Infection is always a potential risk after any type of surgery, and plastic surgery is no exception. Even though many plastic surgeries are done to change or enhance some aspect of a person’s appearance, rather than for medical reasons, such procedures still involve making incisions in the skin. Because the skin provides a natural barrier against bacteria that can cause infection, any opening in the skin can leave the door wide open for unwanted bugs.
Post-Plastic Surgery Infections
An infection that takes hold after surgery can cause a person to become very ill. In the case of plastic surgery, it also can have an enormous impact on the final outcome—how you look afterward. If an incision becomes infected, for example, it may not heal properly, leaving an unsightly scar—not exactly what you’re looking for after a procedure meant to enhance your appearance.
Sometimes an infection after a procedure such as a tummy tuck requires an incision to be reopened in order to drain pus or infected fluid, again creating a more noticeable and unsightly scar. And in the case of a surgery that involves an implant, such as breast augmentation or chin augmentation, if an infection manages to spread from the incision to the implant, the implant may have to be removed. Most doctors will wait three to six months before trying to place a new implant.
Pre-Op Precautions
Preventing infection after plastic surgery actually starts before a surgeon makes the first cut. The room you’ll have your surgery in will be cleaned and sterilized, the doctor and staff will be dressed in proper surgical attire (scrubs, gloves, face masks), the area of your body to be operated on will be prepped with an antiseptic—all part of what’s called aseptic technique.
If despite these infection-preventive practices bacteria still find their way into an incision, it’s likely not a problem: In the majority of cases, the body’s own defense mechanisms will step in and destroy the invaders before they can settle in and multiply.
Overall, the risk of infection after plastic surgery for most people is very low—about 1 percent.
Some folks are more susceptible than others, including those who have diabetes, smoke, take steroids, or have certain vascular conditions. The longer a procedure takes the higher the risk of infection as well.
What You Can Do to Avoid Infection
This doesn’t mean if you’re planning to have plastic surgery there’s nothing you need to do to help protect yourself from infection. Start by making sure the doctor you work with is fully qualified and experienced. The American Society of Plastic Surgeons (ASPS) advises looking for a plastic surgeon who’s board-certified.
Your plastic surgeon will have specific instructions for how you should prepare for your procedure. Follow them! If you smoke and you’re advised to quit, for example, do it. The healthier you are going into surgery, the better able your immune system will be able to kick in if necessary.
Pus coming out of tummy tuck incision
My primary concern when operating is patient safety. Nevertheless all surgery carries the risk of complications. However, this risk is low. Complications tend to be rare and most complications are minor and resolve without the need for further surgery. If complications occur then I will manage the treatment of them.
I believe that my personal philosophy of keeping procedures simple, safe and conventional and my natural tendency to be a conservative surgeon helps to minimise the risk of complications and problems. I do not operate on patients who are unsuitable or who are high risk. Careful patient selection is important.
Some of the potential problems are discussed below.
All surgery entails incisions which can bleed. Bleeding may be early or late, minor or major, and may require a return to theatre to eradicate a collection of blood, called a haematoma, and to control the bleed. Late bleeding can manifest as a seroma, a collection of fluid which may require repeated drainage with a needle and syringe.
Infections may be minor, presenting with redness, tenderness, pain and warmth, or they may be more severe with throbbing pain, swelling, pus collections, and high fever. Treatment options may include local wound care, surgical drainage, removal of implants, antibiotics or other secondary surgery. Where indicated prophylactic antibiotics (antibiotics to prevent infection) are given during your surgery but usually not continued in the recovery period as this has not been shown to be beneficial.
Wounds dehiscence is splitting open of the wound or wound breakdown. This may be caused by infection, tension in the wound, foreign body in the wound, smoking, poor nutrition and so on. Once it has occurred, secondary suture is usually not advised as the wound is in a poor state to receive sutures. Usually wound breakdown is treated with keeping the wound clean and applying a daily dressing with an antiseptic. Antibiotics are not usually required. Later scar revision later is rarely required.
