Wound care after surgery

What is normal in the first days and weeks?

A new wound is usually tender and a little swollen, and it may ooze a small amount of clear or blood-stained fluid in the first days. Bruising and itching as it heals are common. What matters most is whether the wound looks and feels better as the days go by.

• Tenderness, mild swelling and bruising around the wound, which fade on their own
• Redness limited to the edge of the cut
• Itching as the skin heals. Do not scratch, and do not pick at scabs, stitches or tape
• Dissolving stitches under the skin, which need no removal
• After keyhole surgery, pain at the tip of the shoulder from gas left in the abdomen, which eases within about a week

How do I keep the dressing clean and dry?

Leave the dressing on for as long as your surgeon says, and change it sooner if it becomes wet, dirty or soaked with blood or fluid. Wash your hands before you touch it, do not touch the side of a new dressing that lies on the wound, and do not put cream, powder or antiseptic on the wound unless you were told to.

A simple routine for changing a dressing:

• Wash your hands with soap and warm water and dry them on a clean towel
• Put the new dressing and anything else you need on a clean surface
• Loosen the tape gently. If the dressing sticks, moisten it with water, unless your surgeon told you to pull it off dry
• Look at the wound before you cover it, using the warning signs further down this page
• Place the new dressing without touching the inside of it, and tape it down on all sides
• Seal the old dressing in a plastic bag, put it in the bin and wash your hands again

Stitches or staples that do not dissolve are taken out by your surgeon or nurse. Do not pull them out yourself. Avoid tight clothing that rubs the wound. Once a wound has healed it can usually be left uncovered, although some people keep a dressing on for comfort if clothes rub.

When can I shower or bathe?

Showers are better than baths because they do not soak the wound. Some people may shower the day after surgery and others need to wait longer, so your own instructions come first. Take the dressing off first unless it is waterproof and you were told to leave it on, then pat the area dry.

• Let water run gently over the wound. Do not rub or scrub it
• Do not put soap, shower gel, lotion or powder directly on the wound. Mild soap on the skin around it is fine
• Pat dry with a clean towel, then put on a fresh dressing if you need one
• Paper tape strips and skin glue come away on their own. Do not scrub them off
• No baths, hot tubs or swimming until your surgeon says it is safe. After an inguinal hernia repair this means at least the first week

After surgery near the back passage, warm-water soaks are usually part of the routine instead. See the section on wounds near the back passage.

What are the different types of dressing?

A dressing protects the wound, soaks up fluid and keeps the surface in good condition to heal. Your nurse or surgeon chooses the type for your wound, and the choice can change as it heals. The common types are described below in plain terms.

• Film: a thin, clear, sticky sheet that lets air through but keeps water and germs out. It does not absorb fluid, so it suits dry, closed wounds
• Foam: a soft, absorbent pad, often with a sticky border, for wounds that leak a moderate to large amount of fluid
• Hydrocolloid: a sticky pad that turns into a soft gel as it absorbs fluid and keeps the surface moist. It is often left on for several days and suits shallow wounds that leak a little
• Hydrogel: a water-rich gel or sheet that keeps a dry wound moist. It usually needs another dressing over it
• Alginate: a soft fibre made from seaweed that turns into a gel as it soaks up fluid, used for wounds that leak a lot
• Gauze and simple pads: absorb fluid and protect the wound, and are changed more often. Pads are common near the back passage, where they catch drainage
• Skin glue and paper tape strips: used to close the skin of some wounds, and they come off by themselves

No single dressing suits every wound. The right choice depends on the wound, how much fluid it makes, how far it has healed and what is comfortable for you. Do not switch to a different type on your own. Ask your nurse how often yours should be changed and what to do if it leaks or peels.

How do I care for a wound near the back passage?

After haemorrhoid, abscess or fistula surgery, keep the area clean with warm water, soak in warm water if you were advised to, wear a pad to catch drainage, and keep stools soft so you do not strain. Some bleeding and discharge are expected, especially after a bowel movement, and these wounds can take weeks to heal fully.

