Basics of Wound Care for an Outpatient General Surgery Office
Proper wound care in an outpatient general surgery setting should focus on evidence-based practices that prevent infection, promote healing, and optimize patient outcomes through systematic assessment and appropriate interventions. 1
Preoperative Wound Care Considerations
Skin Preparation
- Remove nail polish and rings before surgery 1
- Use appropriate preoperative skin antiseptics 1
- If hair removal is necessary, use clippers rather than shaving (shaving increases infection risk) 1
- For patients undergoing cesarean section, implement vaginal cleansing with povidone-iodine or chlorhexidine 1
- For Staphylococcus aureus carriers, consider nasal decontamination 1
Postoperative Wound Assessment
Initial Assessment
- Document wound characteristics using a consistent assessment method 2:
- Size/dimensions (length, width, depth)
- Wound edges (approximated, rolled, undermined)
- Wound bed appearance (tissue type, color)
- Exudate (amount, type, odor)
- Surrounding skin condition (erythema, maceration, induration)
Monitoring Healing Progress
- Assess wounds at each visit using the same measurement technique 2
- Document changes in wound volume/size as percentage of baseline 3
- Look for signs of complications:
- Increasing pain, erythema, or drainage
- Fever or systemic symptoms
- Wound dehiscence or separation
Wound Cleansing and Care
Cleansing Technique
- Clean wounds with sterile normal saline (no need for iodine or antibiotic solutions) 1
- Remove superficial debris gently 1
- Avoid aggressive debridement that could enlarge the wound 1
Dressing Selection
- Consider patient preferences when choosing dressings 1
- Factor in cost considerations 1
- For clean, healing surgical wounds:
- Simple non-adherent dressings are often sufficient
- Change dressings when soiled or as directed
Topical Treatments
- For minor cuts, scrapes, and burns, a small amount of topical antibiotic (like bacitracin) may be applied 1-3 times daily 4
- Infected wounds should not be closed 1
Wound Complications Management
Infection Prevention and Management
- Implement general strategies to reduce cross-infection 1
- For superficial mild wound infections: consider topical antimicrobials 5
- For deeper mild and moderate infections: use oral antibiotics 5
- For severe infections: initiate parenteral antibiotics 5
Special Considerations
- Hand wounds often require more aggressive care than wounds on fleshy parts 1
- Elevation of swollen body parts accelerates healing 1
- Follow up with outpatients within 24 hours either by phone or office visit 1
- Consider hospitalization if infection progresses despite good antimicrobial therapy 1
Patient Education
- Instruct patients on proper wound care at home:
- How to clean the wound
- When and how to change dressings
- Signs of infection requiring immediate attention
- Activity restrictions
- Wounds can get wet within 24-48 hours after suturing without increasing infection risk 5
When to Refer
- Severe burns 5
- Wounds covering large areas of the body 5
- Wounds involving the face, joints, bone, tendons, or nerves 5
- Wounds that fail to show improvement after 4 weeks of conventional care 6
- Wounds with large volumes and higher grades that are less responsive to conventional care 6
Common Pitfalls to Avoid
- Using antiseptic solutions when sterile saline is sufficient 1
- Performing aggressive debridement that could enlarge the wound 1
- Closing infected wounds 1
- Failing to document wound characteristics consistently 2
- Neglecting to elevate swollen body parts 1
- Overuse of antibiotics for simple, clean wounds 5
- Delaying referral for wounds that fail to improve with conventional care 6
Remember that most chronic wounds (78%) will heal with conventional wound care regardless of etiology, but large wounds with higher grades may benefit from advanced treatments early in the course 6.