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Surgical Wound Care: Questions and Answers

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Introduction
If you are preparing for spine surgery, or have recently undergone a procedure, you may have questions about your surgical wound. Below are common questions, and the answers, surgical patients ask about this aspect of their care.

What does the surgeon use to close the wound?
The different types of closures that you will hear about are sutures, staples, and Steri-Strips?. In most instances, you will have a combination of wound closure techniques. Your surgeon will decide which type of closure he will use for your surgical wound.

Your surgical wound will be closed in multiple layers. In essence the surgeon will first close your muscle layer and then your skin layer. Some types of suture are used to close the muscle layer or layers first. This is common practice.

What is the difference between sutures, staples and Steri-Strips??
Sutures are what most people call stitches. This is when the surgeon actually uses material similar, but stronger, than thread. There are many different types of suture material available to your surgeon. Most often the physician chooses the type of suture to be used based on personal preference. Using a needle and thread the surgeon will sew your wound closed.

Whether your surgeon uses sutures, staples or Steri-Strips? is once again based on the surgeon's preference and his decision of how important it is to close your wound rapidly. Using the Steri-Strip? method requires a closure with many small stitches of the layer immediately below your skin. The Steri-Strips? (which look like tape strips) are placed across the wound to hold the skin edges together. This often takes considerable time in the operating room and may not be indicated if (1) the time of your surgery is extended, (2) you have had previous surgery in the area, (3) your healing may be compromised due to other health problems or, (4) you have any other health concerns that would not make this type of closure the best method for you.

Staples are small metal clips that hold the wound closed. This method allows the surgeon to close your wound more rapidly. Your surgeon is the best judge as to the type of closure appropriate for your surgical wound.

Do all sutures dissolve?
There are many types of suture material, some of which are dissolvable and some are not. The type of suture used to close your wound will depend on whether your surgery is in the front or back of the spine. In many instances, a combination of closure material is used. Some of the suture material will dissolve once your wound is completely healed. You may ask your surgeon about the type of closure he plans for your wound.

Is it painful to have sutures and staples removed?
Removing either sutures or staples may be uncomfortable but should not be painful. Your surgeon or nurse will explain how long this will take for your particular wound. Obviously, the longer the wound the greater time it will take to remove your sutures or staples. Removal of the closure material normally ranges from one to five minutes depending on the length of the wound and the number of sutures or staples to be removed.

How is the wound bandaged?
Immediately after surgery your wound will be covered with sterile bandages. Normally this first bandage, often referred to as the surgical dressing, will be removed the day after surgery. The surgeon or nurse will examine your wound to be sure that it looks as expected. Depending on the type of closure you have had and your surgeon's preference, another bandage may be applied. Do not be concerned if no bandage is reapplied. Once again, your surgeon will make this determination.

How should I care for my wound?
There is very little care that needs to be given to your surgical wound. The most important aspect for the first 72 to 96 hours will be to keep the wound dry and clean. Your surgical wound will be assessed each day by your surgeon and nurses to be sure that it is progressing and that no signs of infection are present. They will alert you to any concerns that they have about your wound and give you specific instructions regarding your wound care.

Is it normal for the wound to itch?
A few days after your surgery you may notice some itching near your surgical wound. Most people say that is a sign of healing but it may also be a result of the Steri-Strips? or other tapes that have been used. It is best to avoid itching the wound. If it becomes too much of a problem, speak with your surgeon or nurse. They may order medications by mouth or some topical cream to help make this more tolerable.

How do I take care of my wound at home?
When you go home from the hospital you should have someone look at your wound on a daily basis. It is normal to have some fullness in your wound after spine surgery. This is a result of swelling or hematoma. A hematoma is an accumulation of blood that has occurred during and after your wound was closed. In most cases, your body will absorb this fluid with no additional concern.

If the hematoma is significant and has not begun to resolve after several days, your surgeon may want to remove the fluid by aspirating the wound. Other signs of concern will be redness or drainage from the wound. If the swelling is increasing, the wound becomes red / inflamed or you notice drainage, you should contact your surgeon or nurse for additional instructions.

When can I take a shower?
Your surgical team will make a determination about when you can take a shower. However in most cases this will be approximately 4 to 5 days after your surgery. Be sure to ask your surgeon or nurse about the timing of that first shower. Normally baths are discouraged for the first couple of weeks due to difficulty getting in and out of a bathtub, as well as avoiding soaking the wound in bath water.

Does it take a long time for the wound to heal?
Your wound will be healed within two weeks from your surgery unless there has been some reason to delay that healing. In addition people that have other medical problems such as diabetes, people who need to take daily steroids for other conditions, and those people whose immune system may be compromised, may need additional time for their wounds to completely heal. If you have questions about the time it will take for your wound to heal, discuss this with your surgeon.

Is wound care different for a child?
Children's wounds heal very quickly and normally without problem. Preventing your child from itching the wound or touching the wound is very important. If the child requires the use of a diaper, an additional measure to protect a surgical wound in that area is necessary. Special bandage material that forms water tight protection for the wound will be used until the wound is healed.

Other Questions?
If your questions have not been answered, we urge you to discuss your concerns with your surgeon.

Updated on: 09/07/12
Thomas G. Lowe, MD
How surgical incisions are closed and how they are managed postoperatively are commonly asked questions by patients. As pointed out in this article surgeons differ somewhat in what they use to close wounds following spine surgery based on physician preference and based on the location of the wound and other factors specific to the individual patient which may effect wound healing such as age, diabetes, or the use of certain long-term medications such as steroids. The author nicely outlines answers to commonly asked questions concerning wound care that should provide useful information to the patient undergoing spine surgery.
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