Key points of wound care after bone plate fixation

Wound care after bone plate fixation is a key link in preventing infection and promoting healing. Targeted plans should be formulated based on the type of wound, surgical site and individual conditions of the patient (such as diabetes and low immune function). The following are the core points of wound care, which must strictly follow the aseptic principle and dynamically observe the changes in the wound.

First, the basic principles of postoperative wound care

Aseptic operation to prevent infection

Dressing change environment: Choose a clean and well-ventilated room, and avoid operating in areas with dust or frequent personnel flow.

Hand hygiene: Before changing dressings, wash your hands with running water and soap or use alcohol-based hand sanitizer to ensure your hands are sterile.

Instrument disinfection: Use disposable sterile dressing packs or instruments that have been sterilized under high pressure to avoid cross-contamination.

Observe the changes of the wound dynamically

Wound appearance: Observe the color of the dressing exudate daily (normally it is light yellow and transparent. If it is purulent, bloody or has an unpleasant smell, be alert to infection) and the amount of exudate (a small amount of exudate is normal. If it penetrates the dressing, replace it in time).

Local symptoms: Pay attention to whether the skin around the wound is red, swollen, hot, with increased pain or a fluctuating sensation (which may indicate the formation of an abscess).

General symptoms: If the patient has a fever (body temperature ≥38.5℃), chills or swollen lymph nodes around the wound, they should seek medical attention promptly.

Second, the specific operational points of wound care

Frequency and timing of dressing changes

In the early postoperative period (0-3 days) : Change the dressing once a day and observe whether there are signs of bleeding, hematoma or infection at the wound site.

Stable period (after 3 days) : If the wound is dry and there is no exudate, the dressing can be changed every 2 to 3 days. If the dressing is damp or contaminated, it should be replaced immediately.

Special circumstances: If the wound drainage tube has not been removed, the frequency of dressing change should be adjusted according to the volume of drainage fluid (usually 1-2 times a day).

Dressing change steps and precautions

Remove the old dressing: Do it gently and avoid tearing the wound. If the dressing adheres to the wound, it can be moistened with normal saline and then slowly removed.

Clean the wound

Sterile normal saline rinse: Remove secretions, blood scabs or foreign substances on the surface of the wound. Avoid direct contact of irritating liquids such as alcohol or iodophor with the wound (which may delay healing).

Disinfection range: Starting from the wound and extending outward by 5 to 10 centimeters, the disinfection sequence is “from the inside out, from the clean area to the contaminated area”.

Dressing selection:

For dry wounds: Use sterile gauze or foam dressings with good air permeability.

For wounds with excessive exudate: Choose highly absorbent alginate dressings or hydrocolloid dressings to prevent exudate from seeping out and causing skin maceration.

For wounds with a high risk of infection: Antibacterial dressings containing silver ions or iodophor can be used for a short period of time, but it is necessary to follow the doctor’s advice and avoid long-term use which may inhibit normal healing.

Fixed dressings: Use medical adhesive tape or self-adhesive bandages for fixation. Avoid overly tight dressings that may affect blood circulation or overly loose dressings that may shift.

Wound pain management

Before changing the dressing, non-steroidal anti-inflammatory drugs (such as ibuprofen) can be taken orally or lidocaine gel can be applied locally to relieve the pain caused by the operation.

If the patient is sensitive to pain, they can inform the medical staff in advance and relieve their tension by using “step-by-step removal of dressings” or “psychological counseling”.

Third, key points of care for special types of wounds

Open fracture wound

Initial treatment: After the operation, it is necessary to keep the wound drainage unobstructed to prevent the accumulation of hematoma or exudate. If the wound is severely contaminated, antibiotics should be used as prescribed by the doctor to prevent infection.

Secondary debridement: If there are signs of necrotic tissue or infection in the wound after the operation, debridement may be necessary again, and even some internal fixation devices may be removed.

Wounds of diabetic patients

Blood glucose control: The fasting blood glucose after the operation should be controlled below 7.0 mmol/L, and the 2-hour postprandial blood glucose should be ≤10.0 mmol/L to avoid delayed wound healing or increased risk of infection caused by hyperglycemia.

Local care: Use healing dressings (such as growth factor dressings), and regularly monitor the skin at the edge of the wound for any ulceration or necrosis.

Wounds on the joint area

Movement restrictions: In the early postoperative period, joint movement should be restricted to prevent dressing displacement or wound dehiscence. When changing dressings, pay attention to the flexion and extension angles of the joint to avoid curling the edges of the dressing.

Scar prevention: After healing, silicone gel dressings or scar patches can be used to reduce restricted joint movement.

Fourth, taboos and precautions for wound care

Taboo behavior

Self-removal of dressings: This may cause wound contamination or secondary injury. It is necessary to strictly follow the doctor’s instructions for dressing changes.

Using folk remedies or herbs, such as applying traditional Chinese medicine ointments or fresh plants, may cause allergies or infections.

Getting wet too early: Avoid taking a shower, soaking in a bath or swimming before the wound is fully healed. You can use a waterproof dressing to protect the wound.

Precautions

Avoid pressing the wound: When sleeping, avoid lying on your side to press the surgical site. You can use a soft pillow or a sponge pad to elevate the affected limb.

Prevent pulling the wound: Avoid severe coughing, sneezing or straining during defecation in the early postoperative period. Use an abdominal binder or cough suppressant if necessary.

Seek medical attention promptly: If the wound shows signs of redness, swelling, increased exudation, an unpleasant odor, fever or severe pain, contact medical staff immediately.

Fifth, guidance on home wound care

Patient and family education

Wash your hands and wear a mask before changing dressings to ensure a clean operating environment.

Learn the correct methods of removing dressings, disinfecting wounds and fixing dressings, and avoid violent operations.

Record the dressing change time, the appearance of the wound and the patient’s symptoms to facilitate feedback to the doctor during the follow-up visit.

Home environment preparation

Prepare sterile dressing change kits (including gauze, cotton balls, tweezers and disinfectant), adhesive tape, gloves and disposable garbage bags.

If there is a lot of exudate from the wound, you can prepare waterproof dressings or pads to protect the bed sheets and clothes.

Psychological support

The wound healing process may be relatively long, and patients are prone to anxiety or depression. Family members should offer encouragement and companionship to avoid excessive focus on the wound, which may cause the patient to become tense.

Sixth, assessment and referral of wound healing

Healing criteria

Primary healing: The wound is dry, free of exudate, and has neat edges. It usually heals within 2 to 3 weeks.

Secondary healing: If there is granulation tissue filling or scar formation in the wound, the healing time may be prolonged to 4 to 6 weeks.

Situations requiring referral

The wound persists in non-healing (more than 4 weeks), with an unpleasant odor of exudate or purulent discharge.

Redness, swelling, a fluctuating sensation or systemic infection symptoms (such as fever and chills) appear around the wound.

The internal fixator is exposed or the wound is cracked.