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Post Operative - Infected Wounds

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Management of post-operative wounds becomes especially challenging when complicated by infection, dehiscence, and fistula formation. Clinical infection occurs when the bacteria colonisation in and around the wound site rises to a critical level and can lead to a deterioration of the wound condition.

Wound healing may be severely compromised or absent in the presence of infection, so it is crucial that infection is identified and controlled appropriately. Clinical signs of infection include redness, heat, swelling, pain, increased levels of exudate, discoloured granulation tissue, a delay in healing or wound breakdown¹.

Many wound dressings, including some film and hydrocolloid dressings, are semi occlusive, thereby offering protection from outside contaminants and helping to reduce the risk of this occurring. Wound dressings containing silver are also now manufactured. The silver acts as an antimicrobial agent, killing the majority of the bacteria that cause problems in wound healing².

For wounds that do become clinically infected, the selection of wound dressing again depends on a holistic assessment including the condition of the wound³. Copious exudate and unpleasant odour are common to infected wounds and dressings with high absorptive properties (i.e. polyurethane foams) 3M™ Tegaderm™ Foam Dressing are useful. Antimicrobial dressings containing iodine and silver can help with bacteria at a local level. Whilst, symptom relief of odour control can be addressed using charcoal containing dressings. For deeper cavity wounds an alginate dressing such as 3M™ Tegaderm™ Alginate Dressing can be used to pack the wound and encourage granulation.

High levels of pain are also associated with infected wounds and to reduce trauma during dressing changes a wound contact dressing such as 3M™ Tegaderm™ Contact Dressing can be left in place whilst secondary absorbent dressings are replaced. 3M™ Cavilon™ No Sting Barrier Film can also offer protection to the peri-wound area against maceration and to prevent skin stripping caused by removal of adhesive secondary dressings.

1. Cutting K, Harding K. (1994) Criteria for identifying wound infection. Journal of Wound Care 3(4): 198-200.
2. Lansdown,A.B.G. (2002) Silver 1: its antimicrobial properties and mechanism of action. J Wound Care; 11(4), 125-130
3. Timmons J, Bell A (2000) Wound Infection. Prim Health Care, 10(2), 31-38

Information provided with support from the Wound Healing Research Unit, Cardiff.

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