Caring for surgical wounds

Types of wound healing
A surgical wound is a cut made to your skin during an operation. Usually, after your surgeon finishes your operation they’ll bring the cut edges together and secure them with stitches, staples or glue. This is called primary wound healing and is what we’re focusing on in this topic.

Sometimes however, your surgeon will decide it’s best to leave the wound open to heal up from below by itself. They may do this if your wound is infected, or if the edges couldn’t be brought together easily. This is called secondary wound healing. Examples might include a wound left after having a bite cleaned, or an abscess drained. If you have a wound of this type, your surgeon will tell you how to look after it.

How a wound heals
Wound healing is a complicated process but can be divided into several phases, which may overlap.

• Immediately after the cut, platelets in your blood form clumps and release chemicals to stop the bleeding.
• In the first few days, blood flow to your wound increases and white blood cells arrive to fight infection and remove dead tissue. New cells arrive to start repairing the wound.
• From three days to three weeks, new blood vessels grow to bring nutrients to your wound and new tissue starts to develop.
• Finally, from three weeks up to about a year, the new tissues laid down in the wound are gradually replaced and re-organised. Your scar gradually gets stronger, paler and more like normal skin.

Closing your wound surgically (with stitches, clips or staples) encourages your wound to heal faster.

The medical term for stitches is sutures. Other methods of closing a wound are also used. These include clips or staples and adhesive dressings, tapes or glue. The method your surgeon uses to close the cut will depend on its location, size and how strong the closure needs to be.

If you have stitches, you may see small pieces of the stitch material poking out of your wound. Don’t be tempted to pull on these. As your skin heals, it’s natural for your stitches and wound to itch – it’s part of the healing process. Try not to scratch the area. If the stitches cause you pain or discomfort, contact your GP or hospital for advice.

Some stitches are dissolvable so you won’t need to have them removed. Dissolvable stitches usually disappear in about 1 to 3 weeks, but it can take longer, depending on the type you have.

on-dissolvable stitches, clips and staples are usually removed by a nurse or doctor after 3 to 21 days. When they need to come out depends on where they are and the type of operation you had. If removal is necessary, your nurse will arrange a follow-up appointment at your hospital.

Not all surgical wounds need dressings. For those that do, the purpose of a dressing is to:

• provide the ideal conditions for healing
• absorb any leakage from your wound
• protect the area until the incision line is healed
• prevent stitches or clips catching on clothing
• Apply pressure, if this is needed

Depending on where your wound is on your body, you can leave your original dressing in place for up to seven days providing that it is dry and not soaked with blood or any other liquid. Your surgeon or nurse will tell you when you should remove it.

Before you remove the dressing, wash your hands with soap and water and then dry them. Remove the dressing carefully, trying not to touch the healing wound with your fingers. Dispose of the used dressing carefully in the bin.

Your wound may then be left without a dressing. However, you might prefer to continue wearing one over the area for protection, particularly if your clothes are going to rub against it. The hospital may give you a replacement dressing to use at home. Apply the dressing carefully following the diagram on the packaging if there is one. Avoid touching the inside of the dressing with your fingers. Don’t use antiseptic cream under the dressing. It’s best to keep your wound dry until it has sealed.

Your surgeon may use special skin glue to close your wound, especially if you have a small wound. One of the advantages of skin glue is that it brings the edges of your skin together very quickly. This helps to seal the wound and form a barrier that lowers the risk of infection.

Although the glue is waterproof, it will come off with repeated washing. You shouldn’t let your wound soak in water. The glue usually peels off by itself in 7 to 10 days so you don’t need to return to the hospital to have it removed. After about two weeks it should be OK to gently rub or massage your wound.

Your surgeon may put a temporary surgical drain in place during your operation. This is a thin plastic or rubber tube which drains blood and fluids from the site of your operation so that they don’t collect there. The fluids may drain into a bag or bottle, which can be emptied. The tube may be held in place by one or two stitches in your skin.

If you have a surgical drain, your nurse will check it regularly to see how much is draining. They’ll also check the area around the drain for signs of infection. Your surgeon or nurse will usually remove your drain when the amount of fluid drained becomes very small or stops altogether.

If the drain is still draining fluid but you’re otherwise well, you may be able to go home with your drain still in place. If so, your nurse will tell you exactly how to look after your drain. You may be given a hospital number you can call if you have concerns about your drain or if you get problems once you’re home.

When you’re at home, contact the hospital if:

• you have signs of infection (see our section on wound infection below)
• the drained fluid suddenly changes colour or smell
• the tube comes loose where it leaves your skin

Your surgeon or nurse will make sure you know what the plan is for removing the drain when it’s no longer needed.