Suture abscesses appear initially as little irritable bumps in the scar. What you are feeling is the stitch. Suture abscesses are relatively common with buried dissolving sutures because an inflammatory response is necessary to cause the suture to dissolve. This process happens usually a few months after surgery. These bumps can progress to a small pustule which can breakdown and discharge. Sometimes suture material can be seen or felt. If suture material is evident then this should be removed as it causes inflammation and interferes with healing. Otherwise suture abscesses are treated as a wound dehiscence. Antibiotics are not usually required.
Bruising and swelling is normal following surgery and tends to resolve 2-4 weeks after an operation. In some patients or procedures this can be prolonged. Bruising and swelling tend to descend following surgery. For example patients who undergo facelift surgery may get bruised on their neck and chest, and tummy liposuction patients may experience bruised and swollen genitalia.
Dissolving sutures are frequently used for many surgical procedures. These sutures dissolve by the body developing an inflammatory reaction against the sutures. Cells called phagocytes then literally eat the sutures away. Sometimes this inflammatory reaction can be close to the surface of the skin and manifest as a pimple. Removal of the suture usually causes the problem to resolve.
Every incision leaves a scar. Part of the art of plastic surgery is knowing where and how to place that scar so that it is well camouflaged and becomes inconspicuous. It should be borne in mind that scars take over a year to mature. During the maturation process there is a phase when the scar becomes red and raised, usually from about 3 weeks after surgery to about 4 months. Sometimes hypertrophic or keloid scars can become excessively red and raised beyond this period necessitating further treatment.
Nerves which carry sensory impulses from your skin may be cut, stretched, bruised or otherwise traumatised, thus causing numbness in the area operated on. Usually this is a transient phenomenon and sensation returns rapidly. One can expect most of the sensory recovery to occur within 6 weeks of surgery, although some degree of improvement may occur for up to 2 years.
Nerves also carry signals to the muscles instructing muscles to move. Trauma to the nerves can result in paralysis of the muscles supplied. In most cases, as for sensory problems, this is transient and recovery occurs, but this can take up to 2 years after surgery. Permanent paralysis is rare after surgery.
Damage to other structures in the area
Salivary ducts, arteries, veins, etc. can all be inadvertently damaged during surgery. Although the utmost care will be taken, aberrant anatomy and other factors can lead to injury.
Anaesthetic related complications
During anaesthesia fluids, gases and drugs will be administered, and lines inserted. Although anaesthesia is much safer these days than it used to be in the past, anaesthesia still carries risks. The risk is probably equivalent to flying.
Lung infections, collapsed lungs, fluid imbalances, kidney problems, strokes, heart attacks and other events can occur or manifest as a consequence of surgery. Deep vein thrombosis is also a risk and is further discussed under Tourism which lists advice to travellers. These problems are all rare, but are part of the risk of surgery.
Cosmetic surgery usually converts a fit healthy individual into a patient who has had surgery and requires time for recovery. In other words, you become sick. Although you may realise this beforehand, it is often difficult to adjust to and it is not unusual for patients to feel depressed, even tearful after surgery. Usually one’s mood improves as the swelling and bruising subside. Also, it is not unusual for an initial satisfaction with surgery to be followed by a period of nit picking and fault finding. This usually passes with time.
Unsatisfactory cosmetic result
Part of the difficulty of cosmetic surgery is for the surgeon to understand what it is that bothers you so that a proper correction can be attained. In this regard it is important for you to find a plastic surgeon with whom you can communicate. You should understand that no person has an absolutely symmetrical body, that the face is different on the two sides; that the left breast tends to be broad and squat while the right breast is usually longer and thinner. Also, there is always the risk of too much, too little, too big, too small, irregularities, dents, bulges, etc. Human beings are not lumps of clay or bronze which can be moulded, but living tissue which can sometimes heal unpredictably.
pus discharge from the incision site
Both surgical and open wounds can have different types of drainage. Purulent drainage is a type of fluid that is released from a wound. Often described as being “milky” in appearance, it’s almost always a sign of infection.
