patientsrsquo electronic records and compiled the background
case study information Those that gave permission for
photos have been used in this article Following the first
application by the author all five patients then carried out
their own dressing application as part of their care plan with
twice-weekly visits for wound assessment measurement and
verbal support and reassurance Pain score was obtained at
dressing change and between visits All wounds had low to
moderate exudate levels The evaluation process was carr ied
out in accordance with current trust policy and therefore
did not warrant ethical approval All data were collected
and stored in the patientsrsquo electronic medical file as per
normal practice Summaries of the patientsrsquo medical histories
and surgery are detailed below and results of the use of
Leukomed Control dressings are detailed in Tables 1ndash6
Case study 2 (Figure 3)
This patient is a 45-year old male who works as a manager
for a large UK firm dealing with computer and service
provision He is normally fit and well with no allergies
medical history or illnesses He had not taken any
medication when he presented to surgery with recurrence
Table 1 Case study 2 Presenting date 2512016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2512016 20 18 10 Low No
2812016 15 15 05 Low No
3112016 10 08 02 None No
322016 0 0 0 None No
No
722016 0 0 0 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
25116 810 310 P=2 N=2 P=3 N=3 None
28116 210 010 P=2 N=2 P=3 N=3 None
31116 010 010 P=2 N=2 P=3 N=3 None
3216 010 010 P=2 N=2 P=3 N=3 None
7216 010 010 P=2 N=2 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 2 Case study 3 presenting date 2512016 ndash classed as day 0 Dressing size 10x35 cm
Date Length Width Depth Exudate Infected
2512016 35 2 8 Low No
2812016 33 2 8 Low No
3112016 28 18 6 Low No
322016 28 18 6 Low No
722016 25 15 5 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2512016 410 410 P=2 N=2 P=2 N=3 None
2812016 210 210 P=2 N=2 P=2 N=3 None
3112016 010 010 P=2 N=2 P=2 N=3 None
322016 010 010 P=2 N=2 P=2 (patient needed
help to apply due to
dressing size) N=3
None
722016 010 010 P=2 N=2 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
8162019 Surgical Wound Healing Not Mines
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S40 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
Table 3 Case study 4 Presenting date 2612016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2612016 3 08 25 Low No
2912016 28 05 25 Low No
122016 25 03 20 Low No
422016 15 02 10 Low No
822016 10 02 03 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2612016 210 010 P=3 N=3 P=3 N=3 None
2912016 010 010 P=3 N=3 P=3 N=3 None
122016 010 010 P=3 N=3 P=3 N=3 None
422016 010 010 P=3 N=3 P=3 N=3 None
822016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 4 Case study 5 Presenting date 2512016 ndash classed as day 0 Dressing size=8x15 cm
Date Length Width Depth Exudate Infected
2712016 1 32 08 Low No
3012016 1 32 08 Low No
222016 1 30 05 None No
522016 1 30 05 None No
922016 1 25 04 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 010 010 P=3 N=3 P=3 N=3 None
3012016 010 010 P=3 N=3 P=3 N=3 None
222016 010 010 P=3 N=3 P=3 N=3 None
522016 010 010 P=3 N=3 P=3 N=3 None
922016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Peri-intervention c) Day 10 healedb) Post-intervention with product
applied
Figure 3 Case study 2
8162019 Surgical Wound Healing Not Mines
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S41
PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 810
S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 1010
C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
8162019 Surgical Wound Healing Not Mines
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S39
PRODUCT FOCUS
verbal information from the author who applied the initial
products collected the relevant data twice per week from
the patientsrsquo electronic records and compiled the background
case study information Those that gave permission for
photos have been used in this article Following the first
application by the author all five patients then carried out
their own dressing application as part of their care plan with
twice-weekly visits for wound assessment measurement and
verbal support and reassurance Pain score was obtained at
dressing change and between visits All wounds had low to
moderate exudate levels The evaluation process was carr ied
