Looking after your surgical wound at home and monitoring for infection
Surgical Wound
A surgical wound is the cut made to the skin by the surgeon during an operation. At the end of the operation the cut is joined back together with either stitches, clips, steristrips or adhesive dressings (glue), to allow the skin edges to come together and heal. The skin edges usually form a seal within a day or two of the operation.
Closure of your wound
Clips and most types of stitches have to be removed by a nurse or doctor, but some stitches don’t need to be removed as they dissolve. If you are told you need to have stitches removed, this can be usually be done by your GP or Practice Nurse. Stitches and clips are usually removed 7-14 days after treatment, depending on the type of operation you have had.
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Surgical Dressing
You may or may not have a dressing on your wound after your operation, not all surgical wounds need dressings. If you do have a dressing on your wound after the operation your surgical team will explain why, and how long it needs to stay dry and in place for.
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Generally the purpose of a surgical dressing is to:
absorb any leakage from the wound
protect the area until the wound is healed
prevent stitches catching on clothing.
Before your operation:
If you have an infection before your operation, even if it’s only a cold or sore throat, tell the hospital immediately. Your operation may have to be delayed to reduce the risk of infection.
You should take a bath or shower the night before and on the morning of surgery, washing your hair and body on both occasions. You will be given surgical wash for this and should avoid using conditioner.
If you smoke it is recommended that you try to stop before your operation, as there is lots of evidence that current smoking results in more wound healing problems and infections. For help with cessation I would recommend contacting your GP as there are lots of service available to support you with that.
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If you are diabetic it is important to work with your diabetic team to ensure that this is as well controlled as possible before your operation. This will reduce the risk of infection and wound healing problems.
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You should eat a healthy balanced diet before and after surgery as this is important for wound healing. Your diet can affect how fast your body heals, how strong your tissue becomes and your resistance to infection during the healing process. A poor nutritional intake can impair healing and result in chronic wounds which take much longer to repair and are more likely to become infected. If you need more detailed advice or if you are following a special diet that makes it difficult to make these changes, please contact your GP or surgical team who may consider referring you to a dietitian.
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After your operation:
If you are given antibiotics, make sure that you take the whole course as instructed.
If any staff come to look or change your wound dressing, it is crucial that they wash their hands before and after touching it. Please ask them if you have not seen them do it.
Do not touch your wound or dressing unless you have washed your hands first. You could accidentally transfer germs from your fingers to your wound.
The wound must be kept dry for two days after your operation, unless your surgical team have specified longer. If you have a dressing and the dressing becomes wet from blood or any other liquid, it must be changed.
You will typically be advised to wait 48 hours before showering and washing your hair after your operation.
If you have longer hair I would recommend bringing a brush such as a 'tangleteazer' (www.tangleteazer.com) to hospital with you as with the washes used before and during your operating (if a cranial operation) hair tangling is common and brushes like these really help.
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When you come to wash, please note these general points about your wound:
Showering is preferable to bathing. Soaking the wounds might soften the scar tissue and cause them to open up. Only take a bath if you are sure you can keep your wounds dry or you are more than 4 weeks from your operation when your wound looks fully healed on the outside.
Some waterproof dressings can be left in place whilst you take a bath or shower. Other dressings may need to be removed beforehand. Your team will tell you which type of dressings you have, and whether they need to be replaced if they come off or get wet.
Do not put any soap, shower gel, body lotion, talcum powder or other bathing products directly onto your healing wound for 4 weeks following your operation. This will cause discomfort and may also encourage an infection. Instead simply let the soap and water run over. If your wound is on your head I would recommend using a gentle shampoo such as baby shampoo for the first 4 weeks after your operation, and avoiding conditioner anywhere near your wound during that period as this can affect how the skin heals.
Do not worry if you wet the wound, but do not rub the wound area. This will cause pain and might delay the healing process. This includes taking care when brushing your hair, particularly for the first month of your operation if your surgical wound is on your head.
Pat the wound dry gently with a clean towel after bathing or showering and do not put a hair dryer directly onto your wound.
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It is not recommended to dye your hair until your wound is fully healed on the outside. Generally this would be at the earliest 2 months after your operation. If you are not sure please seek the advice of your specialist nurse or surgical team.
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If you have a dressing:
The original dressing can be left in place for up to two days (or as advised by your doctor/nurse), as long as it is not oozing.
When/if you change the dressing:
wash your hands with soap and water
carefully take the dirty dressing off, without touching the used side
do not touch the healing wound with your fingers
take care not to touch the inside of the new dressing, so that it remains clean
do not apply antiseptic cream under the dressing.
If the wound is healing it can be left without a dressing, but you may prefer to have a dressing to cover the wound for protection, especially if your clothing can rub against it.
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Taking care of stitches
Dissolving stitches can take up to 3 weeks to dissolve. Other stitches/clips need to be removed after 7-14 days.
You may see nylon threads (the ends of the stitches) poking out of the healing scar. Please do not pull on these. If the loose ends are catching on clothes, cover the wound until the stitches are removed, to prevent them catching.
If you are worried about the stitches or clips, or they are causing you pain or discomfort always seek advice from your specialist nurse or surgical team.
