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Home nursing · Wound and stoma care after surgery

Home nursing after surgery

The time back at home after discharge is when complications are most likely to occur. Our team of registered nurses in Hong Kong visits the home to provide aseptic dressings, stitch removal, pressure sore care and stoma assessment and management of complications. They cover the transition period after surgery, to help patients recover at home with confidence and to reduce readmission.

  • Team of registered nurses in Hong Kong
  • Home visits across Hong Kong
  • Nurse $920 per hour · no minimum charge
  • Aseptic technique · nurse-led

Fees and home visit arrangements

The points below answer the questions people ask most often about our home nursing service. For specific fees, see the fees page.

FeesRegistered nurse HK$920 per hour, with the rate falling by session length: 4 hours $400 per hour, 8 hours $340 per hour, 12 hours $300 per hour. No minimum charge, and a single visit can be booked as needed.
Scope of serviceThe service includes aseptic wound cleaning, stitch removal, pressure sore care and diabetic foot care. We also assess stomas (colostomy, ileostomy and urostomy), help patients match suitable care supplies, manage complications and teach family members the care skills.
Service areasThe service covers Hong Kong Island, Kowloon and the New Territories, and visits private homes, residential care homes or hospitals.
Who visitsA registered nurse who holds a practising certificate from the Nursing Council of Hong Kong visits in person to assess the wound and provide care.
How to bookWhatsApp for instant enquiries and bookings, or call 5473 6204.

The transition period just after discharge from surgery

The transition from hospital back home (transitional care) is an important part of the whole recovery process. Surgical site infection (SSI) is one of the most common healthcare-associated infections worldwide, and the World Health Organization published its first global prevention guidelines as early as 2016. Pressure injuries and skin complications around stomas are also common in patients after surgery and in those who are bedbound for a long time. Many international studies show that transitional or home care led by registered nurses effectively lowers the chance of readmission and of emergency department visits after discharge, which indicates that arranging professional follow-up early after discharge is much safer than treating complications once they appear.

RR 0.67
Lower readmission rate
Risk of readmission for patients who received nurse-led transitional care with follow-up over 12 weeks (pooled from 16 RCTs; Sakashita 2025)
RR 0.63
Fewer emergency department visits
Emergency department visit rate for patients who received nurse-led transitional care in the same pooled analysis (Sakashita 2025)
OR 0.45
Fewer stoma-related complications
The effect of pre-operative stoma site marking combined with a professional care pathway. This analysis covered 2 RCTs and 25 non-randomised studies, and the original study noted very low certainty of evidence (Ambe 2022)

A registered nurse who visits the home to check the wound or stoma, clean the wound aseptically and teach family members care skills helps the patient make the most of the recovery period after discharge, and find infection and other complications early.

Wound care: from assessment to healing

Wound care is more than treating a break in the skin. The cause of the wound and its speed of recovery directly decide the direction of care. In general, an acute wound without infection (such as an injury or a surgical incision) mostly heals within about 2 to 4 weeks. A wound that shows no clear improvement after 4 to 6 weeks is a chronic wound. These often involve poor circulation, long-term pressure, diabetes or a biofilm on the wound surface, and need intervention by health professionals.

The four stages of wound healing

Knowing the physiological stages of wound recovery helps family members watch the progress of healing and notice early when healing has stalled:

  1. 1
    Haemostasis
    At the moment of injury, platelets gather quickly and clot into a blood plug to prevent too much bleeding.
  2. 2
    Inflammation
    White blood cells clear bacteria and dead tissue. During this period the wound becomes red, swollen, hot and painful. This is a normal immune response and does not always mean an infection.
  3. 3
    Proliferation
    The body starts to make collagen, bright red granulation tissue grows, and the edges of the wound slowly draw inward.
  4. 4
    Maturation
    Collagen is rearranged, the wound closes completely and forms a scar, and the toughness of the skin slowly recovers.

Wound management goals and assessment items

Modern wound care widely uses a systematic “wound bed preparation” framework (Schultz TIME, 2003). Its focus is to remove dead tissue, control infection and exudate, keep the moisture balance and protect the wound edges. At every visit the nurse carefully records the clinical indicators below, so that the care plan matches the condition:

Three goals of wound management

  • Debridement: removing slough and eschar to make room for healthy granulation tissue to grow.
  • Infection and exudate control: choosing a suitable dressing, and using antimicrobial dressings or agents when needed.
  • Moist balance: keeping the wound moist but not too wet, so that it heals more easily.

Ten indicators for wound assessment

  • Checking the position, area and depth of the wound (length × width × depth), and whether there is undermining or tunnelling (cavities under the skin).
  • Observing the tissue (bright red granulation, yellow slough or black eschar), the exudate (amount, colour, smell) and the state of the wound edges.
  • Checking the skin around the wound, the pain score (0–10) and signs of infection, and comparing with the last record to see how far the wound has improved.

