Concerns About Slow Healing Wounds After Circumcision Surgery

The wound has not healed, and I am very concerned?

Hello, doctor.
I underwent a circumcision on September 2nd, and during my follow-up appointment, the doctor mentioned that there was skin necrosis and advised me to observe it for a while to see if the skin could heal on its own.
After some time, I was referred to a plastic surgeon, who said that it could heal on its own, and now it has mostly healed.
However, there are still some small holes.
The doctor prescribed paraffin gauze for me to use as a dressing, which I applied for about two weeks.
I noticed that the holes did not improve and seemed to be getting slightly larger.
Initially, applying povidone-iodine did not cause pain, but now it does.
There are also some small areas of broken skin where there was none before.
Each time I change the dressing, there is a slight yellow discharge on the gauze.
My wound does not hurt if I do not touch it, but it occasionally itches, and pressing on it also causes itching.
It only hurts when applying povidone-iodine.

I would like to ask the doctor:
1.
Is it normal for wounds on scars to heal more slowly?
2.
Is the slight yellow discharge on the gauze pus or serous fluid?
3.
Given that there is still an unhealed wound from the black scab of the necrotic skin (the scab has fallen off for some time, but there is still broken skin), is it normal for the wound healing to take this long?
4.
Regarding the phenomenon of wound maceration that people talk about, could my situation be related to that? The areas that were not broken before are now showing small breaks, or could I be having an allergic reaction to the paraffin gauze? It feels like a long time since September 2nd, and I am worried that the small wound has not healed and seems to be getting larger.
I would appreciate your help in answering these questions.

danxin, 20~29 year old female. Ask Date: 2016/12/12

Dr. Zhou Hongzhang reply Plastic Surgery

1.
Your situation is quite complex.
After a circumcision, there has been necrosis of the foreskin tissue.
This may result in insufficient skin on the foreskin, which can lead to the wound reopening during penile erection, causing recurrent minor bleeding or discharge.

2.
Purulent discharge often has a foul odor, while tissue secretions are generally odorless.

3.
Normal wound healing typically takes about 1-2 weeks.
Your wound is more complicated.

4.
Only a small number of individuals are allergic to paraffin gauze.

5.
You can return to your physician's office for a more detailed consultation.

Reply Date: 2016/12/12

More Info

After undergoing a circumcision surgery on September 2nd, it is understandable to have concerns regarding the healing process, especially when complications such as skin necrosis and slow healing arise. Let's address your questions one by one, while also providing some context about wound healing and potential complications.

1. Is it normal for wounds on scars to heal slowly?
Yes, wounds on scar tissue can indeed take longer to heal compared to normal skin. Scar tissue is less vascularized, meaning it has fewer blood vessels, which can impede the delivery of oxygen and nutrients necessary for healing. Additionally, the structure of scar tissue is different from normal skin, which can affect how it responds to injury and healing. Factors such as age, overall health, and the presence of underlying conditions (like diabetes) can also influence healing times.

2. What does the yellow discharge on the dressing indicate?
The yellow discharge you are observing could be either purulent (indicating infection) or serous fluid (which is a normal part of the healing process). If the discharge is thick, foul-smelling, or accompanied by increased redness, swelling, or pain, it may suggest an infection. However, if it is thin and clear, it could simply be a part of the normal healing process. It is essential to monitor the situation closely and consult your healthcare provider if you notice any signs of infection.

3. Why is the wound still not healed after such a long time?
The presence of a wound that has not healed for several weeks can be concerning. Factors such as inadequate blood supply, infection, or persistent irritation can all contribute to delayed healing. The fact that you initially had skin necrosis may have also complicated the healing process. It is not uncommon for wounds to take longer to heal, especially if there are underlying issues that need to be addressed. Continuous monitoring and follow-up with your healthcare provider are crucial to ensure that the wound is healing properly.

4. Could the new small wounds indicate a reaction to the dressing?
The appearance of new small wounds could be due to several factors, including an allergic reaction to the dressing material (in this case, the paraffin gauze), friction, or even infection. If you suspect that the dressing is causing irritation, it may be worth discussing alternative dressing options with your healthcare provider. Additionally, if the itching and new breakouts persist, it could indicate a sensitivity or allergic reaction that needs to be evaluated.

In conclusion, while some degree of slow healing can be expected, especially with complications like skin necrosis, it is essential to maintain open communication with your healthcare provider. Regular follow-ups can help ensure that any potential issues are addressed promptly. If you notice any worsening symptoms, such as increased pain, swelling, or discharge, do not hesitate to seek medical attention. Your health and recovery are paramount, and your concerns are valid.

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