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


used.[5,9]


The dressing should allow a small


degree of evaporation while retaining a moist wound healing environment, yet be resistant to the entry of pathogens. The dressing should be able to allow for swelling of the wound and surrounding skin as the inflammatory stage of wound healing progresses, without affecting the permeability, conformity, or adhesion.


8


MINIMISE DRESSING CHANGES TO PREVENT BLISTERING


Studies into prevention of wound blistering show that the less frequently the dressing is changed, the lower the risk of blistering.[7]


For


this reason, the wound dressing chosen for use postoperatively should have as long as possible in situ duration. Unless changing is required due to signs of excessive exudate and possible infection, keeping dressings in place should be favoured, however this will be determined on an individual patient basis, and as per local guidelines, which could be, for example, 24 hours or until the dressing begins to come away from the wound.[2]


9


WHEN POSSIBLE, THE DRESSING SELECTED SHOULD ALLOW THE


WOUND TO BE VISUALISED WITHOUT ITS REMOVAL


Postoperative wound inspection and evaluation is a mainstay of good wound care. The ability to inspect a wound without removing the dressing will aid in reducing the risk of wound blister formation by reducing the number of episodes of dressing removal / application, however the other required properties of the dressing should not be compromised. Examples of dressings that allow visulaisation of the wound are OPSITE™ Post- Op (Smith & Nephew), OPSITE™ FLEXIGRID™ (Smith & Nephew), Tegaderm™ (3M), Mepore® Film (Mölnlycke Health Care).[2]


10


SEEK EXPERT HELP WHEN NEEDED


The tissue viability team and nurse specialists are expert in providing support and guidance in complex wound care situations. These experts should be consulted when: the choice of dressing is not clear for a particular patient with a complex wound or needs; the wound is showing signs of infection; wound blistering has occurred and needs treatment; or closer liaison with primary care services is


required. Early signs of blistering include: pain in the periwound area; soft tissue swelling surrounding the wound; or redness. The tissue viability team are a useful resource


for policy, guidelines, training, education and knowledge of latest research and products, and can provide regular updates to all key staff.


CONCLUSION Patient assessment preoperatively is extremely important, and of equal importance is the choice of dressing for a moving, orthopaedic surgical wound. Ideally, the dressings chosen in these circumstances should be thin, flexible, self-adherent without skin pulling, friction- reduced, absorbent, foam-filled, transparent, of soft-silicone manufacture, and anti-microbial. The patient care plan and dressing selected must be communicated to all key healthcare professionals providing care to the patient in question prior to surgery, and acted on by the pre-, peri- and post-operative surgical teams. Much of the responsibility for reducing wound blister risk rests with the nursing team in acute and primary care settings, and excellent communication between and within these teams is needed. Orthopaedic surgery-related wound blisters can be prevented, thereby reducing the budgetary burdens associated with adverse wound-related events and improving patient outcomes. n


AUTHOR DETAILS Dr Warren Gillibrand is a Senior Lecturer, Division of Podiatry and Clinical Science, University of Huddersfield, Huddersfield, UK.


REFERENCES 1. Ousey K et al (2013) Int Wound J 10(2): 177–84


2. Polatsch DB et al (2004) Am J Orthop (Belle Mead NJ) 33(9): 452–6


3. Cosker T et al (2005) J Wound Care 14(1): 27–9 4. Jester R et al (2000) J Orthop Nurs 4(2): 71–7 5. Clarke JV et al (2009) J Wound Care 18(1): 5–11 6. Blaylock B (1995) Orthop Nurs 14(3): 25–8 7. Tustanowski J (2009) J Wound Care 18(11): 449–54 8. Ousey K et al (2013) Int Wound J [Epub ahead of print] 9. Bhattacharyya M et al (2005) Wounds UK 1(1): 30–4 10. Stadelmann WK (1998) Am J Surg 176(2A Suppl): 39S–47S


11. NICE (2006) Surgical Site Infection. Available at: http://www. nice.org.uk/CG74 [accessed 07.04.2014]


12. Burton F (2006) Wound Essentials 1(1): 98–107


13. NICE (2010) Venous Thromboembolism – Reducing The Risk. Available at: http://www.nice.org.uk/CG92 [accessed 07.04.2014]


14. Santamaria N et al (2013) Int Wound J [Epub ahead of print] Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com 19


“The less frequently the dressing is changed, the lower the risk of blistering. For this reason, the wound dressing chosen for use postoperatively should have as long as possible in situ duration.”


Ten Top Tips


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