Factors associated with the healing of complex surgical wounds in the breast and abdomen: retrospective cohort study

Abstract

Objective: to estimate the healing rate of complex surgical wounds and its associated factors. Method: retrospective cohort study from 2003 to 2014 with 160 outpatients of a Brazilian university hospital. Data were obtained through consultation of the medical records. Survival function was estimated using the Kaplan-Meier method and Cox regression model to estimate the likelihood of the occurrence of healing. Results: the complex surgical wound healing rate was 67.8% (95% CI: 60.8-74.9). Factors associated with a higher likelihood of wound healing were segmentectomy/quadrantectomy surgery, consumption of more than 20 grams/day of alcohol, wound extent of less that 17.3 cm2 and the length of existence of the wound prior to outpatient treatment of less than 15 days, while the use of hydrocolloid covering and Marlex mesh were associated with a lower likelihood of healing. Conclusion: the wound healing rate was considered high and was associated with the type of surgical intervention, alcohol consumption, type of covering, extent and length of wound existence. Preventive measures can be implemented during the monitoring of the evolution of the complex surgical wound closure, with possibilities of intervention in the modifiable risk factors.

Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study

“…The variables related to the surgical wound consisted of topography (abdomen, breast) and type of surgical intervention. The variables chosen were treated in a previous study on complex surgical wounds, directed by the authors of this study 2 …”

“…And finally, third intention healing happens when the surgical wound is left open for a short period of time and the re-approximation of the edges is performed later 1 . Wound healing for first intention, called surgical site, can become complex (complex surgical wound) when the suture opens as the result of local complications such as seroma, hematoma, infection and dehiscence, requiring a longer time for spontaneous closure 2 .…”

Measurement of wound area for early analysis of the scar predictive factor

“…The main groups of chronic wounds of non-surgical origin are vascular ulcers of the lower limbs, neuropathic ulcers, such as those found in diabetics and pressure injuries (3,5,7) . Surgical wounds can be considered acute when healing happens by first intention and can become complex and chronic when they present complications such as dehiscence and infection, requiring healing by second intention (4,7) .…”

“…About 234 million surgeries are performed worldwide each year. A retrospective study based on data from the US Wound Registry, indicated that 20.8% of all types of wounds are represented by surgical wounds that did not heal, with an average cost of treatment for wound healing of US$ 3,927 (7) . This is an example of how the cost of treating surgical wounds with scar deficits can increase, due to the complexity and longer time of outpatient follow-up (7) .…”

“…The main groups of chronic wounds of non-surgical origin are vascular ulcers of the lower limbs, neuropathic ulcers, such as those found in diabetics and pressure injuries ( 3 , 5 , 7 ) .…”