ОПТИМИЗАЦИЯ УХОДА ЗА ХИРУРГИЧЕСКОЙ РАНОЙ ПОСЛЕ УРЕТРОПЛАСТИКИ У ДЕТЕЙ С ГИПОСПАДИЕЙ

The intricacies of meticulous wound healing or Vrana Ropana has been comprehensively reviewed and diligent attempts have been made at understanding the mechanisms involved in optimal wound healing via the comprehensive explanations of both Ayurveda and contemporary literature to achieve a much sought after integration of post-surgical wound care. Post-operative wound care protocols are regularly and rigorously updated as the burdens of post-surgical wound complications are on the rise. A thorough understanding of surgical wounds, stages of wound healing and optimal wound care along with identifying red flags indicating susceptibility to complications. Classic Ayurveda documents describe specialised wound care strategies associated with the use of surgical instruments as well as para-surgical therapy related to therapeutic cautery, caustic cauterization as well as wounds caused by leeches in blood-letting therapies. This presents an opportunity for the integration of those strategies with conventional knowledge in present-day surgical care which could potentially increase the efficacy and precision of wound care by minimising post-operative complications. Databases like PubMed and Scopus were searched using keywords including Sadyo Vrana, Vrana Ropana, Sastra Karma, post-operative wound care, post-surgical care and Ayurvedic methods for preventing surgical site infections. Comparison of types of wounds, mechanisms of healing and post-operative care according to evidence-based Ayurveda principles with relevant contemporary literature potentially increase understanding of what is required for a holistically integrated care plan which can help achieve uneventful post-operative surgical wound healing. To that end, it is necessary both to understand the conventional care of surgical wounds and to compare that with the existing care of post-surgical wounds as well as to identify new scopes of care including highlighting areas of bridging integrative approaches to reduce post-operative complications and to attain optimum wound healing. KEYWORDS Vrana, post-operative wound healing, Sastra Karma

Background: Postoperative wound healing has been a problem which causes high mortality in the developing world; postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing; however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.

Anal fistula is one of the common infectious diseases in anus and intestines, but also a chronic disease, recurrent episodes, can not be self-healing, at present, surgery is the most effective way to cure anal fistula. However, due to postoperative wound infection, surgical damage to the anorectal peripheral tissues, the patient’s physical weakness and other factors, resulting in patients prone to postoperative anal fistula wound healing slow problem, which affects the quality of the surgery, but also in turn damage to the family economy and the patient’s physical and mental health. Therefore, how to accelerate postoperative wound healing is one of the problems that anorectal surgeons need to solve. At present, there are a large number of domestic studies show simmering pus and long meat method to make the postoperative healing effect of anal fistula has significantly improved. Chang’an Niu’s academic school of anorectal disease originated in Xianyang, Shaanxi Province, which focuses on the study of Chinese medicine diagnosis and treatment of anal and intestinal diseases, and the use of traditional Chinese medicine in clinical practice, the clinical results show that the healing effect of postoperative anal fistula is excellent. The article will describe the experience of Chang’an Niu’s School of Anorectal Disease in promoting postoperative healing of anal fistula through the theory of ‘simmering pus and growing flesh’, which will provide a new idea and a new way for postoperative clinical treatment of anal fistula.

