Necrosis - Prevent This Postoperative Complication!

This week I am going to discuss a postoperative complication that we see in our surgical patients that can be directly related to poor suture technique and poor closure design, NECROSIS.

What is Necrosis -

Necrosis arises postoperatively from tissue ischemia from decreased vascular perfusion. 

If venous insufficiency develops, it appears as dark purple and bleeds readily when pricked.  Eventually developing into a black, dense eschar.

If arterial insufficiency is present, it can also be seen intraoperatively.  Originally appearing dusky, pale and cool to touch.

If you see this postop complication occur, determine the cause.

Determine Cause -

Questions to ask yourself as a dermatology provider performing this skill are -

  • Was this the right repair for the patient? 
  • Should I have considered a flap, graft, or even second intention healing?
  • Did I consider skin laxity, leaving enough room for the sutures to breathe, understanding there will be postop edema?  
  • Was I mindful on my suture technique considering how to maximize blood flow?  
  • Did I overstrangulate my epidermal sutures?  

Aside from poor suture technique and design, other risk factors to consider that could have caused necrosis include -

  • History of current smoker
  • Alcohol consumer
  • Postoperative bleeding
  • Anticoagulant use
  • Wound infection

Treatment -

If this postoperative complication does occur, keep the wound moist and occluded once necrotic tissue is sloughed off. If eschar is present, sterile debridement should be considered to facilitate tissue granulation.  Patients can then heal by second intention followed up with meticulous wound care management.  If the patient is a surgical candidate, surgical intervention and reclosure should also be considered.

Prevention -

Now that you have an understanding on how necrosis develops, here are some tips on how to prevent it from happening to your patient.

  • Perform mindful, meticulous surgical technique
  • Handle tissue delicately
  • Alleviate tension on the wound by undermining as necessary
  • Do not overtighten sutures
  • Use plication sutures 
  • Educate your patient to decrease smoking (nicotine causes vasoconstriction)

Remember, your suture technique can be the one thing that can optimize how your patient heals.  Don’t forget to leave the right amount of room between suture and skin, anticipating postoperative edema.  Allow the wound to breathe!

Master Your Skills -

If you found this topic helpful, I dive more into this topic in my advanced suturing course.

I share patient case studies to help you better understand how to master correct suture technique to prevent these postop complications from occurring.  

How to avoid other postop complications like scarring, suture reaction, and dehiscence are also discussed.

There's nothing worse than having a patient heal poorly and it was something you could have prevented.

Sign up HERE to be on the waitlist for the course and to get updates once enrollment comes closer!

Hope you found this helpful,

Theresa Talens DNP, FNP-C

P.U.L.S.E. Dermatology & Procedures, Inc.

Where we believe in Precision. Ultimate Care. Leverage. Skills. Excellence.