Surgical Incision Complications and Healing

Complications of Surgical Incisions

Surgical incisions play a crucial role in the success of many operations. However, they can also pose risks and complications if not properly managed. One of the most common complications is postoperative surgical site infection (SSI), which accounts for approximately 17-22% of healthcare-associated infections. Other complications include surgical wound dehiscence and formation of haematomas or seromas, which can lead to delayed or impaired incision healing. These complications are more likely when wounds are closed under tension or in patients with specific morbidities, such as obesity. Obese patients may also face difficulty obtaining adequate exposure to the surgical field due to increased subcutaneous fat, predisposing them to greater tissue oedema and seroma formation. Incisional closure complications can have significant economic implications for healthcare systems due to increased medical and surgical procedures required.

Types of Surgical Incisions

Several types of surgical incisions exist, each with their own considerations regarding healing and potential complications. For example:

• Vertical incisions: These incisions are commonly used in abdominal surgeries and can be associated with higher risks of infection compared to horizontal incisions.
• Horizontal incisions (e.g., 'Smith's incision'): Horizontal incisions are often used in laparoscopic procedures and generally have lower infection rates than vertical incisions. However, they may not provide sufficient access for certain procedures.

Healing Process After Surgery

The process of healing after surgery involves a series of biological and molecular events, including cell migration, proliferation, and extracellular matrix storing and remodelling. However, factors such as patient comorbidities like diabetes, hypertension, and vascular disorders, excessive suture tensions, surgical site contamination, surgical technique, operative time, estimated blood loss, and patient-related risk factors can all impact the healing milieu and potentially delay or impair healing.

In recent years, advances in negative pressure dressing technology have shown promising results in promoting healing in open wounds. Similarly, the use of Incisional Negative Pressure Wound Therapy (INPWT) has been investigated as a preventive measure to reduce complications in high-risk, clean, closed surgical incisions. While more studies are needed to fully understand its effectiveness, INPWT has shown potential benefits in reducing infection rates and sero-haematoma formation.