The gut microbiota, made up of trillions of microorganisms that inhabit the gastrointestinal tract, plays a fundamental role in human health, influencing immunological and metabolic processes and even wound healing. Recently, studies have shown that the gut microbiota can also significantly impact post-operative recovery. This emerging field of research is revealing new insights into how the composition and function of the microbiota can affect the recovery of patients after surgery and the effectiveness of wound healing. Understanding these interactions paves the way for the development of innovative therapies that can improve surgical outcomes and promote faster and more efficient recovery. This review seeks to explore the new insights into the impact of gut microbiota on postoperative recovery and wound healing, highlighting the emerging therapies and scientific advances that are shaping this field. By investigating the current literature and evaluating recent clinical studies, we aim to provide a comprehensive overview of the interactions between the microbiota and healing processes, as well as discussing the therapeutic implications of these findings for clinical practice. This literature review aims to investigate the relationship between the gut microbiota and various aspects of health and disease, using a selected set of landmark studies. To this end, high-impact publications were selected that address topics related to the gut microbiota, its functions, benefits and implications for human health. Post-operative recovery and wound healing are complex processes that involve a series of biological responses, including inflammation, tissue remodeling and cell regeneration. The gut microbiota influences these processes in a number of ways, starting with the modulation of the immune system. Studies have shown that a healthy microbiota can promote a balanced inflammatory response, which is crucial for proper wound healing and surgical recovery. Imbalances in the microbiota, known as dysbiosis, can lead to exacerbated or insufficient inflammatory responses, impairing healing and increasing the risk of post-operative complications. The two-way communication between the gut and other organs, known as the gut-organ axis, is fundamental to understanding how the gut microbiota can influence post-operative recovery. Metabolites produced by the microbiota, such as short-chain fatty acids (SCFA), have anti-inflammatory and immunomodulatory effects that can favor wound healing. In addition, the intestinal microbiota can influence the integrity of the intestinal barrier, preventing bacterial translocation and consequent systemic infection, a common complication after surgery. Based on these insights, several emerging therapies are being developed to modulate the gut microbiota and improve post-operative outcomes. One of the promising approaches is the use of probiotics and prebiotics. Probiotics are live microorganisms that, when administered in adequate amounts, confer health benefits on the host, while prebiotics are substrates that promote the growth and activity of beneficial bacteria in the gut. Clinical studies have shown that supplementation with specific probiotics can reduce the incidence of post-operative infections and improve wound healing. Another innovative approach is fecal microbiota transplantation (FMT), which involves transferring microbiota from a healthy donor to a patient with dysbiosis. FMT has shown promising results in restoring the intestinal microbiota and improving post-operative outcomes in patients undergoing major surgery. In addition, diet and nutrition play a crucial role in modulating the microbiota. Diets rich in fiber and bioactive compounds, such as polyphenols, can promote a healthy microbiota and consequently improve postoperative recovery and wound healing. It is concluded that the impact of gut microbiota on postoperative recovery and wound healing is a rapidly evolving field of research with significant potential to transform clinical practices. New insights are revealing how the microbiota influences inflammatory and immunological processes essential for surgical recovery. Emerging therapies, such as probiotics, prebiotics and fecal microbiota transplantation, are showing promising results in improving postoperative outcomes. Modulation of the gut microbiota represents an innovative and effective approach to optimizing patient recovery and promoting faster and more efficient healing. With further research and the integration of this knowledge into clinical practice, it is hoped that microbiota intestinal becomes a key component in post-operative management and wound care, significantly improving patients’ quality of life.

Wound care practices after orthopaedic trauma surgery are highly variable and not evidence based

Post-operative Wound Care Protocol Prevents Surgical Site Infection After Craniotomy

To explore the role of nutritional support in nursing practice on postoperative surgical site wound healing in patients undergoing surgery at risk for pressure ulcers. This study adopted a retrospective experimental design and included a total of 60 patients at risk of pressure ulcers, divided into a nutritional support group and a control group, with 30 people in each group. The nutritional support group implemented specific nutritional support measures after surgery, while the control group received standard postoperative care. Outcome measures included redness and swelling scores, edema scores, anxiety assessments, pain scores, bleeding volume, recovery time and incidence of pressure ulcers. The result indicates that patients who received nutritional support exhibited lower postoperative wound redness and swelling scores compared to the control group (3.11 ± 0.45 vs. 4.85 ± 0.74, p < 0.05). Additionally, the nutritional support group showed significantly lower edema scores (2.75 ± 0.37 vs. 3.53 ± 0.62, p < 0.05). Anxiety levels, as measured by the anxiety assessment scale (SAS), were also lower in the nutritional support group (6.52 ± 1.19 vs. 7.60 ± 1.62, p < 0.05). Moreover, the average healing time was shorter for the nutritional support group (7.27 ± 1.36 days) compared to the control group (9.71 ± 1.84 days, p < 0.05). Postoperative pain scores were lower in the nutritional support group (4.13 ± 0.72 vs. 5.43 ± 0.62, p < 0.05), and patient satisfaction scores were higher (9.42 ± 0.76 vs. 7.25 ± 0.81, p < 0.05). Nutritional support has a positive effect on postoperative wound healing at surgical sites in patients at risk of pressure ulcers in nursing practice. It can significantly reduce redness, swelling, edema, anxiety, and pain scores, reduce bleeding, shorten recovery time, and reduce pressure ulcers. incidence rate.

