Wounds, Abscesses & Surgical Infection
Distinguish expected healing from infection and recognise when drainage or urgent debridement is required.
Quick revision ↓ Medical Dictionary
01Assess the wound and patient
Describe wound location, depth, edges, discharge, surrounding skin and pain, then assess systemic observations and comorbidity. Mild local inflammation can occur during healing, but spreading erythema, increasing pain, purulent discharge or systemic deterioration needs review. Diabetes, impaired perfusion, steroids and malnutrition can alter healing and presentation. A photograph may support documentation with consent but cannot replace examination for deep infection.
02Separate cellulitis from collections
Cellulitis involves spreading tissue inflammation, whereas an abscess is a collection that often needs drainage. Antibiotics alone may not achieve source control in a drainable collection. Choose microbiological sampling and antimicrobial treatment according to severity and local guidance. Superficial swabs can reflect colonisation; deep or operative specimens may be more informative when obtained appropriately. Review the diagnosis if the response is poor.
03Recognise necrotising infection
Severe pain out of proportion, rapid progression, systemic toxicity, bullae or skin discolouration can suggest necrotising soft-tissue infection. Early skin changes may be subtle, and absence of gas on imaging does not exclude it. Urgent surgical assessment, resuscitation, antibiotics and source control are required. Do not allow a low laboratory score or a planned scan to delay necessary exploration in a convincing unstable presentation.
04Support healing and prevent infection
Good perfusion, appropriate closure strategy, nutrition and pressure relief support repair. Infection prevention includes hand hygiene, suitable skin preparation, sterile technique and indicated antibiotic prophylaxis. Hair removal, if necessary, follows the recommended method rather than routine razor shaving. A contaminated wound may need a different closure plan from a clean incision; closing every wound immediately can trap contamination and increase complications.
05Review dehiscence and follow-up
Wound separation can be superficial or involve the abdominal fascia. Sudden wound failure or exposed viscera is an emergency requiring protection of tissues and urgent surgical help, not forced bedside replacement. For less severe wounds, define dressing needs, follow-up and signs of deterioration. Review factors preventing healing and avoid repeated antibiotics without addressing ischaemia, foreign material or an underlying collection.
High-Yield Revision
- A drainable abscess needs source-control assessment.
- Necrotising infection can precede obvious skin changes.
- Fascial dehiscence requires urgent surgical review.
Common Pitfalls
- Do not exclude necrotising infection using one reassuring score.
- Do not force exposed abdominal contents back into a wound.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.