Orthopaedic Surgical Wound Care — When Should You Change the Dressing?

Polish version · Before and After Orthopaedic Surgery

The most important rule is to keep an orthopaedic surgical dressing clean and dry and to follow the wound-care instructions given for the specific procedure. Not every wound needs to be uncovered or redressed every day. A small amount of staining can be normal, but increasing drainage, separation of the wound edges, spreading redness, fever or worsening pain should prompt contact with the treating team.

Why are wound-care instructions different after different operations?

A wound after arthroscopy, fracture fixation or joint replacement may be closed with different materials and protected by different dressings. Drains, negative-pressure wound therapy, coexisting medical conditions and medicines that affect clotting can also change the plan. For that reason, written discharge instructions take priority over general advice.

When should the dressing be changed?

If the dressing is dry, sealed and adheres well, it can often remain in place for the period recommended by the orthopaedic surgeon or the dressing manufacturer. It should be changed sooner if it becomes wet, soiled, loose or if drainage reaches the edge. Specialist dressings and negative-pressure systems should not be removed independently unless this has been specifically advised.

How can a dressing be changed safely?

• Wash and dry your hands thoroughly before touching the dressing and again after the change.
• Prepare a clean surface and the materials recommended at discharge.
• Do not touch the surface of the new dressing that will lie directly against the wound.
• Remove the old dressing gently without pulling on sutures, skin-closure strips or tissue adhesive.
• Do not apply creams, ointments, powders or topical antibiotics to the wound unless they have been specifically prescribed.
• If the wound looks different from before, note the change and contact the treating team when appropriate.

Can the wound be washed or soaked?

NICE guidance indicates that showering is generally safe from 48 hours after surgery. This is not a universal instruction to wet every wound or dressing: the type of closure, a drain, a negative-pressure dressing or an individual instruction from the surgeon may require a different approach. After showering, the area should be dried gently without rubbing.

Bathing, swimming, sauna use and prolonged soaking require more caution. They are usually postponed until the skin has fully closed and the wound has been reviewed. Prolonged water exposure can soften the wound edges and increase the risk of contamination.

What can be normal during the first few days?

• a small, non-increasing blood stain or a small amount of clear or lightly pink fluid on the dressing;
• moderate tenderness that is not progressively worsening;
• mild swelling and bruising around the operated area;
• a pulling sensation in the skin during movement.

The direction of change matters more than a single appearance. Over time, the wound should become calmer, while drainage and pain should gradually decrease.

When does the wound need prompt review?

• redness, warmth or swelling that is spreading around the incision;
• pain that is increasing rather than decreasing, especially after an initial improvement;
• cloudy, thick or unpleasant-smelling drainage;
• a dressing that repeatedly becomes rapidly soaked with blood or fluid;
• separation of the wound edges or a visible deeper defect;
• fever, chills or a clear deterioration in general wellbeing;
• new numbness, limb weakness, pallor or blue discolouration of the fingers or toes.

After an operation involving an implant, even a small but persistent wound discharge should not simply be left until a distant routine follow-up. Early assessment can help distinguish superficial irritation from a problem that requires treatment.

When are sutures or staples removed?

The timing depends on the anatomical site, skin tension, closure method and healing rate. Sutures, staples, tissue adhesive and closure strips should not be removed independently. The wound should be reviewed at the time specified in the discharge instructions even when it appears normal from the outside.

What increases the risk of wound-healing problems?

Closer observation may be appropriate in people with diabetes, tobacco use, impaired circulation, anticoagulant treatment, reduced immunity, obesity or a previous history of wound-healing problems. These factors do not mean that a complication will occur, but they may justify earlier review.

References

• National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. Published 11 April 2019; updated 19 August 2020. Recommendations.
• Centers for Disease Control and Prevention. Surgical Site Infection Basics. Updated 11 April 2024. CDC information.

Content prepared by: Tomasz Poboży - orthopaedic surgeon.