Wound Care Complications

Wounds affect millions of patients each year. Wounds affect the morbidity and mortality of patients. Some wounds might not heal even after proper wound care and become chronic non-healing wounds. These chronic non-healing wounds have a substantial impact due to economic burden and the significant effect on the quality of life, as well as the increased risk of death for those patients affected by them.

The complications linked with chronic wounds increase the cost, both financial and personal, to the individuals with these wounds. There can be various underlying causes for the complications, such as obesity, diabetes, and cancer. The stubborn wounds can affect anyone regardless of a surgeon’s meticulous care. Apart, from the medical costs, these wound complications also cost lives.

Wound Care Complications

Following your surgery, here are some possible wound care complications you should be aware of:

• Infection: This is the most common wound care complication affecting up to 3% of people undergoing surgery. The skin is a natural barrier against infection from various bacteria such as Staphylococcus, Streptococcus, and Pseudomonas. As soon as there is any break in the skin it becomes an open invitation for germs. Surgical Site Infections usually occur 30 days after surgery, and they are categorized in three ways:

  • Superficial incisional- This infection attacks only the area of the incision in the skin.

  • Deep incisional- This would occur beneath the incision area and affects the muscles and their surrounding tissue.

  • Organ or space- This infection can occur in any area of the body that is not involved in the actual surgery. The infection often occurs within an organ or in a space between organs.

  Surgical site infections are commonly treated with antibiotics. But, severe cases might require additional surgical intervention.




• Osteomyelitis: In this, the infection attacks the bone by traveling through the bloodstream or spreading to the nearby tissue. Also, the infection might occur if the bone itself is exposed to germs during the initial injury or surgical procedure. This is common among people suffering from diabetic foot ulcers. Before antibiotic therapy, amputation of the infected part was the only solution. Antibiotic therapy mostly treats the condition if diagnosed early. Some of the common signs to detect osteomyelitis include:

  • Fever

  • Swelling, warmth, and redness over the infected area

  • Pain in the area of the infection

  • Fatigue

  The advantages of antibiotic therapy along with medical intervention include avoidance of surgery, possible avoidance of hospitalization, shortening of hospital stay, and decreased rate of amputation. But, there are some disadvantages including increased risks of recurring infection, re-ulceration, and development of antibiotic resistance or antibiotic toxicities along with an increased risk of Clostridium difficile.




• Tissue Necrosis and Gangrene: This can occur whenever there is a loss of blood supply to the affected area, especially extremities such as hands or feet. Due to an inadequate supply of oxygen and nutrients to the tissues they die. If there is doubt about gangrene, it needs to be treated immediately to halt its spread. If left untreated, it can lead to amputation or even death. Following symptoms of gangrene include:

  • Loss of color: The area will become discolored eventually turning dry and dark. The affected area would change from red to black in dry gangrene, or it will become swollen.

  • Smell: The affected area would be foul-smelling in case of wet gangrene. Gas gangrene produces foul-smelling along with brownish pus.

  • Change in skin appearance: The skin would appear shiny and starts shedding. This would form a clear line between affected and healthy skin.

  • Pain: Pain is usually followed by loss of sensation and an inability to move the part. The affected area becomes cold to the touch and there is a loss of pulse in the arteries.

  Necrotic tissue delays wound healing. The necrotic tissue must be removed before any progress towards the healing of the wound. Antimicrobial therapy is considered to reduce the risk of further infection complications.




• Periwound Dermatitis: Periwound is the surrounding tissue of the wound. If left untreated this may lead to dermatitis. The surrounding area of the wound turns red, swollen, and sore, sometimes with small blisters. This can prevent the wound from closing and healing timely and completely. Periwound dermatitis is accompanied by moisture in skin damage, along with pale or white skin that is wrinkled or "prune-like."




• Periwound Edema: This affects the peri-wound area due to swelling caused by excess fluid trapped within the body's tissues. This would slow or even stop the healing process, and may even cause additional wounds. Edema also compresses the small vessels by decreasing blood flow to parts of the body. You should immediately seek medical advice if you experience any of these symptoms:

  • Swelling or puffiness of the tissue directly under the skin, especially in the legs or arms

  • Stretched or shiny skin

  • Skin that retains a dimple after being pressed for several seconds

  • Increased abdominal size




• Hematomas: This is not a common post-surgery wound complication. Hematomas in the collection of blood, usually clotted, outside of a blood vessel that can spread into tissues. Hematomas cause infection as well as wound dehiscence, in which the wound opens up. Symptoms of a hematoma may include:

  • Headache or neurologic problems include weakness on one side, difficulty speaking, loss of balance, confusion, or seizures.

  • Back pain and weakness

  • Loss of bowel or bladder control

  • Nail pain, weakness, or loss

  • Abdominal pain




• Wound Dehiscence: Surgical staples, sutures, and adhesives can begin to gradually come apart or split completely open known as wound or incision dehiscence. This could be caused by poor suturing, too much stress to the wound area, weakened immune system due to medical conditions like diabetes and or infection.