It’s usually possible for you to have a bath or a shower twenty-four hours after the operation. Your nurse at the hospital will advise you if this is not the case following your particular operation.

General points to note:

• Showering is preferable to bathing – This is so that your wound doesn’t soak in water. This could soften the scar tissue and cause your wound to reopen. Only have a bath if you can keep your wound out of the water.
• Remove any dressing before bathing or showering – Unless your surgeon or nurse gives you different advice. Some dressings are waterproof and can be left in place.
• You can gently wash the area surrounding your wound with mild, neutral soap. Don’t use any soap, shower gel, body lotion, talcum powder or other bathing products directly over your wound.
• When showering, you can let the water gently splash onto your healing wound. However, do not rub the wound, as this may cause pain and could delay the healing process
• Always dry the wound thoroughly by patting it gently with a clean towel but allow your wound to air dry.

Ask your doctor or nurse about whether it’s OK to shower or bath, and how long you should keep your wound dry. Always follow their advice – they’ll know what’s best in your particular circumstances.

Your surgical wound stands the best chance of healing well if your body is as healthy as possible. There’s a lot you can do to help yourself.

If you smoke, try to give up before you have your surgery. Smoking reduces the amount of oxygen that gets to your tissues, which slows down wound healing. Ask your GP practice nurse for advice and support.

Your body needs energy and the right nutrients to heal quickly so it’s important that you eat well. Eating a healthy balanced diet should give you all the nutrients your wound needs to heal. And make sure that you drink enough water because if you’re dehydrated, your wound may take longer to heal. Taking supplements is not generally necessary for wound healing if you were in good health before surgery and you recover normally.

It’s useful to lose any excess weight, preferably before you have surgery. Being overweight can increase the time it takes for your wound to heal and increase the risk of wound infection.

If you have diabetes, it’s important to take care that your blood sugar is well controlled. This is because having high blood sugar can slow down the healing process.

Most surgical wounds heal fairly quickly without causing any problems, but it’s possible that your wound may become infected after surgery. You can ask your surgeon how likely it is that you’ll get an infection after your operation, and what to look out for.

If you develop an infection, you’ll usually be treated with a course of antibiotics. Very occasionally, you may need to have further surgery.

Your doctors and nurses will do everything they can to prevent your wound from becoming infected. But it’s important that you know how to spot if you’re developing an infection after you go home. If your wound becomes infected, it may:

• become more painful
• feel tender
• look red, inflamed or swollen
• leak or weep liquid, pus or blood
• smell unpleasant
• you may have a high temperature

A surgical wound infection can develop 2 to 3 days after your surgery, but may occur up to 2 to 3 weeks after your operation. If you have any of these symptoms or if you’re worried about the appearance of your wound, contact the ward or your GP surgery.

1. I have an abscess in my wound – what will happen?
An abscess is a collection of pus. Your body responds to infections by producing pus. If you get an infection in your surgical wound, although it’s uncommon, the pus formed may collect under your skin, forming an abscess. If you have an abscess, it’s likely to feel swollen and painful. You may also feel feverish. If you think you have an abscess, contact the ward or your GP surgery.

If you have a wound abscess, you’ll need treatment. If your abscess isn’t very big or deep, it may be possible to treat it with antibiotics. However, you may need to have it drained of pus and cleaned to remove damaged or infected tissue. Your doctor may give you antibiotics to take after your abscess has been drained, but this is usually only if the infection has spread.

If there was an infection already before your surgery, such as with acute diverticulitis or appendicitis, you may get a deeper abscess. If you have a deeper abscess, your surgeon may recommend further surgery to drain and clean it. Alternatively, you may have a CT or ultrasound scan so that a drain can be inserted through a thin tube using images to guide it.

2. I’ve heard I may develop cellulitis – what’s this?
Cellulitis is a spreading bacterial infection of the deep layers of your skin. Your skin has many bacteria living on it and these don’t usually cause problems. However, if your skin is damaged – such as when you have a surgical wound – these bacteria can enter your body. Your immune system fights these off, but sometimes that’s not enough and the bacteria grow and cause cellulitis.

If your wound becomes infected you may notice that it becomes red, inflamed or swollen. If you have cellulitis, you may notice the area of affected skin getting larger. You may also feel unwell, with a high temperature and chills or shivers.

If you have any of these symptoms, see your GP. If you have cellulitis, it’s important to start antibiotics early to stop the infection spreading. If your infection is severe, you may need to go into hospital for treatment.

The antibiotic used for cellulitis is usually a type of penicillin, so it’s important to tell your doctor if you’re allergic to penicillin.

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