Postoperative Incision Care

Introduction to Incision Care

• The American College of Surgeons recommends removing sterile dressings within 48 hours after surgery, followed by daily incision washing with chlorhexidine to reduce surgical site infections and promote optimal healing 1

Topical Management

• Early dressing removal and daily chlorhexidine cleansing are strongly supported by evidence as the cornerstone of topical management for healed postoperative incisions, reducing surgical site infections and promoting optimal healing 1
• Chlorhexidine-alcohol is preferred to aqueous povidone-iodine solution for skin cleansing, due to its broader antimicrobial spectrum 2

Scar Prevention and Management

• For patients at risk of problematic scarring, consider adding moisturizers with occlusive properties or silicone-based products to the regimen, with silicone sheets showing particular efficacy in controlled studies 1

Infection Monitoring and Management

• Monitor for signs of surgical site infection, including increased redness, warmth, swelling, purulent drainage, increased pain at the incision site, and systemic symptoms such as fever, and consider prompt and wide opening of the surgical incision if infection is suspected 1
• 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, as recommended by the American College of Surgeons 1
• Systemic antibiotics should not be used routinely for postoperative prophylaxis, unless indicated by the presence of systemic inflammatory response syndrome or organ failure 3
• Systemic antibiotics are indicated for incisional surgical site infections with any systemic inflammatory response syndrome criteria, signs of organ failure, or in immunocompromised patients 3
• Topical antibiotics, such as mupirocin (2%) and retapamulin, are effective against common causes of surgical site infections, including Staphylococcus aureus (including MRSA) and streptococci, according to the Clinical Infectious Diseases guidelines 4, 5
• Mupirocin is the preferred agent for suspected MRSA colonization due to its activity against MRSA, as recommended by the Clinical Infectious Diseases guidelines 5
• Limit use of topical antibiotics to 5-7 days to prevent development of resistance, and consider local resistance patterns when selecting an agent 4
• Incisional surgical site infections require prompt and wide opening of the surgical incision to promote drainage and reduce the risk of further complications 3
• Appropriate timing of prophylactic antibiotics, within 60 minutes before skin incision, is crucial to reduce the risk of surgical site infections 6
• Eradication of staphylococcal colonization with topical intranasal therapies in carriers can reduce the risk of surgical site infections 1
• Maintenance of normothermia during surgery is essential to promote wound healing and reduce the risk of complications 1, 6
• Glycemic control with blood glucose target levels less than 200 mg/dL is important to reduce the risk of surgical site infections and promote wound healing 6

Surgical Drain Management

• Routine prophylactic use of surgical drains is discouraged, given the lack of evidence for benefit in clean and clean-contaminated cases 6
• If drains are used, they should be removed as soon as clinically appropriate to minimize the risk of infection and promote wound healing 6