Pin Site Care

Managing Pins Sites:

Prior to surgery the doctor will explain about the extent of the external fixator that will be applied.  It may have screws, it may have fine wires or a combination of the two.  If there are fine wires they will pass through the skin on both sides effectively making two pin sites.  You may have as few as 4 or as many 20 pin sites to clean.

When you wake up from surgery the pin sites will be dressed with a pink or yellowy/brown antiseptic soaked gauze.  Unless there is a lot of bleeding these dressings will be left in place for 48 hours. 

The first re-dressing will then take place.  The dressings are carefully soaked and removed exposing the pin site there may be some bleeding, there may be slight discomfort since the wounds are still a bit raw.  A nurse will carefully clean around the pin sites with cotton buds or gauze.  Each site will be cleaned separately to avoid cross contamination with germs from one site to another. 

You will be able to observe this dressing and then at the next dressing on day 3 you will be able to perform the dressing with a nurse assisting.  Over your period in hospital, probably about 5 days at most, you will learn how to take care of your pin sites.  If it is possible to seal the stitched wounds where the surgery took place, you will be able shower, dry off using a hairdryer on the leg and then re-dress the pin sites in the normal way. 

Once you go home you will continue these dressings.  The use of gauze material pressed up against the skin has been shown to reduce the risk of infection.  There will always be movement between the skin and the wires or screws, either because you are doing corrections with the fixator or because they are close to a joint which you will be keeping moving.  It is important during those periods or in those sites to put pressure between the frame and the skin to stop excessive skin movement and infection.  If you develop any redness or itchiness around the skin it may be due to a reaction to the antiseptic in the gauze dressing, pink (Hydrex) yellow/brown (Betadine).  Once you are home the dressings should be performed every third day after removing the old dressings and having a shower.

Frequently Asked Questions:

Q: If I get an infection around a pin site is it serious?
A: The skin is a barrier to infection.  Any breach in the skin, like where a screw or wire goes through the skin from outside inwards, opens that barrier and germs settle.  An infection may occur but it is easy to treat.

Q: The environment where I work or my home is a worry and I have pets.  Can any of these increase the risk of infection around the pin sites?
A: it is sensible to use to same hygiene rules that you would use normally.  Bathe regularly and keep the sites clean.  Pets are not a problem. 
If you work in a very dirty environment keep the fixator loosely covered.           

Q: I want to go on holiday/travel by plane will it be a problem?
A: It would be sensible to alert the airline in advance and try to get a seat with extra leg room.  You should take holidays and have as normal a lifestyle as possible whilst the fixator is in place.

Q: If I get an infection around a pin site how will I know?
A: You will be aware of a change perhaps a prickling, burning, tingling, redness, pain on pressure or swelling.  At the early stages of infection any of these symptoms may settle with increased care, massage, cleaning.  If not you may require antibiotics.

Q: If I develop an infection and it doesn’t settle with simple care and is painful what should I do?
A: Contact your GP/doctor or the hospital for a course of antibiotics.  Usually Flucloxacillin is a good tablet to take although if you are sensitive to this or allergic to penicillins you may be better with a different drug such as Erythromycin or Fucidin.  The most common germ is a staphylococcus.

Q: I have never cleaned pin sites how will I know how to manage them?
A: Become involved in your care as much as possible.  Watch the nurses cleaning pin sites and try and emulate their technique.  Choose one other person to do the pin sites if you are not able to reach them or if they are painful or if you are tired.  This person should come into hospital and learn the technique of care.

Q: Is it all right to keep the fixator exposed?

A: You may keep the fixator exposed, some people prefer to wear shorts or dresses and do this.  Be careful about exposure to direct sunlight, particularly on holiday on the beach where you should use a sun block on the skin of the limb around and inside the fixator.