Clinical Update TEN TOP TIPS Preventing orthopaedic surgery-related wound blisters


Ten Top Tips... Preventing orthopaedic surgery-related wound blisters


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Author: Warren Gillibrand


uperficial wound blisters are an abnormal swelling


(i.e. filling with fluid) in the epidermal layer of the skin in response to trauma [FIGURE 1]. Blistering in postoperative wounds may be caused by skin stripping from removal of medical tape removal, or prolonged exposure of the skin


to adhesive contact layers of dressings and associated with the presence of sutures. Deeper dermal blisters are generally associated with burns or direct trauma and can take longer to heal than superficial blisters. Postsurgical blistering can cause pain, wound leakage, delay healing of the wound, and increase the risk of postoperative surgical site infection, which ultimately can result in prolonged and costly hospital stays.[1] The incidence of postoperative orthopaedic


wound blisters ranges from 6% to 24%, with blisters being second only to infection as a surgical incision-related adverse event following orthopaedic surgery. [2–4]


Studies,


mainly of evaluative or audit design, suggest a possible association between post-orthopaedic surgery blisters and the use of adhesive wound dressings[5]


and adhesive tapes,[6] particularly


following knee arthroplasty and hip surgery.[7] When blistering occurs, the patient may be at increased risk of longer term morbidity and mortality, reduced quality of life,[8] subsequently increase the cost burden.[4]


and Postoperative nursing teams – and nurses


in primary care – are integral in preventing postoperative wound blistering. Given the range of wound dressings, and the lack of a standardised approach, it is important nurses implement strategies to prevent wound blisters developing, including careful patient assessment, and selection of the most appropriate dressing for each individual postoperative orthopaedic patient.[4,5] Drawing on current research-based evidence and expert consensus opinion,[1,4]


the


following ten top tips outlines strategies for the prevention of orthopaedic surgery-related wound blisters.


1


PATIENT ASSESSMENT PRIOR TO SURGERY:


THE FIRST STEP IN PREVENTION


A thorough patient assessment, taking into account age and type of surgery planned is important. The clinician should take and document a detailed medical and social history. Any pre-existing conditions or environmental issues that may adversely affect wound healing and skin integrity should be investigated. Patient assessment should encompass the


condition of the skin. Attention should be paid to the periwound area; friability, previous skin damage or trauma, fragility, loss of elasticity, and dehydration place the patient at increased risk of blistering.[9] The clinician should also be alert to certain drug therapies and drug combinations that increase the risk of wound blister development (e.g. steroids, non-steroidal anti-inflammatory drugs, antineoplastic chemotherapy).[10]


Author details


Warren Gillibrand is Senior Lecturer in Adult Nursing, University of Huddersfield, Huddersfield, UK.


Figure 1. An example of surgery-related wound blisters. [Image courtesy of Melissa Rochon, Carlos Morais, Feriel Mahiout. First published in Wounds UK 2014 (10:1).


16 2


PREOPERATIVE PREPARATION: THE SKIN MUST BE READIED


FOR SURGERY AND HEALING, AND PROTECTED DURING SURGERY


Hygiene and skin integrity must be maintained. It is important that the skin is clean, and that during the preoperative hygiene preparation


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com


Ten Top Tips


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