✔️Article written by a veterinarian & reviewed by Dr. Whittenburg, Director, on Dec 5th, 2022.
Our pets will typically undergo a surgical procedure at some point during their lives. This may be for elective surgery like spaying or neutering, or even as an intervention for a medical condition like an orthopedic disease.
While we veterinarians are responsible for doing a good job in surgery, it is then left to the pet owner to ensure recovery is going smoothly. A big part of this is making sure your pet’s incision is healing without complication.
One complication we always educate owners on is recognizing incisional infections. These are uncommon after clean surgical procedures (like reproductive surgery or abdominal surgeries) but still occur with some frequency.
Almost all incisional infections are self-inflicted in dogs. They simply do not understand that they should not lick their incisions, and thus are likely to chew and irritate the wound. If unable to lick or chew, they may rub it on the floor instead. This can lead to the incision failing to heal and secondary infection. In this article, we will review pictures of healthy incisions and pictures of incisions that have become infected. Finally, we will also share 6 tips for dog owners to successfully avoid incision infections.
Related post: Spay Incision Infections: our vet explains.
What a normal incision looks like in dogs [with pictures]
Before we delve into what unhealthy incisions look like in dogs, let’s explore what a normal incision should look like.
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This is an incision with suture material under the skin that will absorb:
This is an immediate postoperative photo. You can see the skin is mildly swollen, which is normal. The brown on the skin is iodine:
The picture below shows a healing incision. There is a small amount of scabbing present, which is very normal:
What an incision infection looks like in dogs [with pictures]
Incision infections can occur for a variety of reasons, but they are most often caused by dogs licking or chewing at the surgical site. Licking the surgical site traumatizes the skin and introduces oral bacteria into the wound.
In the picture below, you can see the difference between inflamed skin and normal healing areas. The skin is reddened and angry caused by licking. The sutures were also chewed out, which could put this dog at risk for dehiscence or breakdown of the surgical site.
This dog’s abdominal incision is very inflamed. It has been closed with staples that are becoming embedded due to the swelling of the skin:
This dog’s incision is very clearly infected. There is tan to green discharge and swelling around the middle of the incision. The incision appears to be breaking down:
This is a picture of a spay incision site that has become infected. It is very inflamed and has discharge:
Below is a photo of a severely infected neuter site. There is significant swelling, discharge, and necrosis of the surrounding tissue:
Other examples of incision infections in dogs, with pictures
Any surgical site and incision can become infected. Orthopedic surgeries are sometimes at a greater risk. This is due to the nature of how the injury happened (contaminated vs not) and if surgical implants are needed. Though surgical-grade implants are very safe, they also create a nidus for bacteria.
Disclaimer: This content is not a substitute for veterinary care. Always consult with your vet for health decisions. Learn more.
This is a picture showing an infection after neutering surgery:
This is a photo of a dog who had orthopedic surgery whose incision dehisced and became infected. Contaminated wounds, such as those secondary to trauma or bite wounds, are at greater risk of infection:
This photo is of a traumatic wound that has become infected and has broken down. This dog will need another surgical procedure to debride the wound, and it will need to heal by second intention:
What causes incisional infections?
The most common cause of infection is self-trauma of the incision by licking and chewing. Secondary to that, dogs develop infections due to the following causes:
Existing skin disease: Dogs that have an existing skin infection or chronic skin disease have unhealthy skin that is more likely to become infected or for infection to spread to a new surgical site.
Poor aseptic technique: Dogs that have surgery performed in an unsterile environment can be more prone to infections.
Dirty wounds: Wounds caused by bites, penetrating trauma, or those that become contaminated by the surrounding environment are more likely to become colonized with bacteria.
Immunocompromised animals: Animals with chronic diseases that impair their immune system are more likely to develop infections.
Chronic antibiotic use: Animals that are on long-term antibiotics or multiple types of antibiotics are at risk for developing multi-drug resistant bacteria. These can cause serious infections.
Chronic corticosteroid use: Animals that are on corticosteroids long-term may have delayed wound healing and be more at risk for wound healing failure and infection.
The picture below is a picture of a dog with skin disease. Skin disease should always be treated first before elective surgery is performed, as these dogs are at increased risk of incisional infections.
What are the visual characteristics of incision infections?
After your dog’s surgery, you will be provided post-operative healing instructions. Your veterinarian will discuss monitoring for infection. These are the most common signs of infection:
1. Swelling – a mild amount of swelling is normal after surgery, but if it becomes excessive or is progressive and not improving, an infection may be brewing.
2. Heat and pain – the incision may be hot to the touch and painful if an infection is present.
3. Discharge – tan, green, or yellow discharge is abnormal. An accompanying foul smell is another clue that there is an underlying infection.
4. Wound breakdown – if the wound begins to open or you can see the underlying tissue, an infection is likely to be present, as shown in the incision infection picture below.
Is it an incision infection, or is it something else?
Diligent owners are monitoring their dog’s incision closely to make sure an infection is not developing. We can often become tricked into thinking an infection is present when the changes are just normal post-operative healing.
A small amount of bloody or pink-tinged discharge is normal after surgery. You may see scabbing or crusting develop, which is how the body heals wounds in a normal fashion. Swelling is expected but is usually mild. The same applies to bruising. Many owners get worried by the amount of bruising they notice 2-3 days after surgery. This is normal if it is not excessive or progressive.