out in accordance with current trust policy and therefore
did not warrant ethical approval All data were collected
and stored in the patientsrsquo electronic medical file as per
normal practice Summaries of the patientsrsquo medical histories
and surgery are detailed below and results of the use of
Leukomed Control dressings are detailed in Tables 1ndash6
Case study 2 (Figure 3)
This patient is a 45-year old male who works as a manager
for a large UK firm dealing with computer and service
provision He is normally fit and well with no allergies
medical history or illnesses He had not taken any
medication when he presented to surgery with recurrence
Table 1 Case study 2 Presenting date 2512016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2512016 20 18 10 Low No
2812016 15 15 05 Low No
3112016 10 08 02 None No
322016 0 0 0 None No
No
722016 0 0 0 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
25116 810 310 P=2 N=2 P=3 N=3 None
28116 210 010 P=2 N=2 P=3 N=3 None
31116 010 010 P=2 N=2 P=3 N=3 None
3216 010 010 P=2 N=2 P=3 N=3 None
7216 010 010 P=2 N=2 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 2 Case study 3 presenting date 2512016 ndash classed as day 0 Dressing size 10x35 cm
Date Length Width Depth Exudate Infected
2512016 35 2 8 Low No
2812016 33 2 8 Low No
3112016 28 18 6 Low No
322016 28 18 6 Low No
722016 25 15 5 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2512016 410 410 P=2 N=2 P=2 N=3 None
2812016 210 210 P=2 N=2 P=2 N=3 None
3112016 010 010 P=2 N=2 P=2 N=3 None
322016 010 010 P=2 N=2 P=2 (patient needed
help to apply due to
dressing size) N=3
None
722016 010 010 P=2 N=2 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
8162019 Surgical Wound Healing Not Mines
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S40 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
Table 3 Case study 4 Presenting date 2612016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2612016 3 08 25 Low No
2912016 28 05 25 Low No
122016 25 03 20 Low No
422016 15 02 10 Low No
822016 10 02 03 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2612016 210 010 P=3 N=3 P=3 N=3 None
2912016 010 010 P=3 N=3 P=3 N=3 None
122016 010 010 P=3 N=3 P=3 N=3 None
422016 010 010 P=3 N=3 P=3 N=3 None
822016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 4 Case study 5 Presenting date 2512016 ndash classed as day 0 Dressing size=8x15 cm
Date Length Width Depth Exudate Infected
2712016 1 32 08 Low No
3012016 1 32 08 Low No
222016 1 30 05 None No
522016 1 30 05 None No
922016 1 25 04 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 010 010 P=3 N=3 P=3 N=3 None
3012016 010 010 P=3 N=3 P=3 N=3 None
222016 010 010 P=3 N=3 P=3 N=3 None
522016 010 010 P=3 N=3 P=3 N=3 None
922016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Peri-intervention c) Day 10 healedb) Post-intervention with product
applied
Figure 3 Case study 2
8162019 Surgical Wound Healing Not Mines
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British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S41
PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 810
S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 1010
C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
8162019 Surgical Wound Healing Not Mines
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S40 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
Table 3 Case study 4 Presenting date 2612016 ndash classed as day 0 Dressing size=7x10 cm
Date Length Width Depth Exudate Infected
2612016 3 08 25 Low No
2912016 28 05 25 Low No
122016 25 03 20 Low No
422016 15 02 10 Low No
822016 10 02 03 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2612016 210 010 P=3 N=3 P=3 N=3 None
2912016 010 010 P=3 N=3 P=3 N=3 None
122016 010 010 P=3 N=3 P=3 N=3 None
422016 010 010 P=3 N=3 P=3 N=3 None
822016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
Table 4 Case study 5 Presenting date 2512016 ndash classed as day 0 Dressing size=8x15 cm
Date Length Width Depth Exudate Infected
2712016 1 32 08 Low No
3012016 1 32 08 Low No
222016 1 30 05 None No
522016 1 30 05 None No
922016 1 25 04 None No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 010 010 P=3 N=3 P=3 N=3 None
3012016 010 010 P=3 N=3 P=3 N=3 None
222016 010 010 P=3 N=3 P=3 N=3 None
522016 010 010 P=3 N=3 P=3 N=3 None
922016 010 010 P=3 N=3 P=3 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Peri-intervention c) Day 10 healedb) Post-intervention with product
