Encyclopedia of Health and Medicine

W
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
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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.