Definition

Surgery that involves a cut (incision) in the skin can lead to a wound infection after surgery. Most surgical wound infections show up within the first 30 days after surgery.

Surgical wound infections may have pus draining from them and can be red, painful or hot to touch. You might have a fever and feel sick.

Alternative Names

Infection - surgical wound; Surgical site infection - SSI

Causes

Surgical wounds can become infected by:

• Germs that are already on your skin that spread to the surgical wound
• Germs that are inside your body or from the organ on which the surgery was performed
• Germs that are in the environment around you

You are more at risk for a surgical wound infection if you:

• Have poorly controlled diabetes
• Have problems with your immune system
• Are overweight or obese
• Are a smoker
• Take corticosteroids (for example, prednisone)
• Have surgery that lasts longer than 2 hours

There are different levels of wound infections:

• Superficial -- the infection is in the skin area only
• Deep -- the infection goes deeper than the skin into the muscle and tissue
• Organ/space -- the infection is deep and involves the organ and space where you had surgery
  

Treatment

Antibiotics are used to treat most wound infections. Sometimes, you also may need surgery to treat the infection.

ANTIBIOTICS

You may be started on antibiotics to treat the surgical wound infection. The length of time you will need to take the antibiotics varies, but will typically be for at least 1 week. You may be started on IV antibiotics and then changed to pills later. Take all of your antibiotics, even if you feel better.

If there is drainage from your wound, it may be tested to figure out the best antibiotic. Some wounds are infected with methicillin-resistant Staphylococcus aureus (MRSA) which is resistant to commonly used antibiotics. A MRSA infection will need a specific antibiotic to treat it.

SURGICAL TREATMENT

Sometimes, your surgeon needs to do a procedure to clean the wound. They can take care of this either in the operating room, in your hospital room or in a clinic. They will:

• Open the wound by removing some or all of the staples or sutures
• Do tests of the pus or tissue in the wound to figure out if there is an infection and what kind of antibiotic medicine would work best
• Debride the wound by removing dead or infected tissue in the wound
• Rinse the wound with salt water (saline solution)
• Drain the pocket of pus (abscess), if present
• Pack the wound with saline-soaked dressings and cover it with a bandage

WOUND CARE

Your surgical wound may need to be cleaned and the dressing changed on a regular basis. You may learn to do this yourself, or nurses may do it for you. If you do this yourself, you will:

• Remove the old bandage and packing. You can shower to wet the wound, which allows the bandage to come off more easily.
• Clean the wound.
• Put in new, clean packing material and put on a new bandage.

To help some surgical wounds heal, you may have a wound VAC (vacuum-assisted closure) dressing. It increases blood flow in the wound and helps with healing.

• This is a negative pressure (vacuum) dressing.
• There is a vacuum pump, a foam piece cut to fit the wound, and a vacuum tube.
• A clear dressing is taped on top.
• The dressing and the foam piece are changed every 2 to 3 days.

It may take days, weeks, or even months for the wound to be clean, clear of infection, and finally heal.

If the wound does not close by itself, you may need a skin graft or muscle flap surgery to close the wound. If a muscle flap is necessary, the surgeon may take a piece of muscle from your buttocks, shoulder, or upper chest to put over your wound. If you need this, the surgeon will not do this until after the infection has cleared.

Outlook (Prognosis)

If the wound infection is not very deep and the opening in the wound is small, you will be able to take care of yourself at home.

If the wound infection is deep or there is a larger opening in the wound, you may need to spend at least a few days in the hospital. After that, you will either:

• Go home and follow-up with your surgeon. Nurses may come to your home to help with care.
• Go to a nursing facility.

When to Contact a Medical Professional

Contact your health care provider if your surgical wound has any signs of infection:

• Pus or drainage
• Bad smell coming from the wound
• Fever, chills
• Hot to touch
• Redness
• Pain or sore to touch

References

Espinosa JA, Sawyer R. Surgical site infections. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1337-1344.

Weiser MC, Moucha CS. Surgical site infection prevention. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 23.

Yepuri N, Pruekprasert N, Cooney RN. Surgical complications. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 12.