Moisture balance and choosing a dressing

The basic principle is to keep the wound in a balanced state that is moist but not too wet, which best promotes recovery. Animal experiments show that epithelialisation in a moist environment is about twice as fast as in a dry, scabbed environment (Winter 1962), and a wound that is too wet or too dry will slow healing (Junker 2013). A dressing should be chosen according to the actual condition of the wound, and not by how well known the brand is. For how the different modern dressings (such as alginate, hydrofibre, foam, iodine and contact-layer dressings) work and when they are used, and for common myths such as whether keeping a wound moist encourages bacteria, see our article on moist wound healing. The list below can be used for quick daily reference:

AlginateRepresentative products are Biatain Alginate and Suprasorb A. These dressings absorb strongly and suit wounds with moderate to heavy exudate, and they also help to stop bleeding.
HydrofibreA representative product is Aquacel Ag. It turns into a gel after absorbing exudate, and the silver ions in it have broad antimicrobial action.
FoamRepresentative products are Allevyn, Biatain and Mepilex. They absorb exudate and cushion outside pressure while keeping the wound moist, and they do not stick to the wound surface.
IodineRepresentative products are INadine and Iodosorb ointment. These products are used for infected wounds, and they kill bacteria and clear biofilm.
Tulle grasRepresentative products are Jelonet and paraffin gauze. They do not stick to the wound and suit shallow abrasions or skin graft sites.
Wound contact layerRepresentative products are Atrauman Ag and Mepitel One. They protect fragile granulation tissue and can stay in place for several days, so the dressing change does not hurt the wound.

Should a wound be cleaned with saline or an antiseptic?

For everyday cleaning of an ordinary wound, normal saline (NS) is the safest and most widely used, and it does not harm new tissue. Antiseptic solutions need to be used with care:

  • Normal saline (NS) is the safest and most commonly used wound wash. It is gentle, does not harm tissue and suits ordinary wound cleaning.
  • Chlorhexidine is usually used to disinfect intact skin. It is toxic to open deep tissue, however, and is not suitable for prolonged direct use on open wounds.
  • Povidone-iodine kills bacteria strongly, but laboratory tests show it is toxic to skin fibroblasts and may slow wound closure, so long-term direct application to open granulation tissue should be avoided.

Pressure sores (pressure injuries): overview and risk assessment

Pressure injuries are graded by severity from Stage 1 to Stage 4, plus unstageable. A registered nurse combines the patient’s nutrition indicators (for example the albumin level) with the Braden Scale to measure the risk of pressure sores. Literature reviews show that the Braden Scale has moderate validity for predicting pressure sore risk (sensitivity about 0.78, specificity about 0.72), so in practice it should be considered together with clinical judgement and not relied on as a score alone. The key to prevention is to reduce continuous pressure and shear on the skin, and studies show that more frequent repositioning (every 2 to 3 hours compared with every 4 to 6 hours) helps to lower the formation of pressure sores (8% vs 13%).

Pressure sores often start in the tissue under the skin and develop outward toward the surface. Even when the skin surface looks intact, or has only slight discolouration, the tissue underneath may already have died. This is called deep tissue injury (DTI). To learn about the causes of DTI, how shear and reperfusion cause damage, how to recognise it in people with darker skin, and the detailed ways to prevent it, read the article on pressure sores and deep tissue injury.

Further reading: Pressure sores and deep tissue injury (DTI): the hidden danger beneath the skin.

Stoma care: assessment, supplies and managing complications

A stoma is made by surgery that brings the end of a section of bowel or ureter out to the surface of the abdominal wall, replacing the original route of excretion. Good stoma care keeps the area clean, and it is also an important way to prevent complications, support the patient’s mental health and protect quality of life.

Three common types of stoma

Different types of stoma differ in the nature of the output and in the main points of daily care:

ColostomyCommon after surgery for bowel cancer or bowel obstruction. The stoma is usually in the lower left abdomen, and the output is mostly formed stool.
IleostomyCommon in people with Crohn’s disease or ulcerative colitis. The stoma is mostly in the lower right abdomen, and the output is watery and contains digestive enzymes, which makes it more corrosive.
UrostomyCommon after surgery to remove the bladder, to drain urine. The stoma is usually on the right side of the abdomen, and the patient has to wear a urine bag long term.

Changes in the stoma after surgery and nursing assessment

A stoma goes through clear physiological changes after surgery. In the early period (about weeks 0 to 6) it is swollen, moist and bright red, and it gradually shrinks as the swelling goes down, so it needs to be measured often to adjust the size of the base plate. By about 6 weeks after surgery, the tissue swelling has mostly settled, the edge of the stoma is fully healed and secure with the skin of the abdominal wall, and the colour settles to a stable pink. At every visit a registered nurse records in detail the appearance of the stoma (colour, shape, height of protrusion), its function (the nature, amount and smell of the output), the condition of the skin around it and how well the base plate fits.

