Postoperative Wound Management

So far, there are varied ways of doing postoperative wound management depending on the type of postoperative wound, mindset of the surgeon, and available resources.

The best postoperative wound management is one that is rational (with good and realistic basis), cost-effective (effective in promoting wound healing and in avoiding complications with the least expense), and efficient (least effort and time on the part of the surgeon and patient).

I have yet to see a health-process-evidence-based clinical practice guidelines on this topic.

I will try to formulate one in the soonest time possible so as to assist surgeons, surgical trainees, and patients.

18dec26

ROJoson's Recommendations for Wounds Primarily Closed:

You CAN wet wounds, both postoperative and non-postoperative ones, with TAP WATER, particularly when taking a bath.

Don’t be afraid to take a bath after an operation and after you accidentally incur a surface wound in any part of your body.

Don’t be afraid if your body surface wounds get wet while taking a bath. You don’t need to wrap your wounds with a towel or a plastic in an attempt to prevent them from getting wet. It is NOT necessary. It is an UNNECESSARY INCONVENIENCE on your part and on your relatives. ENJOY YOUR BATH. It contributes to the restoration of your physical and mental well-being after getting a surface wound.

While taking a bath, wash your wound with soap and water. Doing so will in fact decrease the chances of wound infection.

You can remove the dressing 12 hours postop and do not replace the dressing anymore.

Ask the patient to take a bath or shower cleaning her wound with tap water and mild soap. No need for antiseptic.

The best postoperative wound management is one that is rational (with good and realistic basis), cost-effective (effective in promoting wound healing and in avoiding complications with the least expense), and efficient (least effort and time on the part of the surgeon and patient).

Evidence:

Can operative wounds with sutures be wet? YES

by reyojoson

Yes, operative wounds with sutures can be wet. Thus, one can take a shower soon after the operation without fear of wetting the wound and without fear of increased infection rate.

This recommendation is strongly derived from the following study:

Can sutures get wet? Prospective randomised controlled trial of wound management in general practice

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38800.628704.AE (Published 04 May 2006)Cite this as: BMJ 2006;332:1053

https://www.bmj.com/content/332/7549/1053

This recommendation is also supported by my experience as a physician and a surgeon. I have been giving this piece of advice during the past 37 years (from 1981 to 2018). There is no higher incidence of wound infection with early shower.

Below are excerpts from the study:

Abstract

Objective To compare standard management of keeping wounds dry and covered with allowing wounds to be uncovered and wet in the first 48 hours after minor skin excision.

Design Prospective, randomised controlled, multicentre trial testing for equivalence of infection rates.

Setting Primary care in regional centre, Queensland, Australia.

Participants 857 patients randomised to either keep their wound dry and covered (n = 442) or remove the dressing and wet the wound (n = 415).

Results The incidence of infection in the intervention group (8.4%) was not inferior to the incidence in the control group (8.9%) (P < 0.05). The one sided 95% confidence interval for the difference of infection rates was ∞ to 0.028.

Conclusion These results indicate that wounds can be uncovered and allowed to get wet in the first 48 hours after minor skin excision without increasing the incidence of infection.

https://rojosonmedicalclinic.wordpress.com/2018/12/26/can-operative-wounds-with-sutures-be-wet-yes/

https://rojosonmedicalclinic.wordpress.com/2015/03/10/wounds-can-be-wet-rojosons-3rd-time-around-on-the-web/?fbclid=IwAR1Di3dsnfBDXrVGKkXboCkv3rcym58U-o-H5IF3t8EptQNTia_rxgw00NQ

ROJ@18dec26