What is considered normal healing?
In the first two to three days after surgery, moderate pain, slight swelling and pinkish redness along the suture line are natural: this is what normal inflammation looks like during healing. Possibly scanty blood discharge. A distinctive feature of the norm is that all these phenomena gradually decrease day by day. The reverse dynamics should be alarming: the pain has resumed and intensified, the swelling is increasing, the redness is expanding, the discharge has become cloudy or purulent, the temperature has risen. These are signs of an additional infection that require examination.
- Normal: pain and swelling decrease every day
- Normal: scanty blood discharge in the first days
- Worrying: the pain has returned after improvement
- Alarming: redness is expanding
- Alarming: cloudy or purulent discharge
- Alarming: temperature above 38 °C after the third day
Why does a wound infection occur?
Risk is determined by three groups of factors. The first is related to the operation itself: its duration, volume, intervention on the intestines or in a purulent focus, the presence of drains, accumulation of blood under the suture. The second is the human condition: diabetes mellitus and high glucose levels, obesity, smoking, anemia, exhaustion, taking drugs that suppress the immune system, cancer. The third is wound care after discharge: getting the bandage wet, early exercise, self-treatment with untested means, scratching. Most often, the infection is caused by staphylococci, and after intestinal operations - by intestinal flora.
- Long and extensive operations
- Interventions on the intestines and purulent lesions
- Diabetes and high blood sugar
- Obesity, smoking, anemia
- Hematoma and fluid accumulation under the suture
- Violation of wound care rules
- Decreased immunity
Signs of suppuration
The clinical picture consists of local and general signs. Locally: increasing pain of a pulsating nature, swelling, redness of the skin that extends beyond the suture line, increased temperature of the skin over the wound, discharge of cloudy or purulent fluid, sometimes with an odor. Common symptoms include fever, chills, weakness, and loss of appetite. With deep suppuration, there may be almost no external changes, and persistent temperature and pain come to the fore, so in such cases an ultrasound examination of the wound area is performed.
- Throbbing increasing pain
- Swelling and redness around the stitch
- Local increase in skin temperature
- Purulent or cloudy discharge
- Body temperature, chills, weakness
- Dehiscence of wound edges
What to do and what examinations are needed
If these signs appear, you need to see the operating surgeon as soon as possible, without waiting for a scheduled visit. You cannot remove stitches yourself, squeeze out the contents, apply warm compresses and seal the wound with a thick bandage: this drives the infection deeper. The doctor examines the wound, removes several stitches if necessary, assesses the depth of the lesion, takes the discharge for culture and determines sensitivity to antibiotics. A complete blood count and C-reactive protein are prescribed, and if a deep accumulation is suspected, an ultrasound examination is performed.
- Urgent examination by a surgeon
- Inspection of the wound with removal of some sutures
- Culture of discharge for flora and sensitivity
- Complete blood count and C-reactive protein
- Blood glucose
- Ultrasound of soft tissues with deep suppuration
Treatment and prevention
The basis of treatment is surgical: the wound is opened, pus and non-viable tissue are removed, drainage is ensured and regular dressings are performed. Antibiotics are not always prescribed, but in cases of widespread infection, fever, and in patients at risk, based on the culture result. At the same time, glucose levels, anemia and nutrition are corrected, because without this the wound will not heal well. After cleansing, the wound is either left to heal on its own or secondary sutures are placed. For prevention, sugar control, smoking cessation, and careful stitch care are important.
- Opening the wound and removing pus
- Drainage and regular dressings
- Antibiotics according to indications and culture results
- Glucose control, anemia treatment, nutritious nutrition
- Secondary sutures after cleansing the wound
- Quitting smoking
- Dry, clean bandage and no stress until healing
