How can I promote quick healing of a surgical incision?

Promoting Quick Healing of Surgical Incisions

For closed surgical incisions at risk of complications, apply incisional negative pressure wound therapy (NPWT) immediately after closure to significantly reduce wound complications, infection rates, and dehiscence while supporting early mobility. 1

Primary Strategy: Incisional NPWT for High-Risk Incisions

Application of incisional NPWT on closed incisions should be considered to facilitate healing (Grade B recommendation). 1 This approach has demonstrated:

• Significant reduction in wound complications including wound dehiscence compared with standard gauze dressings in comparative studies 1
• Reduced incidence of infection in wounds treated with incisional NPWT versus standard dressings 1
• "Splinting effect" that aids patient mobility by supporting the wound, which is important for reducing ICU stay duration and improving long-term outcomes 1

The mechanism works by contracting wound edges, removing exudate and inflammatory material, promoting angiogenesis, and creating a protective barrier during the critical healing period. 2

Initial Wound Care Protocol (First 48 Hours)

Keep the surgical wound dressing undisturbed for a minimum of 48 hours after surgery unless significant leakage occurs, and avoid getting the wound wet during this initial period. 3

• If dressing changes are needed due to saturation, use sterile technique 3
• This 48-hour period is critical for initial wound stabilization 3

Post-48 Hour Wound Management

After 48 hours, remove the initial sterile dressing and implement daily incision washing with chlorhexidine to reduce surgical site infections. 3

• Avoid using tape directly on the skin; instead use gauze bandages or tubular bandages to secure any new dressings 3
• Gentle cleansing around (not directly on) the incision line may be performed 3

Infection Prevention and Monitoring

Monitor closely for signs of infection including increased pain, erythema, purulent drainage, or fever. 3

Key warning signs requiring immediate attention:

• Temperature >38.5°C or heart rate >110 beats/minute 4
• Erythema extending >5 cm from the wound edge 4
• Purulent drainage or increasing wound induration 4, 5

If infection develops, the primary treatment is prompt and wide opening of the surgical incision to evacuate infected material, with antibiotics added only when systemic signs are present. 4, 5

Evidence for NPWT Effectiveness

The evidence supporting incisional NPWT extends beyond abdominal wounds:

• Multiple comparative studies (Level 1 and Level 2 evidence) across various surgical indications demonstrate reduction in complications through NPWT application to closed incisions 1
• In high-risk amputation patients, incisional NPWT resulted in only 4% infection rate with no dehiscence, seroma, or hematoma formation 6
• The technique is particularly valuable for incisions with compromised blood supply or prior surgical procedures in the area 6

Special Considerations

For patients with multiple comorbidities or factors that may impair wound healing, more frequent wound assessment is necessary. 3

• Continue any prescribed prophylactic antibiotics as directed, though extending beyond the recommended period does not reduce surgical site infections 3
• Avoid hyperthermia during the recovery period as it may increase risk of infection 3

Common Pitfalls to Avoid

Do not remove dressings before 48 hours unless there is significant leakage, as premature exposure can compromise healing. 3

Do not delay opening an infected incision - delayed drainage can lead to progression of infection and deeper tissue involvement. 4, 5

Do not routinely prescribe antibiotics for superficial incisional infections - most can be managed with incision and drainage alone without antibiotics unless systemic signs are present. 4, 5