Choosing suitable stoma supplies, and the role of pre-operative marking

Choosing suitable stoma supplies is the basic step in preventing leaks and contact skin inflammation. It is also worth noting that marking the ideal stoma position on the abdominal wall before surgery (pre-operative stoma site marking) by health staff, together with continued follow-up by a stoma care nurse after surgery, is linked to fewer stoma-related complications (pre-operative marking OR 0.45, although the original study noted very low certainty of evidence). This continuous care from before surgery to return home shows the clinical value of professional follow-up.

Common stoma care supplies

  • One-piece or two-piece stoma bags: the one-piece bag is lighter and sits close to the body. With the two-piece bag only the pouch is changed, so the base plate does not have to be peeled off often, which reduces pulling on the skin.
  • Stoma powder: absorbs moisture from damaged skin so that the base plate sticks more firmly.
  • Barrier paste or barrier strips: fill skin folds or dips around the stoma and stop output leaking out.
  • Skin protective film and stoma belt: the film keeps output from irritating the skin directly, and the belt holds the base plate in place.

How does follow-up of the stoma after discharge help?

  • An RCT confirmed that telephone follow-up by a stoma care nurse after discharge helps patients adjust to the stoma sooner, raises their ability to look after it themselves and reduces complications (Zhang 2013).
  • An RCT of nurse-led discharge planning showed that systematic follow-up can reduce stoma complications and unplanned readmission (2024).
  • Guidance at home from a professional helps patients and family members learn how to change the stoma bag and the care skills sooner. The overall literature, however, has not reached a consistent conclusion on whether this can “reduce readmission”.

Common stoma complications and how they are managed

Complications of the stoma itself and of the skin around it are fairly common (reported rates vary widely between studies and there is no single exact figure), but with professional nursing intervention most problems can be dealt with well, or even prevented early:

Common complications
  • Irritant dermatitis: output on the skin causes a burning feeling
  • Granuloma: small red spots on the edge of the stoma that bleed easily
  • Parastomal hernia: a bulge in the abdominal wall around the stoma
  • Retraction: the stoma sits below skin level and is prone to severe leaking
Professional nursing responses
  • Adjust the size the base plate is cut to, and use barrier paste and skin film to reduce contact with output
  • Assessment by the nurse, and treating the granulation tissue with silver nitrate where needed
  • An abdominal support belt and posture guidance, and referral to a doctor for assessment
  • Switch to a convex barrier plus a belt to fit a retracted stoma

When should a health professional be contacted at once?

If any of the following occurs, contact the nursing team or seek medical care at once without delay:

  • Redness and swelling spread outward from the edge of the wound. This may be a sign of cellulitis.
  • Exudate suddenly increases, becomes thick, smells bad or turns to pus. These all mean the wound is infected.
  • The patient has a fever, or the wound has not improved after two weeks.
  • The stoma keeps leaking, the skin around it is damaged, or the stoma turns dark purple or pale.
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In-depth articles on wounds and pressure sores

