Wound Care Discrepancies After Ankle Injury

Concerns regarding wound management?

Hello, Doctor.
I have an open wound on my ankle due to a car accident.
After examining the wound, the doctor performed debridement, sutured the wound, and applied a cast.
Two weeks later, the doctor assessed that the condition was good and removed the stitches, applying a silicone gel.
He mentioned that I could replace the gel if it fell off.
I was originally scheduled for a follow-up appointment in two weeks, but two days after the stitches were removed, I noticed some oozing blood from the wound, and the silicone gel had come off.

Feeling concerned, I returned to the hospital for a check-up three days after the stitches were removed.
However, due to time constraints, I did not see my original attending physician and was examined by another doctor in the same department.
This doctor indicated that the wound was not yet healed, so I could not use the silicone gel.
After removing the gel, he noted yellowish tissue on the wound and used povidone-iodine to clean it off, stating that granulation tissue had formed but the epidermis had not yet healed (I didn’t fully understand this part).
He then applied a red ointment and instructed me to change the dressing daily.
I would like to ask about the differing approaches of the two doctors.
I plan to follow the second doctor's method for dressing changes, but I am uncertain which method is truly best for my wound.
Additionally, if my attending physician sees me using a different method at my next follow-up, will it cause any issues? I am a bit worried, and I would appreciate your clarification.
Thank you.

Guai Zhang Ren, 20~29 year old female. Ask Date: 2017/01/24

Dr. Shi Guozheng reply Orthopedics

The wound has not yet healed, so it is necessary to continue treatment.
The current treatment from the second physician is reasonable; let's proceed with this approach.
If there is no improvement, we can discuss it further with the physician.

Reply Date: 2017/01/24

More Info

In your situation, it is understandable to feel confused and concerned about the differing approaches to wound care from the two doctors you encountered. Wound management, especially after an open injury like yours, can vary based on the individual assessment of the wound's healing progress and the specific protocols of the healthcare providers involved.

Understanding Wound Healing
Wound healing is a complex process that involves several stages: hemostasis, inflammation, proliferation, and remodeling. After an injury, the body initiates a healing response that includes the formation of new tissue (granulation tissue) and eventually the closure of the wound with new skin. The presence of yellowish tissue you mentioned is likely granulation tissue, which is a normal part of the healing process. However, the fact that your wound was still bleeding and had not fully closed suggests that it may not have been ready for the application of cosmetic adhesive or any occlusive dressing.

Differences in Treatment Approaches
1. Initial Treatment: The first doctor’s approach of applying a cosmetic adhesive after suturing and allowing for a two-week follow-up is common in cases where the wound appears to be healing well. Cosmetic adhesives can help protect the wound and minimize scarring once the skin has sufficiently healed.

2. Reassessment: The second doctor’s decision to remove the cosmetic adhesive and clean the wound indicates a more cautious approach, likely due to the observation of ongoing bleeding and the presence of yellow tissue. This suggests that the wound may still be in the inflammatory phase and not yet ready for occlusive dressings.

Recommended Care Moving Forward
Given the current state of your wound and the advice from the second doctor, it is advisable to follow their recommendations for daily dressing changes. Here are some general guidelines for wound care that may help:
- Keep the Wound Clean: Use saline or a mild antiseptic solution to clean the wound gently. Avoid using harsh chemicals unless prescribed.

- Apply Appropriate Dressings: After cleaning, apply a sterile dressing that allows the wound to breathe while protecting it from external contaminants. If the wound is still exuding fluid, a more absorbent dressing may be necessary.

- Monitor for Signs of Infection: Watch for increased redness, swelling, warmth, or discharge that has a foul odor. If any of these symptoms occur, seek medical attention promptly.

- Follow-Up Care: Continue to follow up with your healthcare provider as scheduled. If you have concerns about the healing process or if the wound does not seem to improve, do not hesitate to seek further evaluation.

Communication with Your Healthcare Providers
It is essential to communicate openly with your healthcare providers about your concerns. If you are worried about the differing opinions, you can mention this during your next visit. It is common for medical professionals to have varying approaches based on their experiences and the specifics of a case. They can discuss their rationale for their treatment choices and help you understand the best course of action for your recovery.

Conclusion
In summary, while it can be unsettling to receive different treatment recommendations, the key is to prioritize the healing of your wound based on the most current assessment. Follow the advice of the doctor who examined you most recently, and maintain open communication with your healthcare team. This will ensure that you receive the best possible care tailored to your individual healing process.

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