Wound Management & Dressing
Clinical Objective
Apply appropriate wound closure and primary dressing to protect the surgical site during the initial healing phase, minimize contamination from the environment, and facilitate early detection of complications. Wound care decisions in the immediate postoperative period significantly influence SSI rates.
Protocol Steps
- 1
Close the surgical wound in layers, eliminating dead space that provides a nidus for infection.
- 2
Irrigate the wound with sterile saline before closure in contaminated or clean-contaminated cases.
- 3
Apply a sterile primary dressing to all wounds at the conclusion of surgery, prior to the patient leaving the table.
- 4
Select dressing type based on wound classification: non-adherent primary layer for most clean wounds.
- 5
Secure the dressing with appropriate secondary layer to prevent patient interference.
- 6
Label the dressing with the application date and time.
- 7
Provide owner with written wound care instructions before discharge.
Key Pitfalls to Avoid
Failing to close dead space, particularly in large dissections — seromas are a common precursor to SSI.
Applying adhesive dressings directly to freshly sutured wounds without a non-adherent interface.
Leaving wounds undressed in the immediate postoperative period on the assumption they are 'sealed' by sutures.
Using occlusive moisture-retaining dressings on wounds at risk for anaerobic infection.
The first 24–48 hours are when the wound is most vulnerable. An intact epithelial seal typically forms by 48 hours, but this requires an undisturbed wound environment. Any patient activity, licking, abrasion, or moisture ingress in this window meaningfully elevates infection risk. The dressing is not optional — it is the physical barrier that bridges the gap between surgical closure and epithelial healing.