Open Wound From a Surgical Incision

Why a surgical wound is left open

Most incisions are closed with stitches, staples or glue and heal in about 2 weeks (healing by primary intention). A surgeon may leave all or part of a wound open when:

• the operation involved a contaminated area, such as a perforated bowel or a dirty traumatic wound
• an abscess or infected collection was drained
• a surgical site infection developed and stitches or staples were removed to let pus drain
• the incision separated after surgery (wound dehiscence)
• the plan is to close it a few days later once it is clean (delayed primary closure)

Leaving a wound open lets infection drain and prevents an abscess forming underneath. It is a deliberate treatment, not a sign that something has gone wrong in the operation.

How an open wound heals

1. Inflammation (first few days): the wound bed is red and may produce more fluid. White cells clear bacteria and debris.
2. Granulation (days to weeks): new blood vessels and tissue fill the wound from the bottom. Healthy granulation tissue is moist, bright or beefy red and bumpy, and bleeds slightly when touched.
3. Contraction: the wound edges pull inward, shrinking the wound.
4. Epithelialization: new skin grows in from the edges as a thin pink or silvery rim.
5. Remodeling (months): the scar strengthens and fades. It is wider than a stitched scar.

What healthy and unhealthy wounds look like

A thin layer of yellow, stringy slough can be normal. A thick layer usually needs cleaning or removal by your wound nurse or surgeon.

Caring for an open surgical wound

Dressing and packing changes

Follow the exact instructions you are given. A typical routine is:

1. Wash your hands and lay out clean supplies.
2. Remove the old dressing and packing gently. Soak it with saline if it sticks.
3. Clean the wound with saline or clean running water in the shower, as advised.
4. Pat the surrounding skin dry.
5. Fill (pack) the wound loosely with the prescribed gauze or dressing, reaching the base and any tunnels without stuffing it tight.
6. Cover with an outer dressing.
7. Wash your hands again and dispose of old dressings in a sealed bag.

Packing is usually changed once or twice a day, or every few days with some advanced dressings. Home health nurses often visit to help at first.

Negative pressure wound therapy (wound vac)

A wound vac uses a foam dressing, a sealed film and a small pump that applies gentle suction. It removes fluid, pulls the edges together and encourages granulation. Dressings are usually changed every 2 to 3 days by a nurse. Keep the tubing free of kinks, keep the battery charged and call your care team if the alarm sounds and you cannot reseal it.

Showering and daily life

Most people can shower once their surgeon allows, often with the dressing removed so water rinses the wound. Avoid baths, hot tubs and swimming pools until the wound has closed. Avoid heavy lifting after abdominal surgery, usually more than 10 lb (4.5 kg) for several weeks, to reduce the risk of an incisional hernia.

Factors that slow healing

• Diabetes and high blood sugar
• Smoking and nicotine products, which narrow blood vessels
• Poor nutrition, especially too little protein, and low vitamin C or zinc
• Obesity, which increases tension and reduces blood supply in fatty tissue
• Steroids, chemotherapy and other immune-suppressing drugs
• Infection, fluid collections (seroma or hematoma) and pressure on the wound

To support healing, eat protein at every meal, keep blood sugar in your target range, stop smoking, stay active within your limits and take any prescribed antibiotics fully.

How long it takes to heal

Healing time depends on size and depth:

• small, shallow wounds: often 2 to 4 weeks
• deeper abdominal or groin wounds: commonly 6 to 12 weeks
• large wounds, or people with diabetes or other healing problems: 3 months or longer

Your care team measures the wound regularly. If it is not getting smaller after 2 to 4 weeks, they will look for infection, a foreign body such as a stitch, poor blood supply or nutrition problems. Wounds that do not heal may become chronic wounds needing specialist care, and some are closed later with stitches or a skin graft.

Frequently asked questions

Why did my surgeon leave my incision open?

Surgeons leave a wound open when there is a high risk of infection, such as after bowel perforation or abscess drainage, or when an infection has already developed. Leaving it open lets fluid and bacteria drain and allows the wound to heal cleanly from the bottom up.

How long does an open surgical wound take to heal?

Small, shallow wounds may heal in 2 to 4 weeks. Deeper wounds often take 6 to 12 weeks, and large wounds or those in people with diabetes, smoking or poor nutrition can take several months. A wound vac can speed healing in some cases.

What should an open surgical wound look like when healing?

A healing wound bed is moist and beefy red or pink with a bumpy texture, and the wound gets smaller each week. A small amount of clear or pale yellow fluid is normal. Pale, gray or black tissue, pus, spreading redness or a strong smell suggest a problem.

How do I know if my open wound is infected?

Signs of infection include increasing pain, spreading redness or warmth around the wound, swelling, thick or foul-smelling pus, more drainage, and fever of 38 °C (100.4 °F) or higher. Contact your surgeon the same day if you notice these.

Can I shower with an open surgical wound?

Usually yes, once your surgeon allows it. Many people remove the dressing and let clean, lukewarm water run over the wound, then pat the skin dry and apply new packing. Avoid soaking in baths, hot tubs or pools until the wound has fully closed.