Can operative wounds with sutures be wet? YES

Yes, operative wounds with sutures can be wet.  Thus, one can take a shower soon after the operation without fear of wetting the wound and without fear of increased infection rate.

This recommendation is strongly derived from the following study:

Can sutures get wet? Prospective randomised controlled trial of wound management in general practice

BMJ 2006332 doi: https://doi.org/10.1136/bmj.38800.628704.AE (Published 04 May 2006)Cite this as: BMJ 2006;332:1053

https://www.bmj.com/content/332/7549/1053

This recommendation is also supported by my experience as a physician and a surgeon. I have been giving this piece of advice during the past 37 years (from 1981 to 2018).  There is no higher incidence of wound infection with early shower.

Below are excerpts from the study:

Abstract

Objective To compare standard management of keeping wounds dry and covered with allowing wounds to be uncovered and wet in the first 48 hours after minor skin excision.

Design Prospective, randomised controlled, multicentre trial testing for equivalence of infection rates.

Setting Primary care in regional centre, Queensland, Australia.

Participants 857 patients randomised to either keep their wound dry and covered (n = 442) or remove the dressing and wet the wound (n = 415).

Results The incidence of infection in the intervention group (8.4%) was not inferior to the incidence in the control group (8.9%) (P < 0.05). The one sided 95% confidence interval for the difference of infection rates was ∞ to 0.028.

Conclusion These results indicate that wounds can be uncovered and allowed to get wet in the first 48 hours after minor skin excision without increasing the incidence of infection.


Traditional Way

Guidelines for managing surgical wounds that are closed primarily (that is, those with the skin edges re-approximated at the end of the procedure) instruct that patients should keep their wounds dry and covered for 24-48 hours.1

  1. Mangram AJ,  Horan TCPearson MLSilver LCJarvis WR .Guideline for the prevention of surgical site infection.Infect Control Hosp Epidemiol199920:25078.

Literature on wound management is sparse. As regards wetting sutures, previous studies have compared standard management (keeping wounds dry) with washing with soap and water in the first 48 hours after minor skin excisions or compared standard management with early showering after more major surgery.2 3 4 5 These relatively few published studies suggest that getting sutures wet does not increase the infection rate. However, numbers of patients studied have been small, and only one previous study was randomised. No previous studies have been done in the general practice setting.

As regards uncovering sutures, some evidence shows that no difference exists in the incidence of infection between wounds left without dressings and those covered with a dry dressing in the early postoperative period.6 78 Again, no previous studies had been done in a general practice setting.

As the two factors, wetting and uncovering, are difficult to separate in the immediate postoperative period, we decided to assess these factors together.

F1.medium

Note the following (which have been my practice also):

  1. Take off dressing within first 12 hours.
  2. Avoid use of antiseptics

We felt that patients should leave the surgery with a dressing to absorb immediate bleeding, but we also felt that defining an exact time to remove the dressing would be unrealistic; we considered “within 12 hours” to be a reasonable request. We also asked them to avoid using antiseptic washes and soaps.

By the way, my attention was caught in the use of just normal saline for skin preparation (I have tried this also before).

Surgical wound management protocol

A workshop attended by participating general practitioners developed guidelines to ensure that excisions were managed in a standardised manner. The following procedure was agreed: skin preparation (normal saline); usual sterile technique (standard precautions), including sterile gloves; local anaesthetic (type and volume recorded); suture material—nylon (size recorded); no antibiotics, either topical or oral (if required, or already prescribed, exclude from study), topical antiseptics (such as betadine or alcohol), or antiseptic washes or medicates soaps; dressing type—melolin and tape; removal of sutures, according to site (back = 10 days, all other sites = seven days).


Though the paper is on skin incisions, my experience covers more than skin incisions, such as excision of epidermal cysts and lipomas, thyroidectomy, mastectomy, cholecystectomy, herniorrhaphy, appendectomy, etc.  There was no increase in infection rate with early removal of dressing and early shower.

THUS again:
Yes, operative wounds with sutures can be wet.  Thus, one can take a shower soon after the operation without fear of wetting the wound and without fear of increased infection rate.



Related Link:

Cochrane

2015

https://www.cochrane.org/CD010075/WOUNDS_post-operative-bathing-and-showering-prevent-wound-complications

There is currently no conclusive evidence available from randomised trials about the benefits, or harms, with regard to wound complications of early or delayed post-operative showering or bathing. We recommend further randomised controlled trials to compare early versus delayed post-operative showering or bathing.


ROJ@18dec26

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