Wound Care

Overview

Taking care of your incision(s) or wounds after surgery is very important. It decreases the amount of pain, improves speed of recovery, and most importantly decreases the risk of infection. Please review specific discharge instructions from your doctor but below is general information.

  • Do NOT apply any ointments, solutions or lotions to pin sites or surgical wounds.

    • Even though solutions, like hydrogen peroxide kill bacteria, they also damage cells lining the incision/pin sites that can help fight infection.

    • Lotions/ointments can keep wounds moist and cause them to breakdown and open up (increasing the risk of infection).

  • Surgical incisions should be dressed daily

    • Each day it should be inspected to look for signs of infection as noted below

  • If any drainage is noted the following should be applied:

    • Use one layer of a non-adherent (non-stick) dressing, like adaptic, 4x4 gauze, Kerlix wrap, and ACE wrap

    • This may need to be changed more than once a day

  • Once incision is completely dry and without drainage, it may be left open to air

    • Showering may begin 36-48 hours later

    • Clean wounds/incisions with soap and water once cleared to do so. Do NOT rub/scrub incision

    • Do NOT soak incision until clear by your doctor

General Information

  • Always wash your hands before and after changing your dressing. You can use an alcohol based cleaner but soap and water is most effective.

  • Avoid direct sunlight for at least 6-9 months to decrease scarring and visibility of your scar

  • Vitamin E can be used once cleared by your doctor to potentially improve appearance of your incision

Infection

When a wound gets infected it can cause disastrous consequences. It can make you sick (sepsis), decrease the chance of your fracture healing (non-union), or can even increase the risk of having another surgery.

Signs of infection:

  • Increased redness around the wound or incisions

  • Increased warmth and increased tenderness

  • Increased amount of drainage or change in consistency of drainage (yellow or green color)

    • Clear or bloody drainage can be normal, call your doctor with any questions

  • Foul smelling odor to drainage or incision

  • Fever

  • Increased or unusual pain

External Fixator Pin Sites

Sometimes you will be discharged from the hospital with an external fixation device. The following are instructions how to care for the pin sites:

  • Dress pins daily with Kerlix roll starting on postoperative day 2. Wrap the Kerlix so that it tamps the skin down around the pin-skin interface to prevent/limit motion of the skin relative to the pin (Pin-skin motion is the primary cause of pain and infection related to external fixator pin sites).

  • Remove any crust or coagulum that may obstruct drainage with saline moistened gauze or soap and water

  • After postoperative day 3, if there is no drainage from pin sites, the dressing can be changed every other day

  • You may shower with the fixator, cleaning all pin sites gently with soap and water

  • The extremity can be lifted by the fixator to facilitate wound care and transfers

Swelling

  • Using ice and elevating the injured extremity above your heart can help with swelling and pain control.  Icing in a pulsatile fashion, such as 20 minutes on and 20 minutes off, can be followed. 

  • Do not place ice directly on skin. Make sure there is a barrier between to skin and the ice pack. Using frozen items such as frozen peas works well as the conform nicely to the area that needs to be iced.

  • In addition to icing and elevation, Ace wraps or TED hose are used to help limit and resolve swelling.  It is recommended to use Ace wraps or TED hose until you are informed to stop. 

  • When using Ace Wraps start the wrapping distally (farthest away from the body) and wrap proximally (closer to the body)

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