Using physiology to improve surgical wound outcomes.
Despite major advances in surgical management and approaches, including aseptic techniques, prophylactic antibiotics, and laparoscopic surgery, surgical wound infection and wound failure remain common complications of surgery. In a review of the literature, the authors found that a growing body of literature supports the concept that patient factors are a major determinant of wound outcome after surgery. In particular, wounds are exquisitely sensitive to hypoxia, which is both common and preventable. Perioperative management can be adapted to promote postoperative wound healing and resistance to infection. The most important factors are fluid management, temperature management, pain control, increased arterial oxygen tension, and, as has been long recognized, appropriate sterile techniques and administration of prophylactic antibiotics. This article reviews how knowledge of and attention to physiology can improve quality of care in both acute and chronic wounds.
Ueno
Christiane
C
University of California, San Francisco, Wound Healing Laboratory, Departments of Anesthesia and Perioperative Care and Surgery, San Francisco, Calif 94143-0648, USA.
Hunt
Thomas K
TK
Hopf
Harriet W
HW
D019072:Antibiotic Prophylaxis; D001207:Asepsis / Q000379:methods; D001831:Body Temperature / Q000502:physiology; D005440:Fluid Therapy; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control*; D009747:Nutritional Physiological Phenomena / Q000502:physiology; D010100:Oxygen / Q000032:analysis / Q000627:therapeutic use; D059408:Pain Management; D019990:Perioperative Care; D011300:Preoperative Care; D012039:Regional Blood Flow / Q000502:physiology; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013536:Suture Techniques; D014661:Vasoconstriction / Q000502:physiology; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
D010100:Oxygen