Post-Surgery Complications: Managing Wound Healing After Heart Surgery

Postoperative issues?

Hello Dr.
Lee,
First of all, I would like to thank this platform and the doctors for providing such a valuable service to the public for free.
I truly appreciate your efforts to help others.

My father underwent open-heart surgery in May due to his advanced age and multiple chronic conditions, including a history of stroke, diabetes, hypertension, and now heart disease.
He had a valve replacement surgery, and initially, his wound was healing better than expected.
However, in June and July, one of his sutured wounds developed a particularly large scab that eventually fell off.
The skin underneath appeared pink and tender, but just a couple of days later, it suddenly opened up, revealing a somewhat deep wound beneath the skin.

We applied