Post-Surgery Wound Care

Taking care of a wound after surgery can be an intimidating task for someone with little or no medical experience. While each wound is different, there are some general tips that can help make this process easier and safer. This blog will outline some of the most common questions about post-surgery wound care. But remember: Your physician knows you and your wound best; if their instructions differ from ours, you should always follow your physician’s instructions.

What Are the Main Types of Surgical Wounds?

Given how many different kinds of surgery happen on the upper extremity, there are many different types of wounds you might have after surgery. Surgeons use the word “wound” to describe many different things: incisions made during surgery, traumatic openings in the skin, or openings made to allow infections to drain. Some common examples of surgical wounds include: 

• Closed incision: This is usually a cut made during surgery to access the structures below the skin. The skin is then closed in a line after the surgery is finished. 
• Open wound: Just like it sounds, this is an opening in your skin where the structures below the skin are visible. This type of wound often results from a traumatic injury where some tissue was lost. It can also be the result of having an infection drained. Sometimes, wounds are left open for a period of time and then closed later. In other situations, your wound is allowed to heal “secondarily," meaning you will do dressing changes until the wound heals from the bottom up in layers of healing tissue until eventually the wound is closed. 
• Skin graft: If you had a skin graft, that means your surgeon took a piece of skin from one area of your body and moved it to another area of your body to cover an open wound. The skin graft procedure creates two surgical wounds: one where the graft was taken from, called the “donor site," and one where the graft was placed, called the “recipient site." The donor site can look like a bad abrasion or “road rash," or sometimes it just looks like a closed incision. The recipient site is usually covered with a dressing called a “bolster," which holds the skin graft in place while it is healing. The bolster is usually taken off by your physician’s team five to seven days after surgery.
• Flap: Some wounds are too big or too deep to be closed using the techniques above. For these wounds, you might need something called a “flap." “Flap” is the word used to describe moving healthy tissue from one place on your body to another part to cover a wound. Sometimes, the flap is taken from an area of your body near your wound; other times, it is taken from another part of your body altogether. Like a skin graft, a flap procedure creates two surgical wounds: the “donor site,” where the flap was taken from, and the “recipient site,” where the flap was used to cover a wound. The donor site from a flap can be closed in a straight line or covered with a skin graft. The recipient site will look different depending on what type of tissue was used for the flap.

What Should I Expect as Far as Pain After Surgery?

Pain after surgery is highly variable. Your pain will depend on the type of surgery you had, which medications you are taking, and how your body processes pain. 

Before, during, or after surgery, you may be given something called a “block”; this involves injecting numbing medication around the nerves, which would usually allow you to feel pain around your surgical site. This block can help prevent pain, but it can also give you a pins-and-needles feeling. This effect usually lasts anywhere from two to 12 hours, depending on the type of medication used and how your body processes the medication. After the block wears off, you might experience a temporary increase in pain.

Usually, the first day or two after surgery is the worst pain, and it gradually improves after that. The amount of time it takes for the pain to go away varies widely with the type of surgery and can range from days to months. Before your operation, ask your surgeon how long they expect you to be in pain so you can set your expectations.

There are a few things you can do to help decrease your pain after surgery. These include: 

• Elevating your extremity: Keeping your operative extremity elevated helps decrease swelling, which decreases pain. Try to keep your hand above your elbow and your elbow above your shoulder. Imagine there is a marble in the palm of your hand, and you want that marble to be able to roll all the way back to your heart without getting stuck anywhere along your arm. 
• Following your post-operative activity restrictions: Although it is not easy to lose normal use of one of your hands, it is important to follow your surgeon’s instructions about what you can and cannot do after surgery. Make sure you understand your restrictions about what you are allowed to do with your operative extremity and how much it is safe to lift with that arm. 
• Taking your medications as prescribed: Often times after surgery, your surgeon will prescribe one or more pain medications to help you manage pain. If your surgeon prescribes multiple medications, it is often because those medications act on different pathways of pain and work better when taken together. Follow all instructions from your physician about how much pain medication to take and how often to take it.

How Should I Keep My Wound Clean After Surgery?

If your surgeon put dressing on after surgery and asked you to leave it on, you will need to keep that dressing clean and dry. You should avoid any activities that might disrupt or dirty your dressing (such as strenuous activity, lifting objects, or other activities). If you are allowed to shower, cover your dressing with a plastic bag or plastic wrap to keep your dressing dry in the shower. 

If you have been instructed to perform dressing changes, your physician will tell you how to cleanse your wound. Some examples of ways you might be instructed to clean your wound are:

• Washing with soap and water: You can use any gentle soap for this. Do not use any soap with glitter, exfoliant, or beads in it, because these can get stuck in your wound. If you have well water at your home, you will need to buy bottled water to cleanse your wound. If you have city water, it is usually safe to use tap water for wound cleansing. 
• Spraying a wound cleanser: Your physician will explain how much to spray on your wound to clean it.
• Using a cleansing wipe: Your physician may instruct you to use a cleansing wipe on your wound or incision. 

After cleansing, you will need to make sure your wound or incision is dry before applying any dressings. In general, you should pat yourself dry with a clean towel and avoid rubbing vigorously.

Which Dressings Should I Use on My Wound?

The type of dressing you will use for your surgical wound will depend on the type of wound and how it is healing. For a general description of different surgical dressings and how to use them, please see our Dressings topic.

How Long Will It Take for My Wound to Heal?

The amount of time it takes to heal after surgery is highly variable. The time it takes a wound to heal can depend on your age, diet, other medical conditions you have or medications you take, smoking, and the type of wound or where it is located.

In general, wounds closed in a straight line heal the fastest, typically between two and six weeks after surgery. Skin graft donor sites and recipient sites usually heal within four to six weeks after surgery. Flap healing time is highly variable, depending on the type of tissue that was used and where the flap was placed. Wounds that are left open to heal from the bottom up take the longest to heal, usually four to 12 weeks. 

There are a few things you can do to help optimize your healing time: 

• Follow all instructions from your physician regarding dressing changes and activity limitations. 
• Eat well. Try to eat nutritious food that is high in protein. You can also take a multivitamin to help supplement the nutrients from your diet. 
• Do not use any products that contain nicotine. This includes cigarettes, gum, patches, vaping, or chew tobacco. Nicotine use slows healing of all wounds. 
• If you have diabetes, try to keep your blood sugar well-controlled.

How Can I Tell if My Wound Is Infected?

Infection can look like many things, depending on the type of infection or the type of wound. Some signs or symptoms that are concerning for infection include: 

• Redness that spreads out from your wound and keeps getting larger
• Fluid draining from the wound, particularly drainage which is thick or yellow
• A bad smell coming from the wound
• New or increasing swelling that does not get better with elevating your limb
• New or increasing pain
• Fever
• Chills or night sweats
• Feeling tired or fatigued
• Nausea or vomiting

What Should I Do if I Think There Is a Problem with My Wound?

If you think there is a problem with your wound, call your surgeon’s office for advice. It can be helpful to take photos of the area you are concerned about so you can share these with your surgeon’s team.