Latrogenic Wounds

Latrogenic Wounds

Latrogenic wounds are wounds caused unintentionally by medical or surgical treatment. The term “iatrogenic” means “caused by a physician” or healthcare intervention. These wounds are not the result of a disease or accident but rather a complication from a diagnostic procedure, surgery, or medical treatment. They may result from poor wound closure, infections, adverse drug reactions, or prolonged use of certain therapies like chemotherapy.

Surgical Wound Dehiscence

What is Surgical Wound Dehiscence?

Surgical wound dehiscence is the partial or complete reopening of a wound that was previously closed after a surgical procedure. It typically occurs within the first few days after surgery but can happen later as well.

How Does the Wound Happen?

This condition can arise when the wound edges fail to heal and rejoin properly. Common reasons include excessive tension on the incision site, infection, poor suturing techniques, obesity, malnutrition, or chronic diseases like diabetes that impair the healing process. Coughing, straining, or sudden movements can also put stress on the wound, leading to its reopening.

What Happens If Not Treated?

• Increased risk of infection: Once a surgical wound reopens, it becomes more vulnerable to bacterial contamination, potentially leading to local or deep infections.
• Delayed healing process: The healing timeline is significantly extended, often requiring secondary closure or reconstructive procedures.
• Development of incisional hernias: If deeper layers separate, abdominal contents may protrude through the weakened area, resulting in an incisional hernia.
• Pain and discomfort: An open or partially open wound can cause pain, sensitivity, and reduced mobility, especially if located near joints or muscle-heavy areas.
• Need for further surgical intervention: Severe or deep dehiscence may require surgical revision, flap closure, or mesh repair, increasing both medical costs and recovery time.
• Compromised surgical outcomes: The intended benefits of the original surgery may be reduced if the wound fails to heal correctly, leading to poor cosmetic or functional results.

Wounds from Chemotherapy or Biologic Treatments

What are Wounds from Chemotherapy?

Some drugs used in chemotherapy, immunotherapy, or other biologic treatments can interfere with the body’s natural healing mechanisms, leading to wounds or ulcerations. These are considered iatrogenic because they result directly from medical treatment, even though the medication is necessary for managing a serious disease like cancer.

How Does the Wound Happen?

Chemotherapy and biologic agents target rapidly dividing cells, which include not only cancer cells but also healthy skin and tissue cells involved in repair and regeneration. As a result, the skin becomes more fragile, slower to heal, and prone to breakdown. Common manifestations include skin thinning, delayed healing after minor trauma, oral or gastrointestinal ulcers, or open skin lesions, particularly in pressure-prone or friction-exposed areas.

What Happens If Not Treated?

• Progression to chronic wounds: These drug-induced wounds may persist for weeks or months without proper care, becoming difficult to manage and resistant to standard dressings.
• Secondary infections: Damaged skin acts as an entry point for bacteria or fungi, especially in patients with weakened immune systems, increasing the risk of local or systemic infections.
• Interruption of cancer treatment: Severe skin reactions or open wounds may force a pause or reduction in the cancer therapy dosage, potentially affecting the overall treatment outcome.
• Increased pain and inflammation: These wounds can be painful and may cause swelling, redness, and discomfort, significantly affecting quality of life.
• Psychosocial impact: Visible wounds or skin damage may cause emotional distress, anxiety, or body image issues in already vulnerable patients.
• Greater need for specialized care: Management often requires involvement from wound care specialists, dermatologists, or palliative care teams, increasing the complexity and cost of care.