If you’re healing from a wound, you should keep a close eye on its drainage. It’s important to know what types of fluid your wound may ooze normally and which need to be examined.
Purulent drainage is a type of liquid that oozes from a wound. Symptoms include:
Some pale, thin liquid seeping from most wounds is normal. All wounds also have a certain odor. Different kinds of bacteria have different odors, consistencies, and colors. Additional bacteria are introduced to the affected area if there is dead tissue.
Drainage may have become purulent if the amount of liquid increases or the consistency of the liquid changes. Other causes for concern are changes in color and odor.
Wound drainage is the result of the blood vessels dilating during the early stages of healing. This is possibly because certain bacteria are present at the time. Your body is creating a moist environment around the wound in an attempt to heal itself.
When drainage becomes purulent, it’s almost always because the wound has become infected. It’s easier for germs to get inside your skin if it’s broken. The germs then spread into the tissues underneath and cause an infection.
This makes the tissues painful and swollen. It also means they won’t heal as quickly or as well, or in some cases at all. Open wounds are more likely to develop infections than closed wounds, because the break in the skin gives the germs a way in.
Some situations make it more likely that your wound will become infected:
The first objective for purulent drainage treatment is to treat the underlying cause of infection. Other goals include keeping heavy drainage contained and preventing wound softening while also maintaining a moist environment. This will allow the wound to heal on its own.
Treatment varies by the needs of the infected person, the type of wound, where on the body it’s located, and at what point of the healing process the wound is.
The main complication experienced with purulent drainage is wound infection. The most severe complication from a local infected wound is that it becomes a nonhealing wound, otherwise known as a chronic wound. A chronic wound is a lesion that doesn’t heal within eight weeks. This often results in substantial pain and discomfort. It can also affect your mental health.
Other complications can include:
See your doctor immediately if you notice a change in color or odor of the fluid oozing from your wound. Purulent drainage is yellow, green, brown, or white and has a strong odor. The earlier an infection is caught, the easier it can be treated.
The outlook for a person with purulent drainage is good, so long as they’re seen by a medical professional and treated effectively as soon as the infection is identified. Early detection is key. The longer the infection is left to take hold, the more likely it is to lead to more serious health complications.
antibiotic for wound infection with pus
Most patients with wound infections are managed in the community. Management usually takes the form of dressing changes to optimize healing, which usually is by secondary intention.
Resultant increased hospital stay due to surgical-site infection (SSI) has been estimated at 7-10 days, increasing hospitalization costs by 20%. [18, 19, 20] Occasionally, further intervention in the form of wound debridement and subsequent packing and frequent dressing is necessary to allow healing by secondary intention.
Guidelines for the management of SSI were published in 2014 by the Infectious Diseases Society of America (IDSA), in 2017 by the Centers for Disease Control and Prevention (CDC), in 2018 by the World Health Organization (WHO), and in 2019 by the Asia Pacific Society of Infection Control (APSIC). (See Guidelines.)
Antibiotic Prophylaxis
The use of antibiotics was a milestone in the effort to prevent wound infection. The concept of prophylactic antibiotics was established in the 1960s when experimental data established that antibiotics had to be in the circulatory system at a high enough dose at the time of incision to be effective. [25, 26]
It is generally agreed that prophylactic antibiotics are indicated for clean-contaminated and contaminated wounds (see Table 2 in Overview). Antibiotics for dirty wounds are part of the treatment because infection is established already. Clean procedures might be an issue of debate. No doubt exists regarding the use of prophylactic antibiotics in clean procedures in which prosthetic devices are inserted; infection in these cases would be disastrous for the patient. However, other clean procedures (eg, breast surgery) may be a matter of contention. [27, 28]
Criteria for the use of systemic preventive antibiotics in surgical procedures are as follows:
Qualities of prophylactic antibiotics include efficacy against predicted bacterial microorganisms most likely to cause infection (see Table 3 below), good tissue penetration to reach wound involved, cost effectiveness, and minimal disturbance to intrinsic body flora (eg, gut).
