Correcting the Nomenclature: What is the Surgical Wound?

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As the Wound Care Community starts to move beyond the confining world of diabetic foot ulcers and venous leg ulcers, we realize that the majority the wounds that we treat are something else. Looking at our good friend Dr Caroline Fife’s data, we see that approximately 20% of the wounds seen in the outpatient setting are “surgical wounds.”¹ But what is a surgical wound? The open transmetatarsal amputation, the dehisced breast wound, the Mohs wound left open to heal by secondary intent, the dehisced cesarean section wound, or the closed post total knee that is erythematous and warm but is intact, are these all postsurgical wounds? I would say yes!

With this in mind, we need to be more specific. Similar to the differences between a diabetic foot wound and a diabetic foot ulcer, the term “surgical wound” requires inspection and distinction. One must recognize that there are surgical wounds that are planned to be left open which have a very different algorithm of care than surgical site complications. Further, we need to recognize that surgical site infection data is often more readily available than surgical site complication data. However, surgical site infection data often turns up as the surrogate marker in the introduction to surgical wound papers. It must be noted that a surgical site infection, data about which is more readily available, is not necessarily a synonym for a surgical site complication.

They are many reasons for surgical site complication; local tissue ischemia, undue tension, poor technique, malnutrition, periwound edema, and even surgeon hubris, when the surgeon believes that they can “get this wound to close.” Many of the above can be determined and are determined pre- or intra-operatively. Of course, surgical site infection often leads to surgical dehiscence as well, although it may not, as there can be peri-incisional cellulitis that does not lead to tissue breakdown.

Therefore, we will be working and adhering to the following paradigm: we recognize that “postsurgical wounds” is a very large category, however when referenced, it needs to be immediately further described. Inscribed within the Venn diagram of surgical wounds is the circle of surgical site complications, and within that circle sit the overlapping, but not completely inclusive, domains of surgical site dehiscence and surgical site infections. Dr Sandy-Hodgetts has proposed a useful grading tool for surgical dehiscence.² I recommend to our readers that we take a good look at this in preparation for future planning, algorithms, and documents.

 In the upcoming months you will see this journal work to develop an international consensus document that includes United States-facing therapeutic paradigms that will help the practitioner differentiate and appropriate early triage and treat the complex world of postsurgical wounds.