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The surgical wound: healing, dehiscence and infection

  • Assessment

A closed surgical wound usually heals in weeks; the nurse protects it, watches for infection and separation, and reports early changes.

Updated

What it is

Most surgical incisions are closed with sutures, staples or tissue glue and heal by primary intention. If the edges cannot be brought together, the wound heals by secondary intention, filling from the bottom with granulation tissue; if it is left open and closed later, by tertiary intention. Healing passes through haemostasis, inflammation, proliferation and maturation, and a closed wound usually heals in 4 to 5 weeks. Healing is delayed by poor blood flow, infection, poor nutrition, diabetes, obesity, smoking and some medicines. The nurse keeps the dressing clean and dry, uses aseptic technique, watches for infection, haematoma and dehiscence, and teaches the patient to protect the wound.

Reference values

  • Usual healing time of a closed wound: about 4 to 5 weeks; the scar keeps maturing for months.
  • Risk factors for dehiscence: obesity, smoking, diabetes, poor nutrition, wound location and strain on the area.
  • Coughing, vomiting or straining can open an abdominal wound suddenly.
  • Sutures and staples are removed only with a medical order and per institutional policy.

What you need

  • Clean or sterile gloves per protocol, dressing materials, measuring guide.
  • The surgical notes: type of closure, drains and any special instructions.
  • The wound chart to compare with the previous assessment.
  • Vital signs, including temperature.

How to measure it (and why)

  1. Clean hands and use the technique in protocol: the new wound is a door for microorganisms.
  2. Leave the first dressing in place for the time ordered unless soaked or loose: early opening adds contamination.
  3. Look at the edges: closed and aligned edges show primary healing is on track.
  4. Look for redness, warmth, swelling and drainage, and note colour, amount and smell: these are the first signs of infection.
  5. Ask about pain and measure temperature: rising pain or fever suggests infection.
  6. Check sutures or staples and the area around them: broken sutures or gaps may mean dehiscence is starting.
  7. Check drains: record output and the skin around the exit site; drains are removed as soon as no longer needed.
  8. Teach the patient to move carefully and avoid straining or pulling on the wound: this lowers strain on the edges.
  9. Record findings and compare them with the last assessment: the trend guides care and escalation.

How to read it

  • A haematoma (blood under the wound) can become infected and lead to dehiscence; report it.
  • Poor nutrition (protein, vitamin C, zinc) and high blood glucose delay healing; raise them with the team.
  • Advanced dressings over a standard dressing do not prevent infection in closed wounds, according to WHO.
  • Before discharge, teach wound care, hygiene, the warning signs and who to contact.

Next step: when to call for help

  • Call at once: organs visible through the wound, sudden opening of the wound, heavy bleeding or a rapidly growing haematoma.
  • Call promptly: fever over 38 °C, spreading redness, pus, new confusion or rapidly increasing pain.
  • Report today: more drainage than before, edges starting to separate, broken sutures or a bad smell.
  • Record what was seen, who was called and the time.

Test yourself

Think of the answer, then tap the question to see it.

What is the difference between healing by primary and by secondary intention?

In primary intention the edges are brought together and heal under the closure; in secondary intention the edges stay apart and the wound fills from the base with granulation tissue.

What are the warning signs of wound dehiscence?

Redness around the wound edges, increasing drainage, increasing pain and broken sutures; abdominal wounds may open suddenly with coughing or straining.

Which signs of wound infection need urgent action?

Systemic signs such as fever over 38 °C, malaise, new confusion, increasing pain and spreading redness or swelling.

Should antimicrobial ointments be applied to a closed surgical incision?

No. CDC advises against antimicrobial ointments, solutions or powders on the incision, and WHO does not recommend advanced dressings over a standard dressing to prevent infection.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Skills, 20.2: Basic concepts related to wounds (Open RN, Wisconsin Technical College System (LibreTexts copy), 2021); Global guidelines for the prevention of surgical site infection, second edition (World Health Organization (WHO), 2018); Surgical Site Infection (SSI) Prevention Guideline (2017) (Centers for Disease Control and Prevention (CDC), 2017).

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