Background and AimPostoperative wound care is irrigating the surgical wound with normal saline solution and applying sterile gauze or bandage. Even though challenges related to postoperative wound care and its complications are high, information related to the knowledge and practice of nurses on postoperative wound care are minimal. Therefore, this study aimed to find levels of knowledge and practices of nurses on postoperative wound care management and contributing factors among nurses working at public hospitals of West Showa, Oromia region, Ethiopia, 2020.MethodA facility‐based cross‐sectional study was conducted among 465 Nurses working in public hospitals in West Showa Zone, Oromia, Ethiopia, from June 15 to July 10, 2020. Data were collected using a self‐administered structured questionnaire that was adapted from previous studies. Descriptive statistics were performed and results were presented using tables and graphs. Bivariate and multivariable logistic regression analysis was undertaken, and variables with p < 0.05 at a 95% confidence interval (CI) were considered statistically significant.ResultOnly 44.3% (95% CI = 39.5%, 48.9%) and 48.0% (95% CI = 43.4%, 52.4%) of nurses have good knowledge and practice in postoperative wound care, respectively. Male nurses (adjusted odds ratio [AOR] = 1.90 (1.25–2.89), working in gynecology ward (AOR = 0.42 [0.18–0.95]), experience of ≥2 years in surgical units (AOR = 2.97 [1.10–8.02]), working in secondary hospital (AOR = 1.94 [1.16–3.26]), and working in tertiary hospital (AOR = 3.31 [1.81–6.08]) were significantly associated with the knowledge of nurses. An adequate supply of personal protective equipment (AOR = 3.38 [1.29–8.84]), using infection prevention guidelines (AOR = 5.03 [2.16–11.7]) and the presence of an adequate wound care materials (AOR = 3.67 [1.71–7.88]) were significantly associated with the practice of nurses.ConclusionLess than half of nurses had good knowledge and practice in postoperative wound care and several factors contribute to its improvement. Upgrading the nurse's knowledge and practice towards postoperative wound care is essential in preventing postoperative wound infection.

There is limited evidence to suggest patients with epidermolysis bullosa (EB) have more postoperative wound complications than the general population. Despite this, the authors have noted reluctance among some surgeons to operate on these patients. A cross-sectional study was designed to investigate postoperative wound and scar healing outcomes in patients with EB. Patients were asked to complete the "Surgical Wound and Scar Healing in EB" questionnaire, and data gathered were analyzed. Forty-six patients completed the questionnaire for a total of 94 different surgical procedures. Five patients reported blistering at the surgical wound site. All 5 had generalized forms of EB. Four patients reported wound infections, and 1 patient reported wound dehiscence. The postoperative scar healed with keloid or hypertrophic scarring after 26% of the reported surgical procedures. Blistering at the postoperative site seems to be uncommon and particularly unlikely to occur in localized forms of EB. Postoperative wound infections and dehiscence are uncommon. Patients with EB may have a propensity to develop keloid or hypertrophic scarring. With these data, the authors hope clinicians have greater confidence in referring patients with EB for surgery, and surgeons more reassured about postoperative wound healing.

Introduction: Post-operative wound infection is a serious complication that can hinder the healing process. The patient's family's knowledge about post-operative wound infections can play an important role in supporting the healing process. This study aims to analyze the relationship between the patient's family's knowledge about infections in post-operative wounds and the process of wound healing in post-operative patients at dr. Soekardjo Regional General Hospital Tasikmalaya.&#x0D; Methods: This research used a cross-sectional design with a total of 52 respondents selected by purposive sampling. Data was collected using a questionnaire to measure the patient's family's knowledge about post-operative wound infections and observation sheets to assess the wound healing process. Data analysis was carried out using the Chi-square test.&#x0D; Results: The majority of respondents were 32 years or older. Respondents' education was dominated by secondary level. The majority of respondents have incomes greater than or equal to the UMR. The majority of respondents had sufficient knowledge about post-operative wound infections, but there were still 17.31% of respondents who had insufficient knowledge. The results of the study showed that there was a significant relationship between the patient's family's knowledge about post-operative wound infections and the wound healing process (p-value &lt; 0.05).&#x0D; Conclusion: The patient's family's knowledge about post-operative wound infections can support the patient's post-operative wound healing process.

Ankle fractures are among the most common fractures in older adult patients that need surgical treatment. The risk of surgical site infections (SSIs) after ankle fracture surgery ranges between 0.5% and 30%; SSI incidence is higher among older adults. Further, SSIs have significant consequences for subjective functional outcomes and create a need for prolonged intravenous antibiotic therapy and wound care. Accordingly, it is critical to determine risk factors for and establish optimal postoperative wound care to prevent SSIs. The aim of the pilot study was to examine the feasibility of closed-incision vacuum therapy (CIVT) to reduce rates of SSI in older adults. The authors performed a pilot study of a CIVT system in a population of 10 older adult patients after ankle fracture surgery. Nine patients experienced uncomplicated wound healing of the lateral incision. One patient (10%) developed an SSI after premature removal of the vacuum system because of technical failure. Six weeks postoperation, overall satisfaction with the CIVT was high; none of the participants complained of incapacitating discomfort or disruptive limitations in postsurgical recovery. The authors conclude that CIVT is a feasible, safe, and generally well-tolerated therapy to prevent SSIs in postoperative wound healing after open reduction and internal fixation in older adult patients after ankle fracture.

