Nurses' and surgeons' views and experiences of surgical wounds healing by secondary intention: A qualitative study.

Dorothy Mccaughan,Jo Dumville,Ian Chetter,Laura Sheard,Nicky Cullum

doi:10.1111/jocn.15279

Abstract

To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention. Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as "healing by secondary intention." These wounds are often slow to heal, prone to infection and complex to manage. A qualitative, descriptive approach, using semi-structured interviews. Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of "Framework" approach. Consolidated criteria for reporting qualitative research guided the study report. Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. Clinical decision-making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments.

Highlights

Every year, more than 10 million surgical operations are performed in the National Health Service (NHS) in the United Kingdom (UK) (NHS Consideration, http://www.nhsconfed.org/resources/key-statistics -on-the-nhs)
Data concerning the epidemiology of surgical wounds healing by secondary intention have largely been absent, both for the UK and globally
The main types of open surgical wounds managed by surgeons and nurses were open abdominal cavity wounds; wounds relating to treatment for pilonidal sinus; large, open wounds on the feet of patients with diabetes; and axilla and groin wounds

Summary

Introduction

More than 10 million surgical operations are performed in the National Health Service (NHS) in the United Kingdom (UK) (NHS Consideration, http://www.nhsconfed.org/resources/key-statistics -on-the-nhs). Open surgical wounds can be challenging to manage, as they are often large, deep, prone to infection and produce copious amounts of exudate (Dumville, Owens, Crosbie, Peinemann, & Liu, 2015), yet a strong evidence base to guide the management of these wounds is currently lacking (Dumville et al, 2015; National Institute for Health and Clinical Excellence (NICE), 2008). They are often managed with a variety of dressings, requiring patients to undergo frequent dressing changes, and, sometimes, painful packing of the wound. Open surgical wounds may be treated by further surgical intervention, such as debridement and skin grafting, which may require patients to be hospitalised, with implications for quality of life (Sandy-Hodgetts et al, 2013; Smith, Dryburgh, Donaldson, & Mitchell, 2013)

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