This amount of bruising is very normal after surgery:
Sometimes swelling or fluid buildup can develop, which is concerning for infection. Dogs that are too active after surgery can develop a seroma. This is an accumulation of fluid under the skin after surgery. It is not harmful, and most of the fluid will become absorbed by the body without intervention.
6 steps you can take at home to help avoid incision infections
1. Follow your veterinarian’s post-operative instructions: I know your dog’s post-operative instructions may seem exhaustive, but they are crucial for your dog to heal normally. It is now your job to make sure your dog is set up for success. Poor compliance in surgical aftercare is a huge reason why dogs develop incisional infections or other surgical complications.
2. Keep an e-collar or cone on your dog at all times: This is a non-negotiable step in wound healing. Dogs MUST wear their cones to prevent licking and chewing. Incisions become itchy as they heal and are sore immediately after surgery. It is a dog’s nature to want to lick or chew these areas. In a blink of an eye, a dog can chew open its incision or introduce bacteria. E-collars may only be removed when directly supervised with eyes on your dog at all times. Appropriate times include during feedings or potty breaks, then the cone goes back on. It is important to note that ‘surgery suits’ are not a replacement for a cone. Dogs have sharp teeth that can chew through the fabric to the underlying incision, causing significant trauma.
3. Avoid excessive activity: Your dog should be kept strictly rested for a minimum of 2 weeks or longer (if directed by your veterinarian) to allow the tissue to heal appropriately. Excessive motion or exercise will apply tension to the wound, making healing difficult. Poorly healing wounds are at a greater risk of infection.
4. Do not allow your dog to lick or chew its wound: The mouth of a dog contains a large variety of bacteria. When introduced to an incision by licking, the bacteria can colonize and cause an infection. Licking also causes trauma to the skin and can delay healing. I have also seen dogs chew through their sutures and open their incisions, requiring emergency surgery to repair the defect.
5. Keep the area clean and dry: Dogs should not be bathed for 14 days after surgery and only with the blessing of their veterinarian. The incision should not get wet as this can delay healing. Keep your dog as clean and dry as possible. Incisions should be covered if your dog goes outside in the rain or snow. If the incision does become wet or dirty, lightly dab it clean with a moist, clean paper towel. Then blot with a dry paper towel. Do not scrub the incision.
6: Do not touch the incision: Touching the incision with your fingers can also introduce bacteria, so try to limit contact as much as possible. There is no need to clean the incision or apply ointment. Most incisions will heal without any topical treatment.
When to call your veterinarian
If at any point you suspect your dog’s incision is abnormal or infected, you should contact your veterinarian right away. Photos are extremely helpful, and your veterinarian may request you email pictures to their clinic for review. It is always best to be overly cautious because incisional infections can become disastrous if left unattended.
If after hours or on the weekend, it is usually best to follow up with the local emergency clinic for veterinary care.
What do veterinarians do when an incision is infected
If an incisional infection is suspected, your veterinarian will want to take a few steps. They will perform a thorough examination of your dog and ensure they are not feeling unwell. Fevers may be an indicator of systemic illness secondary to an infection.
They will examine the incision closely and may consider collecting a culture of the site. A culture is a swab taken of the incision that is sent to a laboratory to assess for bacterial growth that can indicate an infection is brewing. Once bacteria are grown, susceptibility testing should be performed to determine what antibiotic the bacteria can be treated with. Due to the risk of resistant infections in surgical wounds, culture and susceptibility testing should always be performed.
After examination, your veterinarian will discuss antimicrobial treatment with antibiotics. They may start a broad-spectrum medication until culture results return.
Severe infections may need to be surgically addressed and cleaned. Some incisions will need to be re-opened and left to heal by the formation of granulation tissue. This method is called healing by second intention. Some animals will need drains placed or debridement of necrotic tissue.
The cost associated with these treatments is variable. A sensitivity and culture usually cost around $200-300. Depending on the antimicrobial selection, these are generally inexpensive, but large dogs or those requiring prolonged therapy may need hundreds of dollars of medication.
If revision surgery is needed, the cost may range from several hundred to several thousand of dollars. This is why it is so important to follow post-operative instructions as closely as possible. Some infections are inevitable, but most are caused by inappropriate surgery aftercare.
Frequently asked questions
What happens to a dog’s skin after the incision?
After surgery, a dog’s skin will heal in a normal wound-healing fashion. The stages of wound healing are described here.
What is the typical post-operative care for a dog?
Typical post-operative care includes strict rest, wearing an e-collar, and close incision monitoring for a minimum of 10-14 days. Dogs may not return to normal activity until the incision is healed and sutures are removed if applicable.
How long does it take for an incision to heal on a dog?
Average incision healing is 10-14 days. Infected incisions will take a prolonged time to heal as bacterial contamination will prevent normal healing. Many incisions can take several weeks to heal.
How often should I be checking a dog’s incision after surgery?
Owners should evaluate their pet’s incisions at least twice a day to ensure they are healing appropriately.
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This article has made me much more at ease. My Aussue pup was spayed 4 days ago. All is going well and her incision looks good. It’s been hard to keep her as quiet as she should be. This evening there was a light red watery drainage out of the blue while she was laying down. This article with pics calmed my nerves and helped me look at the situation rationally. Seeing bloody drainage just put me into a panic for a bit. I’m thankful for this article.