This study aimed to assess the impact of varying monopolar diathermy power settings on postoperative pain, hemorrhage, and wound healing following tonsillectomy. A single-center, prospective, randomized, double-blinded, controlled clinical study was conducted. During bilateral tonsillectomy procedures, one tonsil received low-power settings (15 W, cutting/blend) while the other tonsil received high-power settings (35 W, cutting/blend). Postoperative pain scores (0–10) and wound healing scores (0–3) were evaluated immediately after surgery and at 1, 2, and 4 weeks postoperatively using the visual analog scale. Additionally, histological analysis was performed on electrically resected tonsil tissues to assess tissue damage in the tonsil bed. The allocation of high and low power settings to each side was randomized. Results showed that 1 week after the surgery, the high-power group experienced significantly higher pain scores (mean ± standard deviation: 4.84 ± 2.21) compared to the low-power group (3.56 ± 2.24, p = 0.049). Moreover, the high-power side exhibited slower wound healing during the initial 1–2 weeks postoperatively, as indicated by lower wound scores at 2 weeks (high-power: 1.96 ± 0.64; low-power: 2.43 ± 0.59, p = 0.008). Furthermore, histological analysis revealed significantly deeper tissue degradation on the high-power side compared to the low-power side (p < 0.001), with mean depths of 565.2 ± 291.0 µm and 156.0 ± 36.8 µm, respectively. In conclusion, these findings suggest that when employing monopolar diathermy in tonsillectomy, lower power settings can lead to improved outcomes in terms of postoperative pain, wound healing, and tissue damage.Trial registration: CRIS identifier: KCT0005670 (cris.nih.go.kr, registration date: 11/12/2020).

Neurosurgery is characterized by high complexity and risk, with postoperative wound healing being a critical factor in surgical success. Wound healing encompasses not only local tissue repair processes but is also influenced by systemic nutritional status. Consequently, both preoperative and postoperative nutritional assessment and support are essential for enhancing recovery and minimizing complications. Malnutrition or overnutrition can negatively impact postoperative wound healing. By utilizing appropriate nutritional scoring tools, healthcare providers can identify potential nutritional risks following surgery and implement corresponding interventions to optimize the recovery process and decrease the likelihood of complications. This review aims to investigate the application and correlation of various nutritional scores in relation to wound healing after neurosurgery. Through a comprehensive review and analysis, the impact of these scores on postoperative wound healing will be evaluated, providing a scientific foundation for clinical practice. The study on postoperative wound healing in neurosurgery is included, and the relationship between different nutritional scores is thoroughly assessed through review analysis to predict their effects on postoperative healing. Future research should further examine the effectiveness of different nutritional scoring tools in specific neurosurgical contexts and integrate individualized nutrition support strategies to offer patients more precise postoperative care plans.

Postoperative wound care after craniotomy is not standardized. Evaluate the impact of a standardized post-craniotomy wound care protocol on surgical site infection (SSI). Prospective quasi-experimental single-center intervention cohort study involving adult patients undergoing craniotomy at a 461-bed academic medical center in Orange County, California from January 2019-March 2023 (intervention) compared to January 2017-December 2018 (baseline). A postoperative neurosurgical wound care protocol was developed involving chlorhexidine cloths to remove incisional clots and to clean the surgical incision and adjacent hair after craniotomy surgery. Protocol adherence was monitored by routine inpatient surveillance of wounds and photo-documentation for real-time feedback to surgeons and nursing staff. Impact of the intervention was assessed using multivariable regression models. There were 3560 craniotomy surgeries and 62 (1.7%) SSIs; 1251 surgeries and 30 (2.4%) SSIs during baseline, and 2309 surgeries and 32 (1.4%) SSIs during intervention. Process evaluation after implementation found significant decreases in incisional clots, erythema, drainage, and unclean hair. In multivariable analysis, the intervention was associated with fewer SSI (odds ratio (OR): 0.5 (0.3, 0.9), P = 0.02). A standardized post-craniotomy wound care protocol involving cleaning of the incision and adjacent hair, including removal of incisional clots with chlorhexidine cloths was effective in reducing the risk of SSI.

Objective: It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia. Method: A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education. Results: In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (β=–0.776, p=0.013); hospital site (β=–0.702, p=0.025); and number of postoperative days (β=–0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6–10.3% of variance in the postoperative wound care education patients received. Conclusion: Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed.