How to Repair Unstitched Wounds After Abdominal Surgery

How to repair an incision that has not been sutured?

I previously underwent abdominal surgery where a drainage tube was placed, but due to poor healing, there has been continuous fluid leakage, resulting in an open wound of about 7 to 8 centimeters that has not closed.
This has now healed into a large, depressed scar.
What type of surgery should I consider to restore it to a smooth appearance? Additionally, if I also want to repair the scar from the abdominal surgery, is it better to perform the revision surgery soon after the initial procedure or after full recovery for better results?

Hua Wuhen, 40~49 year old female. Ask Date: 2016/07/18

Dr. Zhou Hongzhang reply Plastic Surgery

In general, scar concerns can only be addressed after the wound has healed.
Once the wound has healed, scar care should begin, which typically lasts about 3 to 6 months.
Scar revision surgery should be considered approximately 6 to 12 months after the wound has healed.
If the scar remains unsightly after it has matured, then scar revision surgery or laser treatment can be considered.

Reply Date: 2016/07/18

More Info

When dealing with unstitched wounds after abdominal surgery, particularly those that have not healed properly and have resulted in significant scarring, it is crucial to approach the situation with care and professional guidance. The healing process of surgical wounds can be complex, especially when complications such as fluid leakage occur. Here’s a comprehensive overview of how to manage these issues and what surgical options may be available.

Understanding the Healing Process
After abdominal surgery, the body goes through a natural healing process. However, if a wound remains unstitched and continues to ooze fluid, it can lead to delayed healing and the formation of irregular scars. The first step in managing this situation is to ensure that the wound is clean and free from infection. If there is ongoing drainage, it may indicate that the wound is not healing properly and could require medical intervention.

Surgical Options for Unstitched Wounds
1. Debridement: If the wound has necrotic tissue or is not healing due to debris, a surgeon may perform debridement. This procedure involves removing dead or infected tissue to promote healing.

2. Wound Closure: Depending on the condition of the wound, the surgeon may decide to close it surgically. This could involve suturing the wound if the edges are healthy enough to be brought together. In some cases, a skin graft may be necessary if there is significant tissue loss.

3. Scar Revision Surgery: If the wound has healed but left a significant indentation or irregularity, scar revision surgery may be an option. This procedure aims to improve the appearance of the scar by removing the old scar tissue and re-stitching the area.

Timing for Scar Repair
Regarding the timing of scar repair, it is generally recommended to wait until the wound has fully healed before considering any surgical intervention for scar revision. This typically means waiting at least 6 to 12 months post-surgery. The reason for this delay is that scars undergo a maturation process, and their appearance can change significantly over time. Early intervention may not yield the desired results, as the scar may still be in a state of healing.

Postoperative Care and Scar Management
In the interim, there are several strategies to manage the scar and promote healing:
- Wound Care: Keep the area clean and dry. Follow your healthcare provider's instructions regarding dressing changes and any topical treatments.

- Moisturization: Applying silicone gel sheets or ointments can help in managing scar formation. These products can keep the scar hydrated and may improve its appearance over time.

- Massage Therapy: Once the wound has healed, gentle massage of the scar tissue can help break down the fibrous tissue and improve flexibility.

- Sun Protection: Protecting the scar from sun exposure is crucial, as UV rays can darken scars and make them more noticeable.

Conclusion
In summary, if you have an unstitched wound from abdominal surgery that has not healed properly, it is essential to consult with a healthcare professional. They can assess the wound and recommend appropriate interventions, including potential surgical options. Remember that patience is key, as scars can take time to mature and improve in appearance. Always follow your surgeon's advice regarding the timing of any corrective procedures and adhere to postoperative care guidelines to promote optimal healing.

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