Surgery - Incision Symptoms

Is this your symptom?

  • Concerns or questions about a surgical wound or incision site.
  • A common concern is wound infection. Symptoms of infection include spreading redness or red streaks, pus, and increasing pain or swelling.

Key Points

  • Most surgical wounds heal without any problems.
  • Mild swelling and pain at the incision site are normal.
  • It is important to keep the site clean and protected as it heals.
  • Watch the site for signs of infection such as spreading redness or red streaks, pus, and increased pain or swelling.

Problems - Surgical Wound or Incision

Wound infection is the most common problem that can occur with surgical wounds. Symptoms of wound infection include:

  • Fever
  • Lymph node near wound becomes large and tender
  • Pain or swelling that gets worse 48 hours after surgery
  • Pus or bad-smelling fluid drains from wound
  • Spreading redness occurs around the wound (cellulitis)
  • Red streak is spreading from the wound toward the heart (lymphangitis)

Wound infection occurs more often with abdomen (belly) and emergency surgeries. Other risk factors for surgical wound infections include:

  • Diabetes
  • Older age
  • Overweight
  • Smoking
  • Weak immune system

Less common surgical wound problems include:

  • Bleeding
  • Surgical wound hematoma (collection of blood in tissues)
  • Surgical wound starts to open up

Causes

  • Bacteria on the skin cause most wound infections.
  • Your skin is a natural barrier that keeps out germs (bacteria).
  • Surgery causes a break in the skin barrier. This allows bacteria to enter and cause infection.

Prevention

  • Follow your post-op instructions for wound care and activity restrictions.
  • Keep your wound clean.
  • Protect the incision from injury during the first month.
  • Avoid vigorous exercise or strenuous work for the first month (or longer for some surgeries).
  • Do not smoke for the first month after surgery. Smoking slows wound healing.

When Should Stitches (Staples) Be Removed?

Your surgeon should tell you when your stitches (or staples) need to be removed. These are general guidelines for when they should be taken out:

  • Face: 4 to 5 days
  • Neck: 7 days
  • Scalp: 7 to 10 days
  • Back, chest, and abdomen: 7 to 10 days
  • Arms and back of hands: 7 days
  • Legs and top of feet: 10 days
  • Fingers and toes: 10 to 14 days
  • Palms and soles: 12 to 14 days
  • Overlying a joint: 12 to 14 days

When to Call for Surgery - Incision Symptoms

When to Call for Surgery - Incision Symptoms

Call 911 Now

  • Major stomach or abdomen incision and wound gaping open and visible internal organs
  • You think you have a life-threatening emergency

Call Doctor or Seek Care Now

  • Severe pain in the incision
  • Fever
  • Incision looks infected (spreading redness, pain) and large red area
  • Incision looks infected (spreading redness, pain) and on face
  • Red streak runs from the incision
  • Stitch (or staple) came out early and wound has re-opened
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Increasing pain in incision and more than 2 days since surgery
  • Incision looks infected (spreading redness, pain)
  • Pus or bad-smelling fluid draining from incision
  • Pimple where a stitch (or staple) comes through the skin
  • Clear or blood-tinged fluid draining from incision
  • Overdue to have stitches (or staples) removed
  • Stitch (or staple) came out early and wound is still closed
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Mild pain and swelling at the incision site
  • Questions about sutured or stapled surgical incision

Call 911 Now

  • Major stomach or abdomen incision and wound gaping open and visible internal organs
  • You think you have a life-threatening emergency

Call Doctor or Seek Care Now

  • Severe pain in the incision
  • Fever
  • Incision looks infected (spreading redness, pain) and large red area
  • Incision looks infected (spreading redness, pain) and on face
  • Red streak runs from the incision
  • Stitch (or staple) came out early and wound has re-opened
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Increasing pain in incision and more than 2 days since surgery
  • Incision looks infected (spreading redness, pain)
  • Pus or bad-smelling fluid draining from incision
  • Pimple where a stitch (or staple) comes through the skin
  • Clear or blood-tinged fluid draining from incision
  • Overdue to have stitches (or staples) removed
  • Stitch (or staple) came out early and wound is still closed
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Mild pain and swelling at the incision site
  • Questions about sutured or stapled surgical incision