• Warm soaks (a sitz bath): sit in 3 to 4 inches of warm water a few times a day if your surgeon recommends it, then pat dry. Follow the timing you were given
• After a bowel movement, clean gently with warm water or unscented baby wipes rather than dry toilet paper, and pat rather than rub
• Wear a pad or gauze in your underwear to catch fluid, and change it when it is damp
• Expect some blood, especially with the first bowel movement, and some clear or yellow fluid. This can continue for several weeks
• Avoid constipation and straining. Drink plenty of fluids, take a stool softener if you were prescribed one, and eat fibre as advised. A small footstool under your feet at the toilet can make passing stool easier
• For swelling, an ice pack wrapped in a towel for no more than 15 minutes at a time can help
• Soreness is greatest on and after bowel movements. It usually improves over the first couple of weeks. Tell the clinic if it is not improving or you cannot manage it
• Abscess wounds are often left open to heal from the inside out. They may be packed or covered with a dressing, may leak fluid for a while, and can take several weeks to heal fully. Smoking and poorly controlled diabetes slow healing

Tell the clinic if you cannot pass urine several hours after surgery, or cannot pass stool because of pain.

How do I care for abdominal wounds after keyhole, hernia, gallbladder or bowel surgery?

Abdominal wounds are usually closed with dissolving stitches, glue or paper strips, so most need little more than keeping clean and dry. Keep walking, hold a pillow against the wound when you cough, avoid heavy lifting, and look at the wound each day for warning signs.

• Stitches under the skin dissolve on their own. Stitches or staples on the skin that do not dissolve are removed at a follow-up visit
• After keyhole gallbladder surgery you may be able to shower the day after if the skin was closed with stitches, staples or glue. Paper strips are left to fall off
• Bruising around the wounds and mild redness at the edge are common
• Hold a pillow firmly against the wound when you cough or sneeze. It protects the wound and eases discomfort
• Walk every day. Stop any activity that hurts or pulls on the wound, and avoid heavy lifting for at least a couple of weeks or for as long as you were told
• If the wound opens or the edges come apart, cover it with a clean dressing and seek advice the same day

A longer or open wound, for example after bowel surgery, may need a different dressing routine and review by a nurse. Follow the plan you were given and ask if anything is unclear.

How do pain, food and daily habits affect healing?

Taking pain relief on time, walking a little each day, eating enough protein and drinking fluids all help a wound heal, while smoking and alcohol slow it down. Pain that is rising rather than easing is a reason to call.

• Take pain medicine as instructed, ideally before the pain becomes severe
• Include a source of protein at each meal, with fruit and vegetables, and drink fluids through the day.
• Smoking and alcohol can slow healing. Ask your nurse about help to stop smoking
• Poorly controlled diabetes can lengthen healing time. Keep your usual diabetes care going
• Ask before you restart or stop medicines such as blood thinners

When should I call the clinic or seek urgent care?

Call the clinic the same day if the wound becomes more painful, red, swollen or hot, leaks pus or a bad-smelling fluid, opens up, or you develop a fever. Go to an emergency department or call 995 for bleeding that does not stop with firm pressure, chest pain, breathlessness or a painful, swollen leg.

Call the clinic the same day if you notice:

• Increasing pain, or pain that medicine does not ease
• Redness that spreads, or skin around the wound that feels hot or hard
• New swelling or a hard lump at the wound
• Thick, yellow or green discharge, a bad smell, or much more fluid than before
• Wound edges coming apart, or a wound that looks larger, deeper, dried out or dark
• A temperature of 38°C or higher, chills, or feeling generally unwell
• After surgery near the back passage: being unable to pass urine for several hours, being unable to pass stool, or heavy bleeding

Go to an emergency department or call 995 if you have:

• Bleeding that soaks through the dressing and does not slow after pressing firmly on it with a clean pad for 10 to 20 minutes
• Chest pain or difficulty breathing
• Pain, tenderness, redness or swelling in one leg
• Vomiting that will not stop, or belly pain or hardness that is getting worse

The clinic offers wound review and dressing support after surgery. Call +65 6738 6020. Outside clinic hours, or in an emergency, go to the nearest emergency department or call 995.

What happens at a wound review?

A wound review is a short visit to check that healing is on track. The wound is looked at, the dressing is changed if needed, and you leave knowing how to care for it, when to shower and what to watch for. The clinic offers wound review and dressing support after surgery.

• Stitches or staples that do not dissolve are removed at a follow-up, not at home
• Useful questions: how long to keep the dressing on, when you can shower or bathe, when you can return to work and exercise, who to call with a concern, and when the next review is
• Bring your medicine list and any discharge papers