You go home after an operation with a sheet of instructions, and a week later you notice something at the incision that nobody warned you about. Most people never discussed infection with their surgeon at all, because it is hard to ask a good question about a subject you have no background in. General surgeon Dr. Loucinda spent part of her talk at our 2026 medical conference filling in exactly that background, including why she leaves some wounds a deliberate way to drain.
Why does the subject of infection almost never come up before you go home?
Because the conversation happens when something is already wrong, and by then the patient is anxious and the window for calm explanation has closed.
What fills the gap is not nothing. A lack of information gets replaced by a negative narrative, usually the worst story someone has heard secondhand. People then either panic over normal healing or wait too long because they assumed the worst and did not want to hear it confirmed. Neither helps the surgical team.
What did Dr. Loucinda say she does differently now?
She described a technique she adopted later in her career, well after medical school: close with staples, leave a small amount of space, and place a wick so the wound can drain.
A wick is a narrow strip of gauze that pulls fluid along its length and out of the wound. She uses iodoform, gauze treated with an iodine compound, or a thin ribbon gauze. The reasoning she gave is that fluid is going to exist either way, and the question is only whether it has a route out.
but the truth is there’s drainage and it’s infected. but the skin is not infected because I’ve given it an out, you know, I’ve given it a way to drain
She said her wound infection rate has gone to just about zero since she started doing it. That is her account of her own practice, not a prediction for anyone else’s surgery.
Why would a surgeon leave a wound open on purpose?
Because a closed space with nowhere to drain is a better home for bacteria than an open one.
Think of a basement with a blocked drain. The water is not the problem on its own, the lack of an exit is. Dr. Loucinda also described the far end of her work, wounds left exposed and open for many days while a severe infection resolves. That is not a complication of the plan, it is the plan, and it is nothing like the tidy closed incision most people imagine when they picture surgery.
Why do hospitals treat this as a numbers problem too?
Surgical site infections are counted, reported and tied to hospital safety scoring and Medicare data, which affects reimbursement at the institutional level.
Dr. Loucinda was straightforward that the pressure sits more on the hospital than on the individual surgeon. The practical result is years of institutional attention to anything that lowers complication rates, which is part of why a technique like wicking spreads. [verify: published evidence for prophylactic wicking of staple-closed surgical wounds]
What does our side of it look like in rehabilitation?
We do not perform wound closure, wicking, packing or drainage management. Our contact with infection risk is post-operative patients who are in front of us for rehabilitation while the wound is still young.
Chiropractic and sports chiropractic training covers infection at the introductory level: is it warm, is it swollen, are the vital signs heading the wrong way. One of our mentors, Dr. Bill Morgan, said we always prepare for our worst day. Our worst day is somebody a few days out from an operation whose infection is just starting and whose signs get missed in a rehab appointment. The surgeons who refer patients to our Hendersonville office manage these risks carefully, which is why we see it rarely. Preparing for it anyway is the job.
- We hold to the restrictions the surgical team set, without improvising around them.
- We ask about the incision and about how the patient is feeling overall, not just about range of motion.
- When something has changed, the patient goes back to their surgeon’s office that day, not at their next visit with us.
Key points
- Dr. Loucinda closes with staples, leaves space, and places an iodoform or ribbon gauze wick so a wound can drain.
- Her point: drainage with an exit is less likely to become an infection of the skin.
- Severe infections may be treated by leaving a wound open for days, which is intentional, not a failure.
- Surgical site infections are tracked in hospital safety and Medicare data, which drives institutional focus.
- Our role is rehabilitation around surgery and fast communication back to the surgical team.
Frequently asked questions
What can I ask my surgeon before I go home?
Reasonable questions are what drainage should look like, how long to expect it, what would count as a reason to call, and who to call after hours. Written answers are better than remembered ones. Your surgical team wants the call early rather than late.
Is a draining incision always infected?
Not necessarily. If a wick was placed, drainage is the design working. The surgeon who performed the operation is the one who interprets what a given amount or appearance means.
Can I keep doing rehabilitation if something looks off?
Check with your surgeon first. We work inside the clearance and restrictions the surgical team gives, and if something has changed at the incision we would rather you be seen by them before your next rehabilitation session.
Do chiropractors get trained in infection management?
Not in depth. The training covers recognition at a basic level, which is why we bring surgeons and other physicians in to teach the rest. Knowing the vocabulary makes the handoff to a patient’s other physicians faster.
If you have an operation coming up, or you are in the weeks after one and want rehabilitation that stays inside your surgeon’s restrictions, you can book a visit with Active Sports Therapy here. We will look at where you are now and coordinate with the team that did the surgery.
Active Sports Therapy · 123 Stadium Drive, Hendersonville, TN 37075 · 615-537-5520
Sources
- Berríos-Torres SI, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery. https://doi.org/10.1001/jamasurg.2017.0904
- Centers for Disease Control and Prevention, National Healthcare Safety Network, Surgical Site Infection (SSI) Event. https://www.cdc.gov/nhsn/psc/ssi/index.html
- Agency for Healthcare Research and Quality, PSNet. Surgical Site Infections. https://psnet.ahrq.gov/primer/surgical-site-infections
Transcript of the video
I also cheat as I’ve gotten older. Not only do I closed with staples, but I leave some space and I put little Wicks I use iodoform or like a little ribbon Galls. but just something to kind of Wick out any bacteria and I’ve seen my wound infection rate go to just about zero, but the truth is there’s drainage and it’s infected. but the skin is not infected because I’ve given it an out, you know, I’ve given it a way to drain and I would assume in your field everything’s metrics driven now is actually in the hospital world, but in the hospital world and Medicare world Wound infections are part of like a hospital safety score.
And so there’s been this drive through the years to you don’t want to have four wound infections because that’s going to reflect on your Medicare data, which ultimately affects reimbursement for that hospital not so much me but on a hospital scale, so if we can Wick that wound where now it’s not infected because it never shows an infection. We drive our safety scores up. We drive our complication rate down.
