Spinal wound care

During your spinal operation, we make an incision (cut) in your skin and muscles to access your spine.

After the operation to your spine, the muscle layer covering the spine is repaired by internal sutures (stitches) that are dissolvable. We then close the skin using one of four methods. The method chosen will be the best for you.

We may close the skin layer using:

Subcuticular Stitch – A dissolvable suture that is not visible

Mattress Stitch – Individual sutures in a line that do not dissolve and will need to be removed.

Running stitch – A continuous suture that does not dissolve and will need to be removed

Surgical Clips – Small metal ‘staples’ that will need to be removed

Subcuticular stitches (dissolvable) – We cover the incision with a layer of paper stitches (steri-strips) and place an outer sterile, adhesive dressing over the top. The outer dressing will usually be changed after 72 hours, but the steri-strips can remain until 7-10 days after surgery

Mattress and running stitches – We place a sterile, adhesive dressing over the stitches. This will usually need to be changed after the first 72 hours. The stitches should be covered until they are removed at your GP practice (see below for when this should take place).

Surgical Clips – We place a sterile, non-adhesive dressing over the stitches. This will usually need to be changed after the first 72 hours. The clips will need to be covered until they are removed at your GP Practice (see below for when they should be removed)

This varies depending on the area of the spine that we are operating. The list below shows the average time that stitches or clips need to remain in place, but we will give you individualised information about your wound care needs.

Please be aware that these are average times. Your stiches/clips may be removed at a slightly different time.

Please ask your ward nurse to fill in your individual information before you leave:

• Type of stitches/clips:
• Type of wound dressing:
• When do my stitches/clips need to be removed?
• Who is taking out my stitches/clips?

Most stitches and clips will be removed at your GP practice. If you have clips, we will discharge you with a small device called a clip remover that will be used to remove your clips. Very occasionally, we may want you to return to us for a wound review and we will remove your stitches/clips.

1. Avoid touching your wound or wound dressing as much as possible
2. If you do need to touch the wound or dressing for any reason, make sure that, you wash your hands thoroughly with soap and water before doing so.
3. If anyone else needs to touch your dressing or wound, make sure that they wash their hands thoroughly with soap and water before doing anything with the wound.
4. Avoid getting the dressing wet; do not submerge the dressing and wound in water. For information about showering, see below.
5. Avoid changing the dressing. Surgical wounds and dressings should only be changed if they get wet, if the wound starts oozing, or if it produces an unpleasant odour.
6. Do not scratch the wound or the skin around the wound and dressing. It is normal to experience some itchiness as the wound heals.
7. If there are no problems with the wound the dressing should be left in place. Dressings are routinely and safely left in place from when you leave the hospital until it is time for your stitches/clips to be removed.

Problems with wounds are rare, but when you are discharged from hospital, you should look out for some symptoms that may indicate that you have a wound problem.

These symptoms can include:

• Fever or high temperature
• Development of excessive heat, swelling, redness or pain around the wound
• Wound discharge
• Unpleasant odour

If you develop any of these symptoms, you will need to contact a health care professional to review your wound.

This should be community-based services in the first instance such as your GP, district nurse or local walk in clinic. You can find further advice from NHS direct on 111. You can also contact your neurosurgical team via the consultant’s secretary, within office hours (0900-1700) and the ward we discharged you from (see above).

Can I have a shower?

After 48 hours, it is usually fine to shower. You need to keep the wound covered with a waterproof dressing and avoid spraying water directly onto the wound. We will discharge you from hospital with a waterproof dressing. If your surgeon does not want you to shower this will be discussed with you before you are discharged.

Can I have a bath?

Yes - only if you can avoid submerging the wound in water. Realistically only people that have had high neck surgery will be able to have a bath and not submerge their wound. Once your stitches have been removed, it should be fine to bathe. Please remember that there may be other reasons for spinal patients to avoid baths (for example - restrictions on mobility and bending: safety concerns climbing in and out of the bath). Please discuss this with your neurosurgical team, nursing team or therapy team.

Can I wash my hair?

Yes - only if you can avoid submerging the wound in water. With neck wounds this can be difficult and you will possibly need assistance. The wound should have a waterproof dressing and avoid getting water or shampoo on the wound.

Can I go swimming?

No, it would be impossible to avoid submerging your wound in a swimming pool. Once your stitches have been removed, it should be fine to go swimming. Please remember that there may be other reasons not to swim (for example - restrictions on mobility and bending: safety concerns climbing in and out of the pool).

What should I do if my dressing does get wet?

The dressing needs to be replaced as soon as possible. Thoroughly wash your hands with soap and water (or the person who is going to apply a new dressing). Carefully, avoiding touching the side of the dressing that touches your wound, reapply the dressing.

What should I do if my dressing accidently comes off?

The dressing needs to be replaced as soon as possible. Thoroughly wash your hands with soap and water (or the person who is going to apply a new dressing). Carefully, avoiding touching the side of the dressing that touches your wound, reapply the dressing.

• Baaj AA, Mummaneni PV, Uribe JS, Vaccaro AR and Greenburg MS (2012) Handbook of Spine Surgery. New York. Thieme Medical Publishers
• Featherall J, Miller JA, Bennett E, et al. Implementation of an Infection Prevention Bundle to Reduce Surgical Site Infections and Cost Following Spine Surgery. JAMA Surg. [online] July 20, 2016. doi:10.1001/jamasurg.2016.1794. {accessed 23/7/2016}
• National Institute of Health and Clinical Excellence (2008) surgical site infection. Prevention and treatment of surgical site infection NICE Clinical Guideline CG 74
• National Institute of Health and Clinical Excellence (2014) Surgical site infection NICE [online] 31/10/16 Quality standard /nice.org.uk/guidance/qs49 {Accessed 23/7/16}

You may find the following websites helpful:

• www.brainandspine.org.uk  
• www.patient.co.uk

UCLH cannot accept responsibility for information provided by other organisations.

Victor Horsley Neurosurgical Department
National Hospital for Neurology and Neurosurgery
60 Great Ormond Street
London WC1N 3BG

Switchboard: 0845 155 5000 / 020 3456 7890
Direct line: 020 3448 3568/3150/3395
Fax: 020 3448 3340