Knee Wound Healing: Concerns and Treatment Options

Wound issues (knee)

Dr.
Li: Hello, I would like to ask about an injury I sustained over three weeks ago.
I accidentally punctured my left knee with a sharp edge of a wooden table, resulting in a wound approximately 0.7 cm deep and 0.3 cm wide.
At the time, I did not feel any foreign body sensation, so I treated it with antibiotic ointment as a regular wound.
However, after more than a week, the puncture site developed white necrotic tissue, while the surrounding area is red.
I have been treating it with saline solution, antibiotic ointment, and covering it with gauze.
Despite this, after more than three weeks, the wound has not shrunk and remains approximately 0.7 cm deep and 0.3 cm wide, with the center still having white necrotic tissue and the surrounding area forming scar tissue that is slightly red.
I recently consulted a surgeon who mentioned that wounds typically heal in about three weeks, but this can vary from person to person.
He advised me to continue applying medication and that the wound would eventually heal naturally.
He also mentioned that if I cannot wait, I could consider going to plastic surgery for debridement, which would create a new wound that could be sutured and later have the stitches removed.

I would like to ask:
1.
Could the presence of a foreign body be preventing the puncture wound from healing? How can I determine if there is a foreign body present in the wound?
2.
Is it possible for the wound to result in a permanent indentation? Should I continue to wait, even though applying medication to the wound is very painful? Under what circumstances should I seek further treatment? I am quite confused.
3.
I am also worried that if I undergo debridement surgery on my knee, the scar tissue might cause the skin to become too tight and affect its function.
I apologize for asking what may seem like minor questions, but I am genuinely confused about how to proceed.
Thank you.

Xiao Xin, 30~39 year old female. Ask Date: 2016/12/08

Dr. Li Zhonghuai reply Surgery

Hello! To determine if there are foreign objects inside, debridement is necessary, as cleaning the wound thoroughly can actually promote faster healing.
There's no need to worry about it being too tight; the skin is elastic.
Take care! Changhua Hospital cares about you.

Reply Date: 2016/12/08

More Info

Hello! It sounds like you’re dealing with a challenging situation regarding your knee wound. Let’s break down your concerns and explore the treatment options available for your injury.

1. Foreign Body Concerns: It’s possible that the presence of a foreign body could impede the healing process of your wound. If you suspect that there might be something left in the wound, signs to look for include persistent pain, swelling, redness, or drainage that doesn’t improve over time. A healthcare professional can perform imaging studies, such as X-rays, to check for any foreign objects that may not be visible to the naked eye. If there is a foreign body, it often needs to be surgically removed to allow for proper healing.

2. Wound Healing and Scarring: Wound healing can vary significantly from person to person due to factors such as age, overall health, and the presence of underlying conditions. A wound that remains deep and does not show signs of healing after three weeks may require further evaluation. The white dead tissue you mentioned is likely necrotic tissue, which can hinder the healing process. If the wound continues to remain the same size and depth, it may be beneficial to consult with a surgeon about debridement (removal of dead tissue) to promote healing.
Regarding your concern about the wound forming a "dimple" or indentation, this can happen if the wound does not heal properly or if there is significant tissue loss. However, proper wound care and timely intervention can help minimize this risk.

3. When to Seek Further Treatment: If you are experiencing significant pain when applying medication, or if the wound shows no signs of improvement, it may be time to seek further medical attention. You should consider returning to your healthcare provider if you notice any of the following:
- Increased redness or swelling around the wound
- Increased pain or tenderness
- Pus or other drainage from the wound
- Fever or chills, which could indicate an infection
4. Concerns About Scarring: It’s understandable to be worried about scarring after a potential surgical intervention. Scarring can vary based on the depth of the wound, the surgical technique used, and individual healing responses. Modern techniques, including the use of silicone sheets or gels, can help minimize scarring after surgery. Discussing your concerns with your surgeon can provide you with options to manage and potentially reduce scarring.

5. Continued Care: In the meantime, continue to keep the wound clean and covered. If you find that the pain is too much when applying medication, you might consider discussing pain management options with your doctor. They may recommend a topical anesthetic or alternative methods to help ease the discomfort during dressing changes.

In summary, while it’s normal to feel anxious about a wound that isn’t healing as expected, there are steps you can take to address your concerns. Monitoring for signs of infection, considering the possibility of foreign bodies, and consulting with a healthcare professional about further treatment options are all important. Remember, it’s always better to err on the side of caution when it comes to your health. Don’t hesitate to reach out to your healthcare provider for guidance tailored to your specific situation.

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