applied
Figure 3 Case study 2
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 710
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S41
PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 810
S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 1010
C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 710
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S41
PRODUCT FOCUS
of a raised subcutaneous cyst to his left radial region of the
wrist This was affecting his working role (using computers)
due to its position and resulting pressure and pain The
patient consented to debridement of the mass Leukomed
Control was applied by the author and details of the
dressingrsquos use are in Table 1
Case study 3
This patient is an 82-year-old female who is a retiredteacher independent and lives alone Her medical history
includes hypercholesterolemia for which she is on
medication no allergies and fully mobile She is prescribed
simvastatin 20 mg once per day
She presented to surgery for first dressing change
following a right hip replacement Before this she had lost
her balance in the garden and fallen on to a concrete path
fracturing her neck of femur A Softpore (Richardsons)
adhesive surgical dressing (10 cm x 30 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 2
Case study 4 (Figure 4)This patient is a 23-year-old male who works as a
healthcare worker with older people in the NHS He
suffers from frequent abscess formation folliculitis and
depressive illness and feels well with no allergies He is
taking sertraline 20 mg once per day and flucloxacillin
500 mg four times a day for one week
This patient presented to surgery with a postoperative
surgically debrided abscess on the r ight midaxillary for his
first wound review and dressing application A Softpore
adhesive surgical dressing (6 cm x 7 cm) was in situ on
attendance Leukomed Control was applied by the author
and details of the dressingrsquos use are in Table 3
Case study 5
This patient was an unemployed 48-year-old father of
two who cares at home for his young children alone His
medical history includes diabetes mellitus for which he
takes medication HBA1c 8 SINBAD (diabetic foot
classification) level 3 diagnosed neuropathy and peripheral
vascular disease hypertension hypercholesterolemia obesity
and heavy smoker (30 cigarettes a day) He is currently
taking metformin 500 mg in the morning metformin1000 mg in the evening and ramipril 10 mg simvastatin
20 mg once a day and flucloxacillin 500 mg four times a
day for a 10-day period He wears an offloading diabetic
shoe (Procare) as directed
This patient presented to surgery for first dressing change
following a left great toe amputation Before this he had
chronic and recurrent Staphylococcus aureus infection with
resulting necrosis and cellulitis of the foot A Mepilex Border
adhesive dressing (Moumllnlycke Health Care) (7 cm x 75 cm)
Table 5 Case study 6 Presenting date 2512016 ndash classed as day 0 Dressing size=10x24 cm
Date Length Width Depth Exudate Infected
2712016 15 29 3 Med No
3012016 15 27 3 Low No
222016 1 22 28 Low No
522016 1 22 25 Low No
922016 1 20 2 Low No
Date Pain score 010
peri (on application
and removal)
Pain score 010
post (in between
dressing changes)
Dressing
satisfaction (nurse
N) (patient P) 03
Self-application
satisfaction (nurse
N) (patient P) 03
Adverse events
2712016 410 010 P=2 N=2 P=2 N=3 None
3012016 210 010 P=2 N=2 P=2 N=3 None
222016 010 010 P=2 N=2 P=2 N=3 None
522016 010 010 P=2 (pulled a little
when bending knee)
N=2
P=2 N=3 None
922016 010 010 P=3 N=3 P=2 N=3 None
Dressing satisfaction = 1 poor 2 good 3 excellent Self-application satisfaction = 1 poor 2 manageable 3 excellent
a) Day 0 b) Day 10
Figure 4 Case study 4
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 810
S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 1010
C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 810
S42 British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT
was in situ on attendance Leukomed Control was applied by
the author and details of the dressingrsquos use are in Table 4
Case study 6
This patient is a 51-year-old female who works as a
catering assistant and stands for long periods of time (up
to 8 hours a day) She is normally fit and well with noallergies medical history or illnesses No medications were
being taken at presentation
The patient presented to surgery for first dressing change
