Wound Care - treatment, infection and complications

Wound Care - treatment, infection and complications

Wound Care - The care necessary, including cleansing and dressing changes, to keep surgical incisions, or wounds, healthy as they heal. Most surgical wounds heal quickly and without complication and require very little care beyond keeping them clean and dry for one to five days after surgery. Redness at the incision line is normal, though the surgeon should evaluate any redness that extends farther than one half inch from the incision because this may indicate INFECTION. Sometimes there is bruising (ECCHYMOSIS) around the incision site, which typically heals in about a week.

By the fifth postoperative day the edges of the wound should be adhered to each other, with or without an obvious scab. Most scabs fall off 10 to 14 days after surgery, which indicates the incision is fully closed and about 85 percent healed. Factors that influence HEALING include DIABETES, cigarette smoking, and OBESITY.

Full healing is complete in three months. The SCAR may at first appear reddened and raised, though after about six months most scars are flush with the SKIN’s surface and are pink or white. A scar generally continues to fade over time and remains lighter in color than the surrounding skin. Incisional scars are more sensitive than the surrounding skin to sun exposure and should be protected with SPF (sun protective factor) 30 sunscreen or clothing to prevent SUNBURN.

Skin Closures

A surgeon closes a surgical wound from the inside out, typically using fine sutures (threads that sew the tissue edges together) to bring together the layers of MUSCLE, FASCIA, and subcutaneous fat. These sutures, commonly called stitches, dissolve over 5 to 7 days as the tissues heal. The surgeon may use sutures, staples (small wires that pull together the edges of the skin), glue, or adhesive strips to close the final layer of the skin. The method of closure depends on the incision’s location and length, the tension on the skin edges, and the surgeon’s preference. The surgeon may use a combination of closure methods for large or abdominal incisions. The surgeon must remove staples and nondissolving sutures, typically 3 to 10 days after the OPERATION, though often recommends leaving the adhesive strips in place until they fall off on their own, usually in about 5 days. Staple or suture removal is quick and usually does not hurt, though some people find the minor pulling and tugging sensations uncomfortable or disconcerting.

Dressings and Dressing Changes

At the end of the operation the surgeon will place a surgical dressing over the incision site. The dressing is typically absorbent, as it is normal for the wound to bleed a little, and may be a pressure dressing to limit the amount of bleeding. The surgical dressing stays on for 24 hours, after which the surgeon, if the person stays overnight in the hospital, or the person may remove it. A larger incision may require replacement dressings for the next 72 hours, after which most incisions remain uncovered though some surgeons may instruct that the incision site remain covered for a longer period. When applying a fresh dressing, it is important to wash the hands with warm water and soap before touching bandages or the surgical wound. The surgeon may instruct the application of an antibiotic ointment. The surgeon will remove nondissolving skin sutures or staples 3 to 10 days after the operation, after which the incision is fairly well healed.

Postoperative Complications

Infection is the most common postoperative wound complication. Rarely a surgical wound may bleed. Though some degree of bleeding at the incision for the first 24 hours after surgery is normal for most operations, bleeding that saturates the bandage requires immediate assessment by the surgeon or hospital nursing staff. Extended irritation at the incision site (redness farther than one half inch from the incision), pus, and FEVER are early indications of infection that the surgeon needs to evaluate. Obesity, diabetes, and PERIPHERAL VASCULAR DISEASE (PVD) can affect the circulation of BLOOD in the body, particularly to the limbs.

NOSOCOMIAL WOUND INFECTION

About 500,000 of the 27 million Americans who undergo surgery every year develop postoperative wound infections. About 25 percent of postoperative infections are nosocomial (also called iatrogenic)—that is, they occur as a consequence of exposure to pathogens in the hospital environment. Proper wound care minimizes the risk for INFECTION of any kind and supports optimal HEALING.

People who have these conditions should be alert to changes in the surgical wound that could suggest infection.

Discomfort or PAIN is a common and expected complication for a period of time after the operation, the severity and duration of which depends on the kind of operation. Restricting use of the operated area minimizes discomfort. The surgeon will prescribe appropriate ANALGESIC MEDICATIONS to relieve pain.

Return to Bathing or Showering and Normal Activities

Most surgical wounds are closed enough to permit showering 24 to 48 hours after surgery. Getting the incision wet does not affect the skin closures (sutures, staples, or adhesive strips). Bathing (sitting in a tub of water) should wait until the incision is completely healed (2 to 3 weeks), unless it is possible to sit in the water without getting the incision wet. Soaking in bath water softens the skin at the incision’s edges and may allow BACTERIA to gain entrance, causing infection. The full return to normal activities depends on the operation and the person’s individual rate of healing and can take place anytime from a few days to 3 months.

See also SURGERY BENEFIT AND RISK ASSESSMENT.

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