Home Care Advice

General Care Advice for Incisions

  1. Follow Your Surgeon's Instructions:
    • Closely follow all the instructions your surgeon gave you.
    • If the care advice below is different, follow your surgeon's instructions instead.
  2. Keep Incision Clean and Dry:
    • Keep the incision dry for first 24 hours after surgery (use a sponge bath).
    • Your surgeon will tell you when you can remove your dressing. When the dressing is removed, you can shower. Avoid water pressure directly on the incision. Pat the incision area dry with a clean towel.
    • Apply a small amount of petroleum jelly (Vaseline) on the wound daily. You can buy this at the store. This helps protect the wound and limits scarring. Exception: if your doctor recommended an antibiotic ointment, use that instead.
    • Do not bathe or swim for 2 weeks (or whenever the surgeon says it is ok).
  3. Changing a Dressing:
    • Change the wound dressing if it gets wet or dirty.
    • Follow the dressing directions your surgeon gave you.
    • A dressing that works well is a Telfa dressing covered by gauze. Telfa is a dressing that does not stick to the skin. You can buy it at the drugstore. Place a piece of Telfa on the wound and cover it with a gauze pad.
    • Keep the dressing in place in the same way the surgeon did (such as tape or ace wrap).
    • In most cases, a dressing is no longer needed when the edges of the wound close (usually 48 hours). However, your surgeon may instruct you leave the dressing on longer. This can help protect the wound and catch any drainage.
  4. Cold Pack for Pain:
    • Use cold pack for the first 24 to 48 hours after surgery.
    • Cold helps reduce pain and swelling.
    • Apply the cold pack (or an ice bag wrapped in a towel) to the incision area for 15 minutes.
    • Repeat this once an hour as needed.
  5. Mild Itching:
    • As the incision heals, mild itching is common.
    • Do not scratch. This increases the risk of infection.
  6. Do Not Smoke:
    • Do not smoke during the first month after surgery.
    • Smoking slows wound healing.
  7. Protect the Wound:
    • Protect the wound from injury during the month after surgery.
    • Avoid any vigorous activity or heavy lifting for 4 weeks. Follow your surgeon's instructions for other activity restrictions.
    • At one week after surgery, the incision tissue strength is only 10% of normal. At one month after surgery, the strength is 50% of normal.
  8. What to Expect:
    • Pain and swelling: Incision pain and swelling are often worst on day 2 and 3 after surgery. The pain should slowly get better during the next 1 to 2 weeks.
    • Redness: Mild redness along the incision is common. It should gradually get better and go away. Call your doctor if the red area spreads (gets larger) or red streaks occur. These could be signs of an infection.
    • Drainage: Small amounts of clear drainage or a few drops of blood from the incision are common in the first few days. Call your doctor if the drainage increases, becomes cloudy (pus), or smells bad. These could be signs of an infection.
    • Itching: Mild itching is common as the incision heals. It should go away when the wound is healed.
  9. Call Back If:
    • Incision looks infected (increasing redness, tenderness, pus-like drainage)
    • Incision edges start to gape open
    • Fever occurs
    • You think you need to be seen
    • You get worse

Over-the-Counter Pain Medicines

  1. Pain Medicine:
    • You can take one of the following drugs if you have pain: acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve).
    • They are over-the-counter (OTC) pain drugs. You can buy them at the drugstore.
    • Use the lowest amount of a drug that makes your pain feel better.
    • Acetaminophen is safer than ibuprofen or naproxen in people over 65 years old.
    • Read the instructions and warnings on the package insert for all medicines you take.
  2. Call Your Doctor If:
    • You have more questions
    • You think you need to be seen
    • You get worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2023.

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