Postoperative wound infection — SCE Dermatology MCQ

Correct answer: B — Open wound assessment with culture and oral antibiotics

The correct answer is B, open wound assessment with culture and oral antibiotics. Increasing pain, spreading erythema, warmth and purulent discharge five days post excision are classic local signs of surgical site infection (SSI), not expected postoperative inflammation, which should be settling by this point rather than worsening. NICE guidance on SSI defines infection by exactly these features (heat, redness, pain, swelling, with discharge) and recommends wound assessment with microbiological sampling to guide antimicrobial choice, plus appropriate antibiotic therapy once infection is confirmed. As the patient is afebrile with stable observations, this can be managed with oral antibiotics rather than admission, but the wound still needs formal assessment and a swab before or alongside treatment. This combined approach addresses diagnosis and management together, unlike any single isolated intervention among the options. Why the other options are wrong: E. Reassure that this is normal healing: spreading erythema, increasing pain and purulent discharge at day 5 are red flag features of infection, not the expected trajectory of uncomplicated healing, and untreated infection risks abscess or dehiscence. D. Apply potent topical steroid to the wound: corticosteroids suppress local immune response and impair collagen synthesis, worsening an established bacterial infection and delaying healing further. A. Remove sutures and close again immediately: re-closing an actively infected wound traps purulent material and bacteria, promoting abscess formation; infected wounds should be assessed and often left open or drained, not immediately re-sutured. C. Start phototherapy to speed healing: phototherapy has no established role in bacterial wound infection and does not address the underlying microbial cause. Key point: Spreading erythema, warmth, pain and purulent discharge after surgery indicate SSI, requiring wound assessment, culture and oral antibiotics in a systemically stable patient.

Reference: NICE Guideline NG125, Surgical site infections: prevention and treatment (2019, updated 2020), Recommendations section defining SSI signs (heat, redness, pain, swelling, discharge) and management. https://www.nice.org.uk/guidance/ng125/chapter/Recommendations