Diet and Exercise
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As for before your operation it is important that you maintain a healthy diet and stay active after your operation, as well as ensuring your other medical conditions remain well controlled and you avoid smoking as much as you can.
There is lots of evidence that good nutrition and staying active is essential for optimal wound healing. Your diet can affect how fast your body heals, how strong your tissue becomes and your resistance to infection during the healing process. A poor nutritional intake can impair healing and result in chronic wounds which take much longer to repair and are more likely to become infected.
I would recommend that you stay as active as possible after your operation and consider setting yourself goals for this. For example, if possible having short daily walks after your operation, and building these levels of activity up gradually as you recover. Some people find wearing activity bands helpful to monitor this and using these to set their daily and weekly goals. For more information see the 'exercise' section of this webpage.
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You may need more calories to maintain or increase your weight when your body is healing. Please see the 'diet' section of this webpage for more information. You may find it helpful to regularly weigh yourself to monitor this during your recovery period. This could include:
Eating extra snacks between meals
Choosing higher energy foods (avoid ‘diet’ or ‘light’ options)
It is important that you try to meet a minimum of 5- fruit and vegetables a day, as well as ensuring you have an adequate intake of protein and carbohydrates. Each fruit and vegetable will have a different balance of vitamins and minerals so try to include as wide a range as possible and aim to have at least 5 portions each day. Ways to increase your intake of fruit and vegetables may include:
Chopping extra vegetables into pasta sauces, stews or casseroles
Adding sliced tomato, cucumber or lettuce to sandwiches
Having chopped vegetables as a savoury snack with a dip
Creating your own pizza topping using vegetables
Having fresh, tinned or dried fruit on breakfast cereal or with yoghurt as a pudding
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Fluids
Dehydration is known to affect wound healing. In order to maintain good hydration aim to:
Drink at least 6-8 cups or glasses of fluid each day (includes hot drinks such as tea, coffee and hot chocolate, squash, fruit juices, milk, soups, jelly and other liquids)
Reduce caffeinated drinks if you consume more than 3 cups per day (more than this may start to have a dehydrating affect)
Stay within recommended limits for alcohol consumption (no more than 14 units per week)
An indicator of good hydration is urine which is pale in colour. Dark or strong smelling urine is likely to indicate dehydration.
Long term wound care
Provided you have not had any problems with your wound healing or infection, after 6 weeks from your operation I recommend regular massage of your wound, either with clean hands or a cloth/cotton wool. Using non-perfumed oil such as bio-oil or coconut oil, or non-perfumed cream such as E45, can also help to keep your wound supple and with its long-term healing. Your wound will feel different from the surrounding area and this is normal.Â
I would also recommend not getting sun directly onto your wound, using a hat or protecting it with sunscreen when you are at risk of exposing your wound to direct sun. This is particularly important for the first year after your operation.
Infection
What are surgical wound infections?
Many micro-organisms (germs) live in and on our bodies and also in our environment. Most germs are harmless. Some are useful, for example the germs in our gut (intestines) aid digestion and also help to protect us from harmful germs. Our bodies have natural defences against the organisms that can cause harm. Our skin, for example, normally is a barrier preventing germs from entering our bodies. A surgical wound infection may occur when germs enter the incision (cut) that the surgeon makes through your skin to do an operation.
When do these infections develop?
A surgical wound infection can develop any time from two to three days after surgery until the wound has visibly healed (usually two to three weeks after the operation). Very occasionally, an infection can occur several months after an operation. Most surgical wound infections are limited to the skin but can occasionally spread to deeper tissues.
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How will my wound be monitored?
During your stay in hospital your nursing and medical team will check for any signs of infection. If you are concerned about your wound, tell the nurse or doctor who is looking after you.
When you are at home it can be helpful to take pictures of your wound during the first few weeks after your operation 2-3 times a week. This will allow you to monitor your wound across time and can help to flag problems. If you have a concern about your wound, showing or sending those pictures to your specialist nurse, surgeon, or GP can often be very helpful.
Infection can develop after you leave hospital. Some redness and swelling is to be expected after surgery. Warning signs of infection include:
The skin around your wound gets red or sore or it feels hot and swollen
You develop a fluid collection under your wound that gets worse and feels warm and tender to touch
Your wound has a fluid discharge, often green or yellow coloured pus
The wound becoming more painful to touch
You feel generally unwell or feverish, or you have a temperature
You have a build up of thick scab along your wound edge which is getting worse than better.
If you have a problem or concern with your wound you should contact your surgical team as soon as possible.
This is important as any infection should be treated as soon as possible to prevent it from becoming more serious. If it is out of hours and you cannot get in touch with your surgical team please contact your GP or attend your local hospital for review.
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What happens if I develop symptoms?
If your doctor suspects that you have a surgical wound infection, they may take a sample from the surface of your wound with a swab and send it to the laboratory for tests. They may also arrange for some blood tests to be taken, and some imaging such as a CT scan. Your nurse or doctor may prescribe treatment with antibiotics, or you may need an operation to washout the infected area and/or re-close the wound which is not healing as it should.