Introduction to surgical wounds

Surgical wounds follow surgical intervention, such as excision, incision, reconstructive surgery or debridement. Surgical wounds are generally acute wounds that heal without complication within an expected timeframe. Surgical wounds can be classified into four types based on the potential for microbial contamination: clean, clean-contaminated, contaminated, and dirty or infected (see Stratifying surgical wounds based on the level of contamination).

Surgical wounds heal via:

• primary intention—the open wound edges are approximated and closed with staples, sutures, adhesives or fixation strips
• secondary intention—the wound edges are left open and healing occurs from the base upwards by granulation (new connective tissue), with wound contraction and finally re-epithelialisation
• delayed primary closure—the wound is left open and later closed by primary intention.

The majority of surgical wounds heal by primary intention, typically within 14 days. Healing by secondary intention can take weeks to months, depending on the size of the tissue deficit. The mechanism of healing influences wound management, prognosis and risk of complications.

Wound dehiscence and surgical site infections of the skin and subcutaneous tissue are common postoperative complications.