Management of Post-Appendectomy Erythematous Wound with Serous Discharge

Assessment and Initial Management

The primary therapy for surgical site infections (SSIs) is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention, as recommended by the Infectious Diseases Society of America 1, 3
Erythema around the wound with serous discharge after stitch removal strongly suggests early surgical site infection that requires intervention, with a high degree of certainty 1
Physical appearance of the incision provides the most reliable information for diagnosis of SSI, with local signs of pain, swelling, erythema, and drainage usually present, according to the Centers for Disease Control and Prevention 2

Complete opening of the wound is necessary to properly drain any infected material, considered the standard of care for managing suspected SSIs, with a strong level of evidence 1, 2
After opening the wound, any purulent or serous material should be drained, and consider obtaining cultures if purulent drainage is present, as recommended by the Surgical Infection Society 1

If there is minimal surrounding evidence of invasive infection and minimal systemic signs of infection, antibiotics are unnecessary, according to the Infectious Diseases Society of America 1, 2
For patients with temperature >38.5°C or pulse rate >110 beats/minute or erythema extending beyond the wound margins for >5 cm, a short course (24-48 hours) of antibiotics may be indicated, with a moderate level of evidence 1

Delayed primary skin closure is not recommended as it increases the length of hospital stay and overall costs in open appendectomies with contaminated/dirty wounds and does not reduce the risk of SSI, according to the World Health Organization 4, 5
Surgical site infections rarely occur during the first 48 hours after surgery, with fever during that period usually arising from non-infectious causes, as stated by the American College of Surgeons 1, 6

Patients should be instructed to return if they develop fever >38.5°C, increasing pain, spreading redness, or purulent discharge, as recommended by the American College of Surgeons 1