Post-Surgical Wound Care: Addressing Complications and Treatment Options

Post-debridement wound care?

Hello Doctor, my left calf between the knee and ankle was injured on June 6, 2015.
At that time, I received three stitches for a wound smaller than a coin.
After removing the stitches and continuously changing the dressings, a year has passed, and the wound still hasn't healed enough for me to feel comfortable swimming or soaking in hot springs (except for showering).
By early June 2016, the wound was still oozing.
Due to my concerns after a year, I visited a major hospital on June 17, 2016, to see a plastic surgeon, who performed debridement.
As a result, the originally small wound became the size of a 50 NT dollar coin.
In the first couple of weeks after debridement, the doctor prescribed me a topical ointment, and after a couple of weeks, I was given a burn cream.
Since it was a plastic surgery department, the doctor mentioned that skin grafting or flap surgery would be necessary.
I then consulted another surgeon, who said the wound was too large for a skin graft and could only be treated with a flap.
I have two questions for you, Doctor: First, I’m not sure if the swelling above the ankle and the redness, heat, and pain around the wound are due to my lack of leg elevation or from moving around too much.
There is no fever or skin indentation, so is this cellulitis? Second, if I do not care about the cosmetic appearance of the wound healing, should I continue to see the plastic surgeon at the major hospital? Thank you for your response.

cái, 20~29 year old female. Ask Date: 2016/07/01

Dr. Li Zhonghuai reply Surgery

Hello! It is recommended to perform a contrast-enhanced computed tomography (CT) scan of the left lower limb to determine the extent of the purulent and chronic infection.
Debridement will be necessary; otherwise, there will still be drainage.
Keep your leg elevated during the day and while sleeping.
Even without a skin flap or skin graft, granulation tissue will gradually fill in, though it may take longer.
You can refer to the photos on our hospital's website.
Take care! Changhua Hospital cares about you!

Reply Date: 2016/07/01

More Info

Post-surgical wound care is a critical aspect of recovery, especially following traumatic injuries or surgeries. Your situation, involving a wound that has not healed properly over the course of a year, raises several important considerations regarding complications and treatment options.

Firstly, the persistent drainage from your wound and the surrounding symptoms of redness, swelling, and warmth are concerning and could indicate an infection, such as cellulitis or even a more serious condition like necrotizing fasciitis. While you mentioned that you do not have a fever, the presence of these symptoms suggests that your body is responding to some form of irritation or infection. It is crucial to have a healthcare professional evaluate these signs, as untreated infections can lead to more severe complications, including systemic infections that can affect your overall health.

In terms of your question about whether the swelling and redness could be indicative of cellulitis, it is indeed a possibility. Cellulitis is a bacterial skin infection that can occur when bacteria enter through broken skin. The symptoms you describe—redness, swelling, warmth, and pain—are classic signs of this condition. If you suspect cellulitis, it is essential to seek medical attention promptly, as it typically requires antibiotic treatment to prevent the infection from spreading.

Regarding your second question about whether to continue seeing a plastic surgeon, it depends on your goals for recovery. If you are primarily concerned about the functional aspect of your leg and not the cosmetic outcome, you may consider consulting with an orthopedic surgeon or a wound care specialist who can focus on healing the wound effectively. However, if you are interested in improving the appearance of the scar or addressing any functional limitations caused by the wound, continuing to see a plastic surgeon may be beneficial. They have specialized training in managing complex wounds and can offer advanced techniques such as skin grafting or flap surgery, which may be necessary if the wound is not healing adequately.

In addition to surgical options, there are several non-surgical treatments that can aid in wound healing. These include:
1. Wound Care Management: Regular cleaning and dressing changes are essential. Using appropriate wound dressings that maintain a moist environment can promote healing.

2. Antibiotics: If an infection is suspected or confirmed, antibiotics may be necessary to treat the infection and prevent further complications.

3. Nutritional Support: Adequate nutrition, including protein and vitamins (especially Vitamin C and Zinc), is vital for wound healing. Consider discussing dietary changes or supplements with your healthcare provider.

4. Physical Therapy: If the wound has caused any functional limitations, physical therapy may help improve mobility and strength in the affected area.

5. Monitoring for Complications: Regular follow-ups with your healthcare provider are essential to monitor the wound's progress and address any emerging issues promptly.

In conclusion, it is vital to address the ongoing symptoms you are experiencing with your wound. Seeking a thorough evaluation from a healthcare professional, particularly if you suspect an infection, is crucial. Depending on your healing goals, you may choose to continue seeing a plastic surgeon or consult with other specialists who can provide targeted care for your specific needs. Remember, timely intervention can significantly impact your recovery and overall health.

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