Surgical Incisions Overview and Healing Process

12 Questions

Which of the following is NOT a common complication of surgical incisions?

Increased risk of heart attack

What type of incision is typically used for cardiothoracic procedures?

Median sternotomy

Which of the following patient characteristics can increase the risk of developing surgical incision complications?

Morbid obesity

What technology has shown promise in preventing complications after high-risk, clean, closed surgical incisions?

Negative pressure wound therapy (NPWT)

Which of the following is a potential complication of surgical incisions that can lead to delayed or impaired incision healing?

Seroma formation

What type of incision is typically used for a lower extremity bypass procedure?

Anterior approach

What is the primary purpose of making a surgical incision?

To gain access to the inside of the body for treatment or removal of tissue

Which of the following is NOT a stage in the healing process of a surgical incision?

Wound contraction

Which of the following is a risk factor that can adversely affect incisional healing?

Excessive suture tension

Which type of surgical incision is most suitable for procedures requiring a wide exposure of the surgical site?

Quadrangular incision

Which of the following is NOT a factor that can delay the healing of a surgical incision?

Adequate hydration

What is the main biological function of the inflammatory stage in the healing process of a surgical incision?

To clean and debride the wound

Study Notes

Overview of Surgical Incisions

A surgical incision refers to a cut made in the skin during a surgical procedure to gain access to the inside of the body for treatment or removal of tissue. The healing process following surgical incisions involves complex biological and molecular events such as cell migration, proliferation, and extracellular matrix storage and remodeling. However, various pathophysiological and metabolic conditions can impair or delay the healing process.

Healing Process

Healing of surgical incisions occurs in stages, including hemostasis, inflammation, cell proliferation, tissue remodeling, and wound maturation. Delayed healing can occur due to underlying patient comorbidities like obesity, diabetes, poor vascular status, smoking, radiation therapy, chemotherapy, and the use of steroid or immunosuppressive drugs. Additionally, risk factors such as excessive suture tension, prolonged hospital stays, and contamination of the surgical site can adversely affect incisional healing.

Types of Incisions

There are various types of surgical incisions, including linear, curved, quadrangular, cruciate, and transverse. The choice of incision type depends on the location and nature of the surgery. Some common procedures and their corresponding incision types include:

Abdominal laparotomy: vertical midline incision
Cardiothoracic procedures: median sternotomy
Lower extremity bypass: anterior approach
Hip replacement: lateral approach

Complications

Complications of surgical incisions can include postoperative superficial surgical site infection (SSI), wound dehiscence, seroma formation, hematoma, skin and fat necrosis, and blistering. These complications can lead to delayed or impaired incision healing, increased medical costs, and even life-threatening situations. Patients presenting morbid obesity, diabetes mellitus, peripheral vascular disease, or coronary artery disease, as well as those with extended mechanical ventilation or preoperative malnutrition, are at higher risk of developing these complications.

Recently, prophylactic measures have been investigated to prevent complications via clean, closed surgical incisions. Negative pressure wound therapy (NPWT) technology, delivered through Prevena™ Customizable™ (Kinetic Concepts Inc., San Antonio, TX), has shown promise in preventing complications after high-risk, clean, closed surgical incisions. This technology may assist in maintaining incision closure and reducing the rate of postoperative wound complications such as dehiscence and infections.