following postoperative cartilage repair of her left patella
Before this she had chronic pain and a lsquogrindingrsquo sensation
especially at the end of the day and on long walks A
Softpore adhesive surgical dressing (10 cm x 35 cm) was in
situ on attendance Leukomed Control was applied by the
author and details of the dressingrsquos use are in Table 5
Summary of case studies 2-6
While using the product the author noticed the following
Reduced adhesion to skin that is hairy and pulls onhairy skin suggest hair removed before application
Only applied to none low or moderate serous
haemoserous exudate in this evaluation
One older patient needed some assistance with long-
length dressing application
The author received positive feedback from the patients
who in the main applied the dressing independently
with no problems thus promoting self-care and reducing
the need for extra dressing visits The patients found
the dressing to be light comfortable and atraumatic in
application and removal They all wished to continue use of
the product and felt it was visually appealing because it was
almost invisible The author found the product easy to useand found the transparency when in situ useful she felts it
was a good alternative to dressings traditionally used
ConclusionThis article provides a general overview of surgical
wound healing and potential complications including SSI
Care bundles NICE guidance and quality standards are
considered and should be used to direct care to minimise
complications It is hoped that increased knowledge and use
of these standards will ensure early recognition of signs and
symptoms that will in turn reduce the adverse effect on a
patientrsquos quality of life and minimise any associated costs
The limited evidence for the selection of postoperative
dressing products is also addressed Guidance to choose a
product on the basis of cost features and benefits matched
to the wound type support the introduction of Leukomed
Control dressings The case studies have been used to
demonstrate that appropriate dressing choice can have
a positive effect on healing outcomes in patients with
acute wounds BJN
Declaration of interest this article was supported by BSN medical
Aindow D Butcher M (2005) Films or fabrics is it time to re-appraisepostoperative dressings Br J Nursing 14(19) S15-20
Baxter H (2003) Management of surgical wounds Nurs Times 99(13) 66-8Bhattacharyya M Bradley H Holder S Gerber B (2005) A prospective
clinical audit of patient dressing choice for post-op arthroscopywounds Wounds UK 1(1) 30ndash4
Briggs M Torra i Bou JE (2002) Pain at wound dressing changes a guideto management In EWMA Position Document Pain At Wound DressingChanges httptinyurlcomz9jsw8r (accessed 17 March 2016) 12ndash17
Burton F (2006) Best practice overview surgical and trauma woundsWound Essentials 1 98ndash107 httptinyurlcomze9nfvv (accessed 3March 2016)
CareFusion (2011) Under the Knife Taking a Zero Tolerance Approachto Preventable Surgical Site Infections in UK Hospitals CareFusionBasingstoke
Collier M (1996) The principles of optimum wound management NursStand 10(43) 47-52
Cosker T Elsayed S Gupta S Mendonca AD Tayton KJ (2005) Choiceof dressing has a major impact on blistering and healing outcomes inorthopaedic patients J Wound Care 14(1) 27-9
Cowan T ed (2015) Wound Care Handbook 2015ndash16 MA Healthcare LtdLondon
Dealey C (2005) The Care of Wounds A Guide for Nurses 3rd edn BlackwellPublishing Oxford
Department of Health (2011) High Impact Intervention Care Bundleto Prevent Surgical Site Infection httpbitly11kifVJ (accessed 12November 2015)
Diegelmann RF Evans MC (2004) Wound healing an overview of acutefibrotic and delayed healing Front Biosci 9 283ndash9
Dumville JC Walter CJ Sharp CA Page T (2014) Dressings for theprevention of surgical site infection Cochrane Database Syst Rev
(7)CD003091 doi10100214651858CD003091pub2European Wound Management Association (2005) Position Document
Identifying Criteria for Wound Infection httptinyurlcomblzjrc(accessed 16 March 2016)
Gupta SK Lee S Moseley LG (2002) Postoperative wound bli stering isthere a link with dressing usage J Wound Care 11(7) 271ndash3
Health amp Social Care Information Centre (2015) Hospital EpisodeStatistics Admitted Patient Care England 2013-14 httpbitly1MpS5la (accessed 12 November 2015)
Hopkinson I (1992) Growth factors and extracellular matrix J Wound Care1(2) 47ndash50
