If you have a surgical incision infection your weight loss doctor, or a nurse, will give you instructionsabout how to take care of your incision sites. Generally, the incision site is packed with saltwater soaked gauze and this dressing is changed a couple of times a day. Antibiotics are prescribed, and typically, these are Keflex® or Augmentin® (unless you have an allergy). An infection usually comes from bacteria that live on your skin. It is rare that it will come from a dirty instrument in the operating room or some other source. This is why it is important to keep your incision clean.
If your incision has been opened to allow the pus to drain, it is still advisable to wash your wound out with soap and water—it won’t hurt the incision and is the best thing for it. Once the infection has passed, and the incision looks healthy the skin may be re-closed with suture, or the weight loss surgeon may wait until the incision closes itself. Sometimes these infections can take weeks to take care of, so be patient. This does not mean that you will need to be on antibiotics for all this time. If the surrounding skin doesn’t show red streaking, chances are the weight loss surgeon will take you off the antibiotics.
Packing an incision
Your weight loss surgeon will have you “pack” the wound with some saline soaked gauze. Please do not stuff this in the wound—the idea is for the edges to remain moist. If you stuff gauze into the incision, it will take longer for it close. Over time, this wound will start “contracting” and closing itself, and after a few months, no one will notice a difference. But, if you stuff incisions with gauze, instead of layer it, it will take the wound a lot longer to close. So, be gentle.
Some weight loss surgeons use other materials to soak the wound. Some use a weak bleach or iodine solution, acetic acid, or one of a number of other solutions. The important principles are to pack the incision lightly, change the dressing twice a day (unless otherwise instructed) and take a shower. Likewise, there are a number of other products that weight loss surgeons can use, such as the wound vac, various forms of gels, or even material from algae (Sorbsan®). These all come with special instructions, and probably will come with a home health nurse to help you manage all of this material. Fear not, if you eat well and consume adequate protein, your incision will close nicely, and look just fine.
Wound infections are common and happen about five percent of the time. These infections can be small and easy to manage, or your entire incision might be opened up and allowed to close on its own. If your wound is left to close on its own, a binder sometimes helps. The forces on most incisions are from side to side, tending to keep it open longer. Check with your bariatric surgeon—he or she may have other ideas.
Closure of an incision
Sometimes a weight loss surgeon will take you back to the operating room to close the wound. This only happens after it is very well healed and has a nice red bit of “granulation” tissue in it. Sometimes a weight loss surgeon will allow the incision to slowly close by itself—that’s your bariatric surgeon’s decision.
What suture did they use?
There are a lot of ways for a weight loss surgeon to close the skin, and a lot of tools. There are advantages and disadvantages to all of them. Skin staples are the least painful, and lead to a good cosmetic result, although a number of bariatric patients don’t like them too well. Most weight loss surgeons use a dissolving suture and then place steri-strip tapes over the incision. These steri-strips are a wound closure device—some of them are as strong as suture. Still other bariatric surgeons use Demabond®, which is superglue for the skin. There is no right or wrong way to close an incision, but there are a lot of opinions. One friend of mine said that in her part of the country, surgeons don’t use staples because patients think they are not cosmetically appropriate. Wherever you live, and however your incision is closed it probably will affect how the wound looks later on.