Postoperative Incisional Care Guidelines
Postoperative incisional care should include early dressing removal within 48 hours, daily incision washing with chlorhexidine, and avoidance of routine topical antibiotics for clean incisions. 1
Core Components of Incisional Care
Dressing Management
- Remove sterile dressings within 48 hours after surgery 1
- No significant difference in surgical site infection (SSI) rates between impermeable adhesive drapes and absorbent dressings 2
- Patients may shower or bathe as part of normal daily hygiene before suture removal without increased infection risk 3
Wound Cleansing
- Daily incision washing with chlorhexidine is recommended after dressing removal 1
- Chlorhexidine-alcohol is preferred to aqueous povidone-iodine solution for skin cleansing 1
Antibiotic Use
- Topical antibiotics should only be used for small, clean incisions rather than large or contaminated wounds 4
- When indicated, mupirocin 2% is effective against common pathogens including Staphylococcus aureus and streptococci 4
- Limit topical antibiotic use to 5-7 days to prevent development of resistance 4
- Systemic antibiotics should not be used routinely for postoperative prophylaxis 1
- Systemic antibiotics are indicated for incisional SSIs with any Systemic Inflammatory Response Syndrome criteria, signs of organ failure, or in immunocompromised patients 1
Special Considerations
Infected Incisions
- Incisional SSIs require prompt and wide opening of the surgical incision 1
- Clean technique, appropriate dressing changes, and monitoring for signs of infection are essential 4
Drainage Management
- Routine prophylactic use of surgical drains is discouraged given lack of evidence for benefit in clean and clean-contaminated cases 1
- If drains are used, they should be removed as soon as clinically appropriate
Advanced Wound Care Options
- Incisional Negative Pressure Wound Therapy (INPWT) may be beneficial for high-risk surgical incisions to decrease infection and seroma/hematoma formation 5, 6
- Consider INPWT for patients with multiple comorbidities or other risk factors for poor wound healing
Risk Factors and Prevention Strategies
Preoperative Measures
- Preoperative shower or bath with soap or antiseptic agent at least the night before surgery 7
- Appropriate timing of prophylactic antibiotics (within 60 minutes before skin incision) 1
- Eradication of staphylococcal colonization with topical intranasal therapies in carriers 1
Intraoperative Measures
- Maintenance of normothermia during surgery 1
- Glycemic control with blood glucose target levels less than 200 mg/dL 1, 7
- Appropriate skin preparation with alcohol-based agents unless contraindicated 7
Common Pitfalls to Avoid
- Prolonged use of occlusive dressings beyond 48 hours
- Unnecessary use of topical antibiotics on clean, healing incisions
- Restricting showering or bathing unnecessarily (no evidence this increases infection risk) 3
- Continuing systemic antibiotics postoperatively when not indicated 1
- Failing to recognize and promptly address signs of incisional infection
By following these evidence-based guidelines for postoperative incisional care, healthcare providers can optimize wound healing while minimizing the risk of surgical site infections, ultimately improving patient outcomes and quality of life.