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Caring for surgical wounds

A surgical wound is a cut made in your skin during an operation. Taking proper care of your surgical wound can lower your risk of infection and help your wound to heal.

You will have a surgical wound after any type of operation that involves making a cut into your skin, including minor procedures carried out by GPs and other doctors, as well as those done by surgeons. For simplicity, we will refer to surgeons throughout this factsheet.

The position and size of the cut your surgeon makes will depend on the type of operation and surgery you have. For example, if you have keyhole (laparoscopic) surgery, your surgeon will make small cuts to your skin, which will be closed with stitches, clips or skin glue to bring the skin edges together to heal.

There are many different types of surgical wound, so it's important to follow your surgeon's advice.

Wound healing

The process by which your surgical wound heals is complex but can be divided up into three main steps.

  • Inflammation – this happens straight away and lasts for up to 10 days during which time the blood flow to your wound increases.
  • Proliferation – this starts after a few days and can carry on for several weeks. New blood vessels grow to bring nutrients to your wound and new tissue starts to develop.
  • Maturation – new skin cells develop to seal your wound and a scar forms. This phase can continue for over a year.

Skin edges usually form a seal within a day or two of an operation, but this can vary from person to person and from operation to operation. Closing your wound surgically (with stitches, clips and staples) encourages your wound to heal faster.

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  • Dressings Dressings

    You may not need to have a dressing on your surgical wound. The purpose of a dressing is to:

    • absorb any leakage from your wound
    • provide the best conditions for healing
    • reduce your risk of infection
    • reduce pain
    • protect the area until your wound has healed
    • apply pressure if this is needed
    • prevent your stitches or clips from catching on clothing

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  • Stitches, clips and staples Stitches, clips and staples

    The medical term for stitches is sutures. Other methods that may be used to close your surgical wound include metal clips or staples and adhesive dressings or tapes. The method your surgeon uses to close the cut will depend on its location, size and how strong it needs to be.

    Some stitches are dissolvable and you won’t need to have them removed. You will need to have certain other types and also clips and staples removed by a nurse or doctor. If this is necessary, your nurse will arrange a follow-up appointment at your hospital or with your nurse.

    You will usually need to have stitches, clips and staples removed between three and 21 days after your treatment. This will depend on a number of things including where on your body the wound is, the type of operation you had and what method and material were used to close your wound. Your surgeon will be able to give you more information about when they need to be removed.

  • Tissue adhesive skin glue Tissue adhesive skin glue

    Your surgeon may use special skin glue to close your wound, but this will only be for smaller wounds. One of the advantages of skin glue is that it brings the edges of your skin together quickly – within a couple of minutes – to seal the wound and form a barrier that lowers the risk of infection. This may decrease the time that it takes for your wound to heal. Although the glue is waterproof, don't let your wound soak in water. The glue usually peels off in five to 10 days.

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  • Caring for a healing surgical wound Caring for a healing surgical wound

    There are a number of things that you can do to look after your wound, lower your risk of infection and encourage healing.

    Changing the dressing

    You can leave the original dressing in place for up to five days (or for as long as your surgeon advises) providing that it's dry and not soaked with blood, and that there are no signs of infection.

    Before you remove the dressing, wash your hands with soap and water and then carefully take off the dressing. Try not to touch the healing wound with your fingers.

    Your wound may then be left without a dressing. However, you might like to continue wearing one over the area for protection, especially if your clothing rubs against it. The hospital may give you a replacement dressing for you to use at home. Apply the dressing carefully and don't touch the inside of it. Don't use antiseptic cream under the dressing.

    Taking care of stitches

    Dissolvable stitches will usually disappear in about one to three weeks, but it can take longer, depending on the type you have. Non-dissolvable stitches, clips and staples are usually removed after three to 21 days, depending on the type of operation you have.

    During this time you may see small pieces of the stitch material poking out of your healing wound. Don't be tempted to pull on these. If there are loose ends that are catching on clothing, trim the stitch carefully with a clean pair of scissors. Otherwise wait until they are removed or fall out on their own. If the stitches cause you pain or discomfort, contact your GP for advice.

