PREVENTION & TREATMENT

Tips for treating post-surgery wounds

By Saeed A. Chowdhry, MD

When it comes to post-surgery wounds, treatment shouldn’t be intimidating. Of course, by practicing key preventative measures in the OR— when incisions are made—we can hope to avoid complication of these types of wounds. These measures include gently handling tissues, minimizing excess foreign material and suture usage, and using a sterile technique.

However, if a patient has a wound infection or SSI (surgical site infection), the wound probably won’t manifest itself until 7 to 10 days post-surgery. Since you can’t prevent an infection after the incision has been closed and dressed in the OR, it’s necessary to be proactive immediately following surgery to reduce the risk of infection.

Here’s what you should know:

Follow surgical guidelines

There are many guidelines (i.e. CDC, NIH) that minimize the risk of wound infections or post-surgical incisional complications. You can typically minimize the potential risk of complicated wounds in the OR and post-surgery by practicing these techniques:

  • Maintain normothermia and normal glycemic indices
  • Use a sterile technique
  • Monitor surgery time (length of surgery is related to wound complications)
  • Clip, rather than shave, patients’ hair
  • Administer perioperative antibiotics

Practice basic wound care

While commonly practiced in treating acute wounds, basic wound care shouldn’t be neglected when it comes to post-surgical wounds. Be sure to practice the following steps:

  • Cleanse the wound
  • Debride nonviable tissue
  • Enact appropriate antibiotic-targeted therapy
  • Address patient-centric factors that lead to a wound
  • Optimize the patient’s nutrition

Identify the risk of SSIs

Patients at risk for incisional problems or wound-healing problems are easily compromised. Keep an eye out for these risk factors:

  • Previous SSI or a track record of SSIs
  • High BMI
  • Cardiopulmonary disease
  • Cardiopulmonary comorbidity (such as peripheral vascular disease, COPD, or poor oxygenation)
  • Malnourishment
  • Prior radiation
  • Poorly controlled diabetes
  • Immunocompromised state
  • Malignancy

Before treating an SSI or an infected wound, assess how it occurred. A comprehensive assessment of the patient will include a very detailed history and physical exam.

It’s important to not overlook the patient’s conditions prior to surgery. Patients with multiple comorbidities or risk factors may be more susceptible post surgical complications. It pays to be hyper vigilant with high-risk patients. It may be beneficial for these patients to have closer clinical follow up.

Consider using a barrier dressing

There are many benefits to using a barrier dressing. Once you complete an incision and apply the dressing, it’s likely to be as clean as possible. By securing this area and locking out a potentially “dirty” environment, there’s a better chance of maintaining a clean incision and preventing an SSI.

With colostomies or ileostomies, placing a barrier between the contaminated intestinal contents and your incision provides a better opportunity to prevent an SSI.

Keep extremities elevated to avoid extra swelling that could put tension on an incision. Many orthopedists use ice or cold therapy to help with swelling, which ultimately takes tension off an incision.

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Know when to inspect wounds

If you suspect that an incision or surgical site may be a problem for a patient, don’t hesitate to take the dressing off and examine the surgical site. Classic surgical teaching suggests that incisional epithelialization occurs at 24-48 hours; however, if there is suspicion for an infection, the surgical site should be evaluated.

A surgical site infection typically manifests after 5-7 days. If you suspect a patient’s incision isn’t healing well, look for additional symptoms and signs, such as red and cellulitic skin, fever, or crepitus around the dressing. If these signs are absent, the surgical site is unlikely to be the source of infection or post-operative fever.

By following these tips and understanding the risk factors, treating post-surgery wounds is nothing to be intimidated by. Remember, as with all things that carry risk, a little prevention can make a huge difference.

Headshot of Dr. Saeed A. Chowdhry.

Saeed A. Chowdhry, MD, a plastic surgeon, is chairman and chief, Department of Plastic and Reconstructive Surgery, Advocate Christ Medical Center, Chicago, IL

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