Neurology - Caring for your spinal surgical wound

Surgical Wounds

A surgical wound is the cut made to the skin by the surgeon during an operation. At the end of the operation the cut is joined back together with either stitches, steristrips or clips/ staples to allow the skin edges to come together and heal.

The skin edges usually start to heal within a day or two of the operation. The time this takes varies from person to person and from operation to operation.

Dressings

Not all surgical wounds need dressing.

The purpose of a dressing is to:

• Absorb any leakage from the wound
• Provide ideal conditions for healing
• Protect the area until the wound is healed
• Prevent stitches catching clothing

Stitches and Clips/Staples

Stitches are also known as sutures. Steristrips or tapes may also be used.

Most types of stitches must be removed by a nurse or doctor, but some stitches don’t need to be removed as they dissolve.
Dissolvable stitches will typically disappear within four to eight weeks depending on the type.
 
If you are told you need to have stitches and clips to be removed, this can be done by a local district nurse or practice nurse in a local clinic. The ward nurses will send a referral to your local district nurses/practice nurse for these to removed and will be contacted by them regarding an appointment.

Stitches and clips are usually removed 7-14 days after treatment, depending on the type of operation you have had.

If you have stitches, you may see small pieces of the stitch material poking out of your wound – do not be tempted to pull of these. Usually, they will dissolve or be cut away by your nurse. As your skin heals, it is natural for your stitches and wound to itch – it is part of the healing process. Try not to scratch the area and do not apply any moisturises or ointment on your skin to try and reduce the irritation.

Wound healing complications

Most surgical wounds will heal without causing any problems or complications; however, it is possible that your wound may become infected following surgery – where germs have begun to grow in the wound, which typically delays the normal healing process. This is referred to as a ‘surgical site infection (SSI).’
 
If you develop an infection, you will usually be given a course of antibiotics and occasionally, may need to have a further procedure such as surgery or drainage.

You have an increased risk of developing infection if you:

• Smoke
• Have diabetes
• Are overweight or obese
• Have a condition that affects your immune system, such as leukaemia
• Are you undergoing a treatment that affects your immune system, such as chemotherapy

An SSI can develop at any point, until the wound has healed (usually two to three weeks after the operation). It is therefore crucial that you know the different signs and symptoms to look out for when you go home:

• Increased pain
• The skin around your wound becomes more tender, sore, red, and swollen or feels hot
• Your wound has a green or yellow coloured discharge (pus) or blood
• An unpleasant smell
• You feel unwell or feverish, or you have a temperature

If you have noticed any of the above symptoms or are worried about the appearance of your wound, please speak to your GP or contact the ward from which you were discharged. If you develop symptoms whilst in hospital, your nurse will take a swab to be sent to the laboratory for testing.

Taking Care of your Wound

Your nurses and doctors will do all they can to prevent an SSI, however it is important that you know what you can do yourself to help prevent infection and to promote healing.

Changing your dressing

The original dressing will be place for a minimum of 24 hours before your nurse removed and assess the site. Another dressing will then be applied for a further 7 days unless discussions have taken place for removal at an earlier time with yourself. When you go home with a dressing in place, it is important that you know how to remove and change the dressing if necessary and what you look out for on your wound site. If the wound is healing it can be left without a dressing, however you may prefer to have a dressing to cover the wound for protection, especially if your clothing can rub against it.

• Wash your hands with soap and water and dry them thoroughly before removing the dressing
• Carefully take off the dressing whilst trying not to touch the healing wound with your fingers
• Put the used dressing straight in the bin
• You might then be able to leave your wound without a dressing
• If you require another dressing, apply carefully taking care not to touch the inside of the new dressing

Please be advised to continue using only the dressing supplied to you by the hospital or GP/Practice nurse. If you do have any concerns about the current dressing, you are using please contact your GP.

Bathing and showering

You will typically be advised to wait 48 hours post-surgery to shower safely. After 48 hours, a surgical wound can get wet without increasing the risk of infection; however, it depends upon the type of operation. Your doctor/nurse will advise you specifically.

When bathing/showering, there are some important points to consider:

• If possible, have showers rather than baths. It is important not to soak your wound too much as this may soften the scar tissue, causing the skin edges to open. Only take a bath if you are sure, you can keep the wound dry
• Do not put any soap, shower gel, body lotion, talcum powder or other bathing products directly onto your healing wound. This may cause discomfort and encourage an infection. You can gently wash the surrounding skin with mild non-scented soap though
• Do not worry if you splash the wound, but do not rub the wound area. This will cause pain and might delay the healing process
• Pat the wound dry gently with a clean towel after showering/ bathing

Spinal Wound Discharge Assessment

The back of this leaflet is to provide your relatives and community services with information on the condition of your wound when you leave the ward.