Key Findings

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1. Categories of Surgical Wound Complications
   The working group identified the following as potential complications after surgical procedures:

   • Hypergranulation

   • Skin damage related to adhesives

   • Maceration (moisture-related skin damage)

   • Abnormal scar tissue formation

   • Surgical site infections

   • Wound dehiscence (wound reopening)

2. Skin Antisepsis in the Operating Room

   • The use of chlorhexidine or povidone-iodine for skin antisepsis is strongly recommended (high evidence).

3. Choice of Postoperative Dressing

   • There is no definitive evidence that any specific type of postoperative dressing significantly reduces the incidence of complications compared to others.

   • Dressings containing DACC (dialkylcarbamoyl chloride), such as Sorbact, have demonstrated significantly lower postoperative infection rates after cesarean sections and vascular surgeries.

   • Silver-containing dressings have not shown significant advantages in reducing postoperative complications.

   • Topical antibiotics are not recommended.

   • Negative pressure wound therapy (iNPWT) has shown a significant reduction in wound complications following certain types of surgical procedures. However, the consensus group calls for further studies before drawing definitive conclusions.

   • Postoperative dressings should ideally remain in place for 7 days and can be kept on for up to 14 days if wound exudate is minimal.

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Our Conclusion

Drawing definitive conclusions for all types of surgical procedures remains a challenge. Factors influencing wound healing vary significantly between procedures, such as hip surgeries and abdominal operations. For example, a notably higher incidence of complications is observed after groin surgeries. These challenges likely posed significant difficulties for the working group, as the heterogeneous patient population makes it challenging to offer generalized recommendations.

We found it somewhat surprising that the working group devoted time to analyzing advanced tools such as spectroscopy, thermography, or fluorescence imaging to predict surgical complications, given that these tools are unavailable to most practitioners.

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Additionally, we believe the document lacks an important discussion on the evidence surrounding different types of suture materials. Do absorbable skin sutures result in fewer infections than removable sutures? What about metallic staples—do they lead to more or fewer complications? A discussion on methods of skin closure would have been a valuable addition to the document.

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Nonetheless, the publication represents a commendable effort by the working group, and we congratulate them on this achievement. While it does not address all questions, it is an important contribution to improving our understanding of clinical practice in surgical wound management.