In short. The signs that need urgent attention after surgery — infection, bleeding, clot, breathing problems and flap compromise — and exactly what to do when you see them.
Key points
- Before you leave hospital, write down who to call during working hours, who to call at night and at weekends, and which emergency number to use for anything life-threatening.
- Keep it somewhere you will find it while drowsy or in pain.
- That one note is the difference between acting in ten minutes and deliberating for two days.
Most recoveries are uneventful. A small number are not, and the difference between a minor problem and a serious one is usually how quickly it was acted on. The signs below are the ones that matter, and none should wait for the next appointment.
Infection
Infection after surgery usually announces itself with increasing pain, spreading redness and warmth around the wound, swelling that gets worse rather than better, discharge that is thick or foul-smelling, and fever. A high temperature, or a fever that comes with chills and feeling generally unwell, needs assessment the same day. Early infection is usually straightforward to treat; an infection that has had a week to develop is not.
Bleeding and collections
Some oozing is expected. Bleeding that soaks through a dressing, that keeps restarting, or that comes with a rapidly enlarging, hard and painful swelling is not. A collection of blood under the skin can threaten the tissue around it, and after some operations needs to be released. A dressing soaked through should be reinforced with a clean dressing and reported immediately — not simply replaced and watched.
Clot in the leg or lung
Surgery and reduced movement both increase the risk of a blood clot. A clot in the leg produces swelling, warmth, tenderness and pain in the calf, often on one side only. A clot that travels to the lungs produces breathlessness, chest pain that worsens on breathing in, a racing heart, coughing blood, or a feeling of impending collapse. The second is an emergency: call the emergency services immediately rather than arranging your own transport.
Know your own contact route before you need it
Before you leave hospital, write down who to call during working hours, who to call at night and at weekends, and which emergency number to use for anything life-threatening. Keep it somewhere you will find it while drowsy or in pain. That one note is the difference between acting in ten minutes and deliberating for two days.
Breathing problems
Breathlessness, noisy breathing, or drowsiness deeper than expected can follow anaesthesia, sedatives or pain relief, particularly in the first day or two. If breathing becomes difficult, if you cannot be woken properly, or if the lips or fingertips look dusky, treat it as an emergency.
Flap or graft compromise
Where tissue has been moved or grafted, its blood supply is what is watched. A flap or graft that turns pale, white, blue, grey or black, that feels cold compared with the surrounding skin, that becomes suddenly swollen and tense, or that develops a dark blister, is in trouble. Time is critical: failing tissue can sometimes be saved if it is seen within hours, and rarely after days. Do not wait for a scheduled appointment, and do not cover it up and hope.
Seek emergency care immediately for
- Chest pain, breathlessness, coughing blood, or a swollen, warm, tender calf.
- Heavy or continuing bleeding, or a dressing soaked through with blood.
- A flap or graft that turns dark or cold, spreading redness with fever, or a wound that has opened.
Being wrong about a warning sign is a small embarrassment. Being late with one is not. If something feels clearly wrong, contact your team, and if you cannot reach them and the problem is severe, go to an emergency department.
Frequently asked questions
How does infection show itself after surgery?
Increasing pain, spreading redness and warmth around the wound, swelling that gets worse rather than better, discharge that is thick or foul-smelling, and fever. A high temperature with chills needs assessment the same day rather than at the next appointment.
What are the signs of a clot in the leg or lung?
A clot in the leg causes swelling, warmth, tenderness and pain in the calf, often on one side. A clot in the lungs causes breathlessness, chest pain that worsens on breathing in, a racing heart or coughing blood, which is an emergency.
What does a failing flap or graft look like?
It turns pale, white, blue, grey or black, feels cold compared with the surrounding skin, becomes suddenly swollen and tense, or develops a dark blister. Time is critical, so do not wait for a scheduled appointment or cover it up.
Risks & Limitations
- Recovery takes longer than most patients expect, and the final result of most operations is judged at six to twelve months, once swelling has settled and scars have matured.
- Some swelling, bruising, numbness and discomfort are a normal part of healing rather than a sign that something has gone wrong.
- Scars are permanent, though they mature and usually become softer and less noticeable over twelve to eighteen months.
- Rushing back to activity commonly causes setbacks and costs more time than it saves.
- The written instructions from your own discharging team override any general guidance here, including on dressings, medication, activity and follow-up.
When to Seek Care
- Severe or worsening pain, or a wound that opens or discharges.
- Spreading redness or warmth around the wound, or a fever.
- A swollen, painful calf; chest pain; or breathlessness — seek emergency care immediately.
- Heavy bleeding, or a dressing that is soaked through.
- A flap or graft that turns dark or cold.
- Do not wait for your next appointment for any of these. Contact your own clinical team, and if the problem is severe and you cannot reach them, go to an emergency department.
References & Further Reading
- World Health Organization (WHO) — surgical safety and patient safety resources
- National Institute for Health and Care Excellence (NICE, UK) — guidance on surgical site infection and recovery
- American Society of Plastic Surgeons (ASPS) — patient safety and aftercare guidance
This page is patient education, not medical advice, and it does not cite individual studies. It cannot replace the instructions given to you by the team that performed your operation. Discuss your own recovery with that team. To contact them, see Contact & Consultation.