Cancer Surgery Wound Care & Scar Healing

In the first week the wound is sealed by stitches, staples, glue or adhesive strips. The skin edges knit together. A narrow band of pink along the line is expected, along with mild swelling and tenderness. Bruising spreads and changes color before it fades.

By two to three weeks the surface is usually closed. The tissue underneath is still fragile, though. That is why lifting restrictions outlast the visible wound. Between one and three months the scar often looks worse than it did at the start: red, firm, sometimes raised and itchy. That is normal remodelling, not failure. Scars keep softening, flattening and paling for 12 to 18 months, and some for longer.

Numbness around the incision is common, because small sensory nerves are cut. Feeling returns patchily over months to a couple of years. Sometimes it does not return completely.

Most surgical site infections appear within 30 days of surgery.

• Call 911 or go to an emergency department if the wound splits open and deeper tissue or bowel is visible, bleeding soaks a dressing and does not stop with firm pressure, or you are shivering hard, confused, or breathless with a rapid heartbeat.
• Call your surgical team the same day if redness is spreading outward from the incision, the skin is hot to touch, or pus, cloudy drainage or a bad smell appears. The same applies to pain that climbs after about day three instead of settling, to wound edges beginning to part or a sudden jump in swelling, and to chills, feeling generally unwell, or a temperature of 100.4°F (38°C) or higher.
• Call your surgical team within a day or two if a soft fluid-filled swelling appears under the incision after breast, groin or armpit surgery, a stitch or staple is catching, or the scar is thickening, itching, or starting to restrict how far you can move.

Infections caught early are usually treated with antibiotics. Left longer, they can need the wound opened and drained, which sets recovery back. Calling early is not overreacting.

After breast, groin or axillary surgery, a soft fluid-filled swelling under the incision is often a seroma rather than an infection. It still deserves a look. It can be uncomfortable, and it occasionally needs draining.

Keep the area clean and dry. Follow your surgeon's specific instruction on showering, since it varies by closure type and by whether drains are in. Let water run over the wound rather than scrubbing. Pat dry. Skip baths, pools and hot tubs until cleared. Avoid antibiotic ointments and creams unless your team has told you to use one. They are not routinely helpful, and they can cause contact reactions.

Respect the lifting limits. They exist because the deep layers gain strength weeks after the skin looks finished.

Silicone has the strongest evidence base. Reviews of randomised trials found consistent benefit for preventing and treating raised scars, above all in higher-risk people. That literature gives some practical points. Start once the wound is fully closed, with no scabs or open areas. Wear it around 12 hours a day; 24-hour wear caused skin maceration and was poorly tolerated. Continue for two to three months. By then most of the achievable benefit has been reached. Sheets and gels have not been compared head to head in trials. Gel is easier on awkward contours; sheets are more durable and stay put better overnight.

Massage has less evidence behind it, but it is low-risk once the wound has sealed. A few minutes daily of firm circular pressure can soften a thickened scar and reduce tethering. Sun protection matters too. New scars pigment easily, so keep the area covered or use a high-SPF sunscreen for the first year.

Is a scar thickening, painful, itchy or restricting movement? Ask for referral rather than waiting. Steroid injection, pressure therapy and other options work better on an active scar than a mature one.

Radiation reduces the small blood vessel supply. It also leaves fibrosis, or scarring, in the treated field. Skin there is thinner, less elastic, and slower to repair. Wounds made in previously radiated tissue take longer to close. They break down more often, and they carry a higher infection risk. Surgical teams plan around this. They may delay certain reconstructions until after radiation, or bring in tissue with its own blood supply.

If you have had radiation, tell every future surgeon, dermatologist and dentist which area was treated and when. It changes their planning. It also explains healing that otherwise looks unexpectedly slow.

• NCI — Surgery to Treat Cancer
• Textbook on Scar Management — Silicone Gel for Scar Prevention (NCBI Bookshelf)
• NCI — Infection and Neutropenia during Cancer Treatment