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

Abstract

Aims and Objectives To explore surgeons’ and nurses’ perspectives of managing surgical wounds healing by secondary intention. Background 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. Design A qualitative, descriptive approach, using semi‐structured interviews. Methods 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. Results 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. Conclusions 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. Relevance for clinical practice Clinical decision‐making in wound care could be optimised through further robust studies to inform practitioners about the cost‐effectiveness of available treatments.

Patient decision‐making and regret in pilonidal sinus surgery: a mixed‐methods study

“…Treatments may be advocated without evidence of clinical or cost effectiveness [17] while inadequate preparation for postoperative wound care, uncontrolled pain and delayed wound healing affect patient well-being and activities of living [18,19].…”

A mapping review of sacrococcygeal pilonidal sinus disease

“…While PiTStOP will report healing, recurrence and re-intervention rates, stratified by severity of disease, a principal objective is to inform a large nominal group technique consensus exercise, currently scheduled for Jul 2021, on optimal management and research priorities. Published qualitative research already describes the lived experience of pilonidal sinus [ 41 , 42 ], the frequent disconnect between provision and the expectations of service-users [ 43 ], as well as the use of poorly evidenced interventions [ 6 ]. The PiTStOp programme of research will improve our understanding of the context of pilonidal sinus management through: large-scale surveys about shared decision-making [ 44 ] and decision regret [ 45 ]; a discrete choice experiment to assess which interventions patients would rather avoid and which outcomes they most value; semi-structured interviews aimed at understanding service-user decision-making and practical coping strategies.…”

“…Even where healing of the primary cause is achieved, there can be longer-term challenges related to wound healing [ 3 ]. The absence of a front-running intervention reliably associated with long-term healing, and concerns about research deficits [ 4 ] have led to widespread variation in practice [ 5 ] and concern that practice is not evidence based [ 6 ]. The rapidly proliferating scientific literature on pilonidal sinus is said to be poor and to comprise principally of single-centre case series and non-randomised comparative studies, leading to calls for more focused, better-quality research [ 4 ].…”

Design, preparation, and characterization of CS/PVA/SA hydrogels modified with mesoporous Ag2O/SiO2 and curcumin nanoparticles for green, biocompatible, and antibacterial biopolymer film

“…31 In general, small wounds require less healing time, and deeper wounds require more time and care to heal completely. 31,32 The process of complete healing or healing of a wound depends on many factors: the suitable wound dressings, the attention and care that is spent on the healing of the wound, and so on ref. 33 and 34. Among the new wound dressings, hydrogels, which are made of hydrophilic polymeric materials, can swell and can create a cold surface on the wound, which reduces the patient's pain.…”