Keast D Swanston T (2014) Ten top tips managing surgical site infectionsWounds International 5(3) 13ndash18
Leal A Kirby P (2008) Blister formation on primary wound closure sites acomparison of two dressings Wounds UK 4(2) 31ndash7
Martin P Nunan R (2015) Cellular and molecular mechanisms of repairin acute and chronic wound healing Br J Dermatol 173(2) 370-8doi101111bjd13954
Milne J Vowden P Fumarola S Leaper D (2012) Post-operative incisionmanagement Wounds UK 8(4) 1ndash4
National Collaborating Centre for Womenrsquos and Childrenrsquos Health (2008)Surgical Site Infection Prevention and Treatment of Surgical Site Infection httptinyurlcomgsj5how (accessed 16 March 2016)
National Institute for Health and Care Excellence (2008) NICE guidelines[CG74] Surgical Si te Infections Prevention and Treatment wwwniceorgukguidancecg74 (accessed 12 November 2015)
National Institute for Health and Care Excellence (2013a) Surgical SiteInfection Evidence Update June 2013 httptinyurlcomzm4nkbb(accessed 16 March 2016)
National Institute for Health and Care Excellence (2013b) NICE Support for Commission ing for Surgical Site In fection httptinyurlcomhvv3yqx(accessed 16 March 2016)
Oldfield A Burton F (2009) Surgical wounds why do they dehisceWound Essentials httptinyurlcomhkepkdx (accessed 16 March2015)
Public Health England (2013) Protocol for the Surveillance of Surgical Site
KEY POINTS
992672 Surgical site infections account for 16 of all healthcare-associated
infections in England
992672 Increased knowledge and use of guidelines clinical standards and care
bundles will ensure early recognition of signs and symptoms of wound
complications
992672 Leukomed Control dressings contain hydropolymer-free zones that allowgreater flexibility breathability and visualisation of the wound
992672 Being completely transparent Leukomed Control allows clinicians to
easily inspect the wound without the need to remove the dressing
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
The best wound care videos from the web all together in one place
Including educational channels fromthe industryrsquos leading companies
wwwwoundcaretvcom
Assessment | Infection | Leg Ulcers Pressure Ulcers
Diabetic Foot Ulcers | Management Dressings
Management Therapeutic Techniques New Developments
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 1010
C o p y r i g h t o f B r i t i s h J o u r n a l o f N u r s i n g i s t h e p r o p e r t y o f M a r k A l l e n P u b l i s h i n g L t d a n d i t s
c o n t e n t m a y n o t b e c o p i e d o r e m a i l e d t o m u l t i p l e s i t e s o r p o s t e d t o a l i s t s e r v w i t h o u t t h e
c o p y r i g h t h o l d e r s e x p r e s s w r i t t e n p e r m i s s i o n H o w e v e r u s e r s m a y p r i n t d o w n l o a d o r e m a i l
a r t i c l e s f o r i n d i v i d u a l u s e
8162019 Surgical Wound Healing Not Mines
httpslidepdfcomreaderfullsurgical-wound-healing-not-mines 910
British Journal of Nursing 2016 Vol 25 No 6 TISSUE VIABILITY SUPPLEMENT S43
PRODUCT FOCUS
Infection Surgical Site Infection Surveillance Service PHE LondonPublic Health England (2014) Surveillance of Surgical Site Infections in NHS
hospitals in England 201314 PHE LondonRoberts N Sorrell J Bielby A Searle A (2011) A survey of postoperative
wound dressing practice before and after implementing nationalguidelines Wounds UK 7(4) 12ndash21
Schultz GS Sibbald RG Falanga V et al (2003) Wound bed preparat ion asystematic approach to wound management Wound Repair Regen 11
Suppl 1 S1ndash28Schultz GS Ladwig G Wysoki A (2005) Extracellular matrix review of
its roles in acute and chronic wounds World Wide Wounds httpbitly1kQPfPl (accessed 12 November 2015)
Silver IA (1994) The physiology of wound healing J Wound Care 3(2)
106ndash9Tortora GJ Grabowski SR (1996) Principles of Anatomy and Physiology
Harper Collins Publications New Yorkvan Ramshorst GH Nieuwenhuizen J Hop WC et al (2010) Abdominal
wound dehiscence in adults development and validation of a riskmodel World J Surg 34(1) 20ndash7 doi101007s00268-009-0277-y
World Health Organization (2009) Safe Surgery httptinyurlcom56y97w (accessed 12 November 2015)
World Union of Wound Heal ing Societies (2008) Principles of Best PracticeWound Infection in Clinical Practice An International Consensus httptinyurlcomoglcy8c (accessed 16 March 2016)
Yao K Bae L Yew WP (2013) Post-operative wound management AustFam Physician 42(12) 867ndash70
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