    Eating and drinking properly

    Your body needs a lot of energy to heal quickly so it's important that you eat well. In particular, you need vitamin C and protein so it’s important that you try to eat a healthy, balanced diet with plenty of fruit and vegetables. Make sure that you drink enough water because if you're dehydrated, your wound may take longer to heal.

    It's important that you lose any excess weight before your operation, as being overweight can increase the time it takes for your wound to heal. If you have diabetes, it’s important to take care that your blood sugar is well controlled.

    Bathing and showering

    It's usually possible for you to have a bath or a shower about 48 hours after surgery, but this will depend on the particular operation you have – ask your nurse for advice.

    Some general points to remember are as follows.

    • If possible, have showers rather than baths 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 you have a bath or shower, unless your surgeon or nurse gives you different advice. Some dressings are waterproof and can be left in place.
    • Don't use any soap, shower gel, body lotion, talcum powder or other bathing products directly over your healing wound.
    • You can let the shower water gently splash onto your healing wound. However, don't rub the area, as this might be painful and could delay the healing process.
    • Dry the surrounding area carefully by patting it gently with a clean towel but allow your wound to air dry.
    • If you had surgery on your face, don't wear make-up over the scar until it has fully healed.

    Once your wound has healed, you may find gently rubbing petroleum jelly or a fragrance-free moisturiser into the scar helps to reduce how noticeable it is. There is also some evidence that using a cream or ointment that contains arnica can help wound healing, but you shouldn’t use it on broken skin or if you have a skin condition. Always speak to your GP or surgeon before using any herbal remedies. Silicone gel sheets are also sometimes used to improve the appearance of scars, but there is only evidence for their effectiveness on certain types of scars.

    Once you get home, if you have any concerns about your surgical wound, contact your hospital or GP.

  • Complications Complications of wound healing

    Most surgical wounds will heal without causing you any problems, but it’s possible that your wound may become infected after surgery. If you develop an infection, you will usually be treated with a course of antibiotics but occasionally you may need to have further surgery. See our frequently asked questions for more information.

    You're more likely to develop an infection if you:

    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 tell if you're developing an infection after you go home. If your wound becomes infected, it may:

    • become more painful
    • look red, inflamed or swollen
    • leak or weep liquid, pus or blood
    • smell unpleasant

    You may also have a high temperature.

    If you have any of these symptoms, contact your GP. Wound infections can usually be treated successfully with antibiotics if they are diagnosed early. See our frequently asked questions for more information.

  • FAQs FAQs

    I think I may have an abscess in my surgical wound. What should I do?

    Answer

    Visit your hospital or GP to confirm if you have an abscess. If you do, you‘re likely to need to have the pus drained from it.

    Explanation

    An abscess is a collection of pus and infected material that can occur anywhere in or on your body. It’s likely to be swollen and painful, and you may also have a fever.

    If you get an infection in your surgical wound, it can lead to the development of an abscess. This happens because part of your immune system’s reaction to the infection is to produce pus – if this collects under your skin, it will form an abscess. An abscess can take some time to form, so it may not have developed before you go home after surgery.

    If you’re diagnosed with a wound abscess, you will need to have treatment otherwise you may be at risk of more serious complications (for example the abscess could burst). If your abscess isn’t very big or deep, it may be possible to treat it with antibiotics. However, you will usually need to have it drained of pus and cleaned to remove damaged or infected tissue. You may be given antibiotics to take after your abscess has been drained but this is usually only if the infection has spread.

    If you have a deeper abscess, for example in your abdomen (tummy), you may need to have 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 the images to guide it.

    I have heard that I may develop cellulitis – what is this?

    Answer

    Cellulitis is an infection of the deeper layer of your skin. It usually affects your face or lower legs.

    Explanation

    Cellulitis is a bacterial infection of your skin. Your skin usually has many bacteria living on it and these don't cause problems. However, if your skin is damaged these bacteria can enter your body and grow.

    If your wound becomes infected you may notice that it becomes red, inflamed or swollen. If you have cellulitis, you may also have flu-like symptoms such as:

    • feeling unwell
    • fever or chills
    • lack of energy
    • muscle aches

    If you have any of these symptoms, see your GP. He or she may prescribe you antibiotics. If your infection is severe, you may need to go into hospital for treatment.

