Wound Management & Dressing

Clinical Objective

Apply appropriate wound closure, dressing, and bandage management to protect the surgical site during the early healing phase, minimize environmental contamination, support patient comfort, and enable regular reassessment.

Why This Matters

The first 24–48 hours are when the wound is most vulnerable. The dressing and bandage are the physical bridge between surgical closure and epithelial healing — they cannot be skipped or treated as optional.

Critical Control Points

• Sterile primary dressing applied before patient leaves the table

• Dressing changes scheduled and documented

• Bandage tension verified by the 2-finger rule

• Bony prominences padded before circumferential wraps

Step-by-Step Protocol

1. 1

   Close the wound in layers, eliminating dead space that provides a nidus for infection.

2. 2

   Irrigate the wound with sterile saline before closure in contaminated or clean-contaminated cases.

3. 3

   Apply a sterile non-adherent primary dressing before the patient leaves the table.

4. 4

   For wounds requiring bandaging: apply a secondary padded layer (cast padding, cotton roll) for cushioning and exudate absorption.

5. 5

   Apply a tertiary conforming and cohesive layer with uniform pressure — verify with the 2-finger rule.

6. 6

   Pad bony prominences (lateral malleolus, olecranon, calcaneus) before any circumferential wrap.

7. 7

   Label the dressing with application date and time.

8. 8

   Schedule bandage changes: 24–48h initially, then every 2–3 days for clean wounds; immediately if wet.

9. 9

   Provide written wound care instructions to the owner before discharge.

Key Pitfalls

• Failing to close dead space — seromas are a common precursor to SSI.

• Applying adhesive dressings directly to fresh sutures without a non-adherent interface.

• Bandaging too tightly — pressure necrosis is a common iatrogenic injury, particularly over bony prominences.

• Failing to pad bony prominences before conforming wrap.

• Allowing the bandage to become wet and not changing it immediately.