Wound Problems

What normal healing looks like

Healing happens in overlapping stages:

Small cuts and scrapes typically heal within 1 to 2 weeks. A surgical incision is usually sealed within 48 hours and fully closed at the surface in about 2 weeks, though deeper healing takes months.

Common wound problems

Infection

The most common problem. Signs include increasing pain, redness and warmth spreading outward after the first few days, swelling, pus or cloudy drainage, a bad smell and fever. Superficial infections may need antibiotics. Deeper ones, or abscesses, need opening and drainage. See wound infection. Infection that spreads into the surrounding skin is cellulitis.

Wound opening (dehiscence)

The edges of a closed wound separate, partly or completely, usually 5 to 10 days after surgery. A sudden gush of pink fluid from an abdominal wound can be the first sign. Risk factors include infection, obesity, coughing or straining, smoking and diabetes. See wound dehiscence.

Fluid collections

• Seroma: clear yellow fluid collecting under the skin after surgery, especially after breast, hernia or abdominal surgery. A soft swelling that may leak. Small ones are reabsorbed; larger ones may be drained with a needle.
• Hematoma: a collection of blood causing a firm, bruised, painful swelling. More common on blood thinners.

Slow or non-healing wounds

A wound that has not healed in 4 to 6 weeks is called chronic. The usual reasons are poor circulation, diabetes, pressure, swelling from vein disease, infection, smoking, malnutrition and some medicines. See delayed wound healing and chronic wounds.

Abnormal scars

• Hypertrophic scars: raised, red and itchy but stay within the wound edges, often improving over a year.
• Keloids: grow beyond the original wound, more common on the chest, shoulders and earlobes and in people with darker skin. See keloid scars.

Other problems

• Contact dermatitis from adhesive tape, antibiotic ointments (especially neomycin) or dressings: an itchy rash with sharp edges matching the dressing
• Retained foreign body: glass, splinters or dirt causing ongoing pain, discharge or poor healing
• Spitting stitch: a buried dissolving stitch working its way out weeks later, causing a small pimple-like spot
• Excess granulation tissue: red, raised, bleeding tissue that stands proud of the skin

Risk factors for wound problems

• Diabetes, especially with high blood sugar
• Smoking and vaping nicotine, which constrict blood vessels
• Peripheral artery disease and vein disease
• Obesity
• Older age
• Steroids, chemotherapy and other immune-suppressing medicines
• Poor nutrition, especially low protein, vitamin C and zinc
• Pressure, friction and moisture
• Radiation to the area

How a clinician assesses a problem wound

They will look at the size, depth, edges, base, surrounding skin and any drainage, measure it to track progress, and check pulses and sensation. Tests may include a wound swab or tissue culture, blood tests for infection and blood sugar, an ultrasound for collections, an X-ray for foreign bodies or bone infection, and blood flow tests (ankle-brachial index) for leg wounds.

Caring for a wound to prevent problems

1. Wash your hands before touching the wound.
2. Clean gently with clean running water. Avoid hydrogen peroxide and alcohol, which damage healing tissue.
3. Keep it moist and covered with petroleum jelly and a clean dressing. Moist wounds heal faster and scar less than dry, scabbed ones.
4. Follow surgical instructions about showering and when to remove dressings.
5. Do not pick scabs or stitches.
6. Avoid strain on surgical wounds: support your belly with a pillow when coughing.
7. Eat enough protein, control blood sugar and avoid smoking.
8. Check tetanus status for dirty wounds. A booster is advised if it has been more than 5 years for a dirty wound, or 10 years for a clean one.
9. Protect scars from the sun for a year, and consider silicone gel or sheets for raised scars.

Frequently asked questions

How do I know if my wound is healing normally?

A normally healing wound has mild redness, swelling and tenderness only in the first 2 to 3 days, small amounts of clear or pinkish fluid, and steadily improves. The edges come together and a scab or line forms within about a week. Worsening after day 3 is a warning sign.

What are the signs of a wound infection?

Signs include increasing pain, spreading redness and warmth, swelling, pus or cloudy discharge, a bad smell, red streaks extending from the wound, and fever. Contact a clinician the same day if you notice these, and seek emergency care for rapid spread or feeling very unwell.

Why is my wound not healing?

Common reasons are infection, poor blood supply, diabetes, smoking, ongoing pressure or friction, swelling from vein problems, poor nutrition, and medicines such as steroids. A wound not clearly improving after 2 weeks or not healed by 4 to 6 weeks should be assessed.

Is yellow tissue in a wound pus?

Not necessarily. A thin, yellowish layer in an open healing wound is often fibrin or slough, part of normal healing, especially in the mouth and on scrapes. Pus is thicker, cloudy and often comes with increasing pain, redness and odor.

Should I keep a wound covered or let it air out?

Keeping most wounds clean, moist and covered helps them heal faster and with less scarring than leaving them to dry out. Change the dressing daily or if it gets wet or dirty, and follow any specific instructions for surgical wounds.