Dressings After Hand Injury or Surgery

“Dressing” is the word medical professionals use to describe the materials placed on top of a wound or incision. After a hand injury or surgery, your physician may use a dressing to keep your wound clean and protected. There are several kinds of dressings used for wounds and incisions on the hand and arm. While your wound heals, you may use more than one kind of dressing.

Your physician may ask you to leave your dressing in place until you return for an appointment. This involves keeping your dressing clean and dry, as well as avoiding any activities that might disrupt, wet, or dirty your dressing (i.e., strenuous activity, lifting, etc.) That typically means using a sealed plastic bag over the arm and hand while bathing.

If needed, your physician might give you instructions and materials to do dressing changes on your own. This usually involves removing your existing dressings, cleansing your wound or incisions, sometimes adding ointments, and replacing your dressings. If you are instructed to do dressing changes, make sure you understand what dressings to use and how often to change them. It can initially be helpful to ask your physician or one of their assistants to show you how to change your dressing. You can also ask them to watch while you practice changing your dressing to make sure you are doing it correctly.

Wound Cleansing

An important step in any dressing change is cleansing your wound or incision. Your physician will tell you how to cleanse your wound as soon as it’s ready to get wet. 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.

Types of Dressings

Surgical glue

Some incisions are closed with absorbable sutures beneath the skin and surgical glue. Surgical glue is usually a shiny, hard layer on top of your skin (see Figure 1). The surgical glue falls off on its own over time. You can get the glue wet, but you should not use any ointments or lotions on the glue, as these can cause the glue to dissolve early.

Ointment

Ointment is a cream or gel used to keep a wound or incision moist. Some ointments such as Bacitracin, Neosporin, Polysporin, and Triple Antibiotic Ointment have an antibiotic in them. Other ointments such as Vaseline and Aquaphor do not have antibiotic in them. If they are used, ointments are usually the first layer of a dressing, applied directly onto an incision or wound. You only need a thin layer of ointment to keep the wound moist, just enough to make it look greasy. You can apply ointment with your finger or using a q-tip.

Splint

A splint is a hard material that holds your joints still. Sometimes, a splint protects a fracture or a repaired structure. Other times, splints are used to help you remember to rest your hand while it is healing. You will use the same splint for every dressing change. Splints can be made of plaster, ortho-glass, or plastic. A plastic splint in sometimes called an orthosis (see Figure 2). If your splint is made of plaster or ortho-glass, it is very important to keep it dry because getting it wet will cause the splint to lose its shape. If you accidentally get your splint wet, you need to call your physician to get a new splint.

Packing

If you have an open wound that is deep, your physician may instruct you to pack the wound. This type of dressing is used to get wounds to heal from the bottom in layers of healing tissue until eventually the wound is closed. The packing material you use will depend on the size of your wound. You should only use one continuous piece of packing material to pack your wound so nothing gets left in your wound on accident. You should place packing material gently just to fill the wound, but do not over-pack it. Examples of material used for packing include gauze packing strips and gauze roll (also known as Kerlix).

Non-stick gauze

If your wound or incision uses ointment or if it has blood or fluid leaking from it, your physician may instruct you to use non-stick gauze as a barrier between the wound and the rest of the dressings. This gauze is used to keep the rest of your dressings from sticking to any dried blood or fluid that might come from your wound. Non-stick gauze is very important to making dressing changes more comfortable for you. Examples of brand-name non-stick gauze include Adaptic, Telfa, and Xeroform. There are many over-the-counter versions of non-stick gauze, as well, which are usually labelled as “non-stick pads,” “non-adherent pads,” or “non-adherent gauze.”

Absorbent padding

If your wound is leaking small amounts of blood or fluid, your physician might instruct you to use absorbent padding as part of your dressing. Examples include dry gauze squares, Kerlix gauze roll, and abdominal pads (also known as ABD pads). To know how much padding to use, pay attention to how much padding there is when you remove your dressing. When you replace the dressing, use the same amount.

Bandage wraps

To hold your other dressings in place, you may be instructed to use a bandage wrap. This usually comes in a roll. Examples are Ace Bandages and Coban wraps. It is very important not to put these on too tightly. Only wrap them tight enough to keep everything in place, but not so tight that they are painful. The coban wrap should be placed in separate strips, as this type of wrap specifically gains tightness with every pass and overtightening this wrap can have serious consequences.

Wound VAC or negative pressure wound therapy

A wound VAC (Vacuum-Assisted Closure), sometimes called negative pressure wound therapy, is a specialized dressing applied by a healthcare professional. It consists of a foam bandage covered with adhesive and hooked up to a machine that creates suction. The wound VAC can remove fluid from a wound, reduce swelling, and help an open wound heal faster. It can also be used as a dressing over a skin graft. If your wound was dressed with a wound VAC, this will be changed by your physician’s office, or they may arrange for someone to come to your house regularly to change it (known as Home Health).

Drains

After some surgeries, your surgeon may choose to use a drain, which is placed inside your wound at the time of surgery and is usually hooked up to a bulb or container. This helps remove extra fluid from your wound until your body heals enough to remove that fluid by itself. The drain is usually sewn in place to keep it from falling out. Your physician may ask you to keep track of how much fluid comes out of your drain. Because there are many types of drains, you will be shown how to do this by a medical professional. Your drain will usually be removed at your physician’s office.

© 2022 American Society for Surgery of the Hand

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.