Evaluation of patient-led post-operative wound self-care following foot surgery

K. Dash, V. Gupt, A. Hopkins, K. Shah

Introduction: In line with the Scottish government's healthcare vision 2020 with a focus on supported self-management, our study was focussed on post-operative wound care at around two weeks after elective forefoot surgery. This normally involves a change of dressing at the health centre or a home visit by a district nurse. We wanted to offer patients the option of changing their own dressings at home in straight-forward forefoot surgery (bunion, MTP fusion) and avoid additional healthcare appointments.

Methods: We recruited 50 patients prospectively between February-June 2017. Each patient who consented to take part in the study was educated by the involved clinician in the aspects of wound-care, with written instructions and a helpline number. Subcuticular dissolvable stitches were used in all patients. Each patient was followed-up by a senior nurse to capture all adverse events as well as to record patient-satisfaction with a simple yes/no option.

Results: 46/50 patients were followed-at an average 18 days after surgery, with no adverse events in 38/46 (83%). Of the 8 patients with adverse events, 3 patients required renewal of a soaked dressing before the scheduled two weeks, 4 patients called the practice/district nurse for reassurance after changing their own dressing, 1 patient had a minor wound dehiscence but no intervention was required. 40/46 (87%) patients were satisfied with their own wound care, and found it convenient and said they would do it again.

Conclusion: Our results show that by focussing on patient-education and using subcuticular stithes in straight-forward forefoot surgery, it is possible to allow patients to change their own dressings at home without any increased risk of adverse events. Majority of patients in the study were satisfied with the process and found it very convenient. This obviously saves routine healthcare appointments in the community/hospital depending on the practice of individual surgeons.