Sutures Need to Remain Dry for at Least 48 Hours After Surgery
Surgical wound dressings should be kept undisturbed and dry for a minimum of 48 hours after surgery unless leakage occurs. 1
Evidence-Based Recommendations for Post-Operative Wound Care
Initial Post-Operative Period (First 48 Hours)
- The World Journal of Emergency Surgery guidelines clearly state that surgical wound dressings should remain undisturbed for a minimum of 48 hours after surgery 1
- This recommendation is based on the understanding that it takes approximately 48 hours for the skin to restore continuity and become impermeable to microorganisms 2
- During this initial period, the dressing acts as a physical barrier to:
- Protect the wound from external contamination
- Absorb exudate from the wound
- Keep the wound clean and dry
After 48 Hours
- After the initial 48-hour period, the dressing can be safely removed 1
- There is no evidence that extending the time a dressing remains in place beyond 48 hours reduces surgical site infections (SSIs) 1
- A Cochrane review found that early dressing removal (within 48 hours) compared to delayed removal showed:
- No significant difference in superficial surgical site infection rates
- No significant difference in wound dehiscence
- Potentially shorter hospital stays and reduced treatment costs 2
Bathing and Showering
- Traditional practice has been to keep surgical wounds dry until suture removal
- However, recent evidence suggests that early bathing or showering (after the initial 48-hour period) does not increase wound complications:
- A 2015 Cochrane review found no conclusive evidence that early post-operative bathing increases SSI rates 3
- A 2000 study of 817 patients with varicose vein surgery found no infections regardless of whether wounds were kept dry or had water contact from the second postoperative day 4
- A recent 2024 randomized controlled trial found that water exposure as early as 6 hours post-surgery did not increase infection rates compared to standard 48-hour dry protocol 5
Special Considerations
Wound Type and Location
- These recommendations apply to primarily closed surgical wounds (where skin edges are approximated with sutures, staples, adhesive tape, or glue) 1
- Different considerations may apply for:
- Contaminated wounds
- Wounds in areas with high bacterial load (perineal region)
- Wounds with drains in place
High-Risk Patients
- Patients with factors that may impair wound healing may require more cautious management:
- Immunocompromised patients
- Patients with diabetes
- Those on corticosteroids
- Patients with nutritional deficiencies 6
Conclusion
While traditional practice has been conservative about keeping wounds dry, current evidence supports that after the initial 48-hour period when the skin barrier has been restored, exposure to water does not significantly increase infection risk. However, the strongest guideline evidence still recommends keeping surgical wounds dry and undisturbed for at least the first 48 hours after surgery.