Frequently asked questions

What is the biggest risk to a surgical wound? Why should a nurse do the dressing?
Surgical site infection (SSI) is one of the most common healthcare-associated infections worldwide, and the World Health Organization has issued global guidelines for its prevention. A registered nurse cleans and dresses the wound with aseptic technique and regularly assesses its size, exudate and signs of infection. This allows infection to be found early and keeps the moisture balance that helps the wound to heal. A study has also found that nurse-led transitional care significantly lowers the risk of readmission after discharge (RR 0.67).
Should a wound be kept dry or moist?
Many people still think a wound heals faster if it is kept dry and allowed to form a scab, but the reverse is true. A moist environment that is not too wet helps healing. In animal experiments, epithelialisation of wounds in a moist environment was about twice as fast as in a dry, scabbed environment (Winter 1962). The key is to choose a suitable dressing after professional assessment to keep the moisture balance. A wound that is too wet, causing maceration, or too dry will slow recovery. For how the different dressings work and the types available, see the article on moist wound healing.
How can pressure sores be prevented in a bedbound patient after surgery?
The core of prevention is to reduce continuous pressure and shear on the skin. A systematic review found that more frequent repositioning (every 2 to 3 hours compared with every 4 to 6 hours) lowers the chance of pressure sores (8% vs 13%, although the original study noted a low certainty of evidence, so it should be seen as helping to reduce risk and not as absolutely effective). A registered nurse uses assessment tools such as the Braden Scale to measure risk, and draws up a repositioning and pressure-relief plan for the caregiver to carry out in daily care. For the hidden damage beneath the skin in pressure sores, and how to recognise deep tissue injury (DTI) early, see the article on pressure sores and deep tissue injury.
Is saline or an antiseptic solution better for cleaning a wound?
For cleaning an ordinary wound, normal saline is safe and does not harm tissue, and it is the first choice. Antiseptics such as chlorhexidine and povidone-iodine kill bacteria strongly, but laboratory tests show concentration-dependent cytotoxicity to skin fibroblasts, which may slow wound closure. They are therefore not suitable for prolonged direct use on open granulating wounds, and the actual use should be decided by a professional.
Is redness and leaking around a stoma (colostomy or urostomy) normal? What should be done?
Complications of the skin around a stoma are fairly common (reported rates vary widely between studies and there is no single exact figure). The most common is contact dermatitis from irritation by stool or urine. Care focuses on cutting the base plate to the right size, applying barrier paste or film, and switching to a convex base plate where needed. If leaking continues or the skin is damaged, a stoma care nurse should do a detailed assessment. Studies have also confirmed that continued follow-up by a stoma care nurse helps to reduce stoma complications.
After discharge, does having a nurse visit to follow up stoma care really help?
There is evidence that it does. A randomised controlled trial found that telephone follow-up by a stoma care nurse after discharge helped patients adjust to life with a stoma, raised their confidence in self-care and reduced complications. A more recent RCT of nurse-led discharge planning also showed that follow-up reduced complications and unplanned readmission. For patients and family members learning stoma care for the first time, guidance at home from a professional helps them pick up the skills sooner and make fewer mistakes. (Note: the overall literature is mixed on whether this can “reduce readmission”, and some studies show no significant difference.)

Need a registered nurse to visit for dressings, stitch removal or stoma care after surgery? Message us on WhatsApp for a free explanation of transition care arrangements and an instant quote.

WhatsApp for a free enquiry and instant quote

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Winter, G. D. (1962). Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature, 193, 293–294. PubMed
  2. Junker, J. P. E., Kamel, R. A., Caterson, E. J., & Eriksson, E. (2013). Clinical impact upon wound healing and inflammation in moist, wet, and dry environments. Advances in Wound Care, 2(7), 348–356. PubMed
  3. Schultz, G. S., Sibbald, R. G., Falanga, V., et al. (2003). Wound bed preparation: a systematic approach to wound management (TIME framework). Wound Repair and Regeneration, 11(Suppl 1), S1–S28. PubMed
  4. Rueda-Fernández, M., et al. (2022). Cytotoxicity and wound closure evaluation in skin cell lines after treatment with common antiseptics for clinical use. International Journal of Molecular Sciences, 23(10), 5657. PubMed
  5. World Health Organization. (2016/2018). Global guidelines for the prevention of surgical site infection; Gulland, A. (2016). WHO launches global guidelines to stop surgical site infections. BMJ, 355, i5942. WHO · PubMed
  6. Avsar, P., Moore, Z., Patton, D., O'Connor, T., Budri, A. M., & Nugent, L. (2020). Repositioning for preventing pressure ulcers: a systematic review and meta-analysis. Journal of Wound Care, 29(9), 496–508. PubMed
  7. Huang, C., Ma, Y., Wang, C., et al. (2021). Predictive validity of the Braden scale for pressure injury risk assessment in adults: a systematic review and meta-analysis. Nursing Open, 8(5), 2194–2207. PubMed
  8. EPUAP/NPIAP/PPPIA. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline (Haesler, E., ed.). internationalguideline.com
  9. Salvadalena, G. (2008). Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review. Journal of Wound, Ostomy and Continence Nursing, 35(6), 596–607. PubMed
  10. Ambe, P. C., Kugler, C. M., Breuing, J., et al. (2022). The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy: a systematic review and meta-analysis. Colorectal Disease, 24(8), 904–917. PubMed
  11. Zhang, J., Wong, F. K. Y., You, L., et al. (2013). Effects of enterostomal nurse telephone follow-up on postoperative adjustment of discharged colostomy patients. Cancer Nursing, 36(6), 419–428. PubMed
  12. Liu, J., et al. (2024). The effects of a nurse-led discharge planning on the health outcomes of colorectal cancer patients with stomas: a randomized controlled trial. International Journal of Nursing Studies, 155, 104753. PubMed
  13. WOCN Society. (2018). Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy (Executive Summary). Journal of Wound, Ostomy and Continence Nursing, 45(1), 50–58. J WOCN
  14. American Cancer Society. Living with an Ostomy (Colostomy / Ileostomy / Urostomy). cancer.org
  15. Sakashita, C., Endo, E., Ota, E., & Oku, H. (2025). Effectiveness of nurse-led transitional care interventions for adult patients discharged from acute care hospitals: a systematic review and meta-analysis. BMC Nursing, 24, 379. PubMed