    You can help to prevent cellulitis by cleaning your wound properly and watching for symptoms of an infection. You should also try to stay healthy. If you're unwell or if you have a condition or treatment that affects your immune system, you're more likely to get an infection.

    What are 'superbugs'?

    Answer

    The term 'superbug' is used to refer to a type of bacterium that has become resistant to the antibiotic that would usually be used to treat it. It can also be used to refer to healthcare-associated infections (HCAIs). These are infections that you catch in hospital or as a result of healthcare treatment.

    Explanation

    HCAIs include resistant strains of bacteria (sometimes called 'superbugs') as well as infections that arise as a result of other treatments, such as surgery. There are many bacteria that cause HCAIs, but some of the most common include:

    If you become infected with a resistant bacterium, you will be treated with alternative antibiotics that are effective against these infections. However, treatment is likely to be more difficult and take more time. There is also an increased risk of you passing on the infection to other people as you will have it for longer.

    To help prevent the spread of these infections always wash your hands with soap and water before and after visiting people in hospital or a care home. You can use an alcohol gel but these aren’t effective against all types of bacteria.

  • Resources Resources

    Further information

    Sources

    • Wound healing and repair. Sequence of events in wound healing. eMedicine. www.emedicine.medscape.com, published August 2011
    • Grey JE, Harding KG. ABC of wound healing. 1st ed. Oxford: Wiley-Blackwell; 2006
    • Prevention and treatment of surgical site infection. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
    • Clinical practice guidelines: wound dressings – acute traumatic wounds. The Royal Children’s Hospital Melbourne. www.rch.org.au, accessed 5 February 2013
    • Wound closure technique – equipment. eMedicine. www.emedicine.medscape.com, published May 2011
    • Personal communication, Mr A D Riddell MBChB MRCS MD, Department of Surgery, University Hospital of Wales, Cardiff, 13 March 2013
    • Topical skin adhesives. DermNet NZ. www.dermnetnz.org, published February 2011
    • Wound infections. DermNet NZ. www.dermnetnz.org, published June 2011
    • Smoking and surgery. ASH. www.ash.org.uk, published July 2009
    • Sharp A, Clark J. Diabetes and its effects on wound healing. Nurs Stand 2011; 25(45):41–47. www.nursingstandard.rcnpublishing.co.uk
    • Wounds – how to care for them. Better Health Channel. www.betterhealth.vic.gov.au, published October 2012
    • Wound healing and care. TeensHealth. www.kidshealth.org, published November 2011
    • General wound care. NSW Ministry of Health. www.nscchealth.nsw.gov.au, published April 2008
    • Arnica. University of Maryland Medical Center. www.umm.edu, published October 2011
    • Puri N, Talwar A. The efficacy of silicone gel for the treatment of hypertrophic and keloids. J Cutan Aesthet Surg 2009; 2:104–6. doi:10.4103/0974-2077.58527
    • Abscesses. The Merck Manuals. www.merckmanuals.com, published November 2012
    • Intra-abdominal abscess. Johns Hopkins Medicine. www.hopkinsmedicine.org, accessed 6 February 2013
    • Cellulitis. Johns Hopkins Medicine. www.hopkinsmedicine.org, accessed 6 February 2013
    • Cellulitis. The Merck Manuals. www.merckmanuals.com, published February 2012
    • Cellulitis and erysipelas. British Association of Dermatologists. www.bad.org.uk, published January 2012
    • Healthcare-associated infections (HAI). Centers for Disease Control and Prevention. www.cdc.gov, published October 2012
    • Antimicrobial resistance. World Health Organization. www.who.int, published March 2012
    • Diseases/pathogens associated with antimicrobial resistance. Centers for Disease Control and Prevention. www.cdc.gov, published January 2013
    • Hand hygiene products techniques. The Royal Children’s Hospital Melbourne. www.rch.org.au, published September 2012
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    Produced by Polly Kerr, Bupa Health Information Team, March 2013.

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