Table 3. Recommendations for Prophylactic Antibiotics as Indicated by Probable Infective Microorganism Involved [8, 30] (Open Table in a new window)
The timing of administration is critically important because the concentration of the antibiotic should be at therapeutic levels at the time of incision, during the surgical procedure, and, ideally, for a few hours postoperatively. Antibiotics are administered intravenously, generally 30 minutes prior to incision ; they should not be administered more than 2 hours prior to surgery.
Colorectal surgical prophylaxis additionally requires bowel clearance with enemas and oral nonabsorbable antimicrobial agents 1 hour before surgery. High-risk cesarean surgical cases require antibiotic administration as soon as the clamping of the umbilical cord is completed.
Risk Assessment
The current risk index used to predict the risk of developing a wound infection is the NNIS system of the CDC. The risk index category is established by the added total of the risk factors present at the time of surgery. For each risk factor present, a point is allocated; risk index values range from 0-3. This risk index is a better predictor for SSIs (see Table 4 below) than the surgical wound classification is (see Table 2 in Overview).
Table 4. Predictive Percentage of SSI Occurrence by Wound Type and Risk Index* (Open Table in a new window)
The NNIS risk index integrates the three main determinants of infection—namely, bacteria, local environment, and systemic host defenses (patient health status). The risk index does not include other risk variables, like smoking, tissue oxygen tension, glucose control, shock, and maintenance of normothermia. All these factors are relevant for clinicians but difficult to monitor and fit into a manageable risk assessment.
how to treat infected incision
An infection of a surgical wound can delay healing and cause additional pain and discomfort. Knowing what to do if you spot signs of a surgical site infection may prevent serious complications. Surgical site infections are the leading cause of hospital readmission after surgery, according to the Agency for Healthcare Research and Quality. Appropriate home care and prompt medical treatment may allow you to continue your recovery at home.
Signs of a Surgical Site Infection
Be alert for signs of infection, including:
If you notice any of these signs or symptoms, call your healthcare provider. Your provider will likely ask a few questions about your condition—How are you feeling over all? How high is your fever? When did you start having chills?—and give you advice based upon your responses.
In some cases, your provider will advise you on how to care for the infection at home, ask you to monitor the incision, and have you call with an update in a day or two. In other cases, your provider may ask you to go to the clinic or a local urgent care for evaluation.
Do not worry about “bothering” your healthcare provider. The sooner an infection is identified and treated, the better the outcome. A delay of a couple days can be the difference between home care and hospital readmission.
Surgical Site Infection Treatment
If you don’t have a fever, you may be able to manage the infection at home with topical antibiotic ointment, which may be prescribed for you or is available over the counter at most stores. Always wash your hands well before managing your incision. Follow the instructions on the packaging (and your doctor’s direction) regarding ointment application. Redness, swelling and tenderness at the surgical site should improve within a day or so. If your surgical site starts looking worse instead of better, contact your healthcare provider ASAP.
If you’re running a fever or have a more advanced infection, your healthcare provider may prescribe antibiotics. Many infections can be managed with oral antibiotics. It is important to take antibiotic medication as prescribed and to finish the entire course of medication, even after you start feeling better. Stopping your medicine too soon can allow the infection to take hold again and may contribute to the development of antibiotic-resistant bacteria.
Some surgical site infections are best treated with intravenous (IV) antibiotics. You don’t necessarily need to be hospitalized to receive IV antibiotics; however, you may need to report to the hospital or clinic a few days in a row to receive treatment. Usually, a nurse will administer the medication—a process which could take an hour or so—and observe your reaction. If you tolerate the treatment, you can go home until your next dose is due.
If your surgical site infection is widespread or severe, your doctor may need to clean the incision. In some cases, cleaning a surgical wound means removing any staples or stitches and physically removing infected and dead tissue. If the wound isn’t large, this procedure may be performed in a clinic. If the wound is extensive, you may need a second surgery to thoroughly clean the wound.
A surgical site infection can delay wound healing and, in the most extreme cases, become life-threatening. Prompt identification of infection and appropriate treatment can prevent complications and get the healing process back on track.