What does good surgical wound closure look like?

I love and hate SSI prevention in equal measure. On the one hand, we have good evidence and strong guidelines around SSI prevention – but on the other hand, implementing these interventions to prevent SSI can be enormously tricky in practice. One key factor in preventing SSI is creating a well-closed wound in theatre. Surprisingly, there’s precious little data on how to measure what a well-closed surgical wound looks like. This qualitative study presents some potential indicators to measure good surgical wound closure in order to prevent SSI.

Through a combination of literature review, direct observation, and expert interview, the researcher developed a ‘long list’ of factors associated with the quality of surgical wound closure. This included visible markers indicating the quality of wound closure (e.g. suture visibility, apposition of wound edges, evidence of gaps in the wound or tethering of the skin edges), factors that might influence this (e.g. surgeon’s expertise, time taken to closure the wounds) and patient factors (e.g. obesity, skin conditions). From this list, the team created a framework for a tool to measure the quality of a surgical wound.

On the one hand, this piece of work is stating the (sometimes literally) bleeding obvious: a poorly closed surgical wound is obvious immediately to the trained (and sometimes untrained) eye. But on the other hand, I think there’s potential here to create a really simple and useful tool to assess the quality of surgical wound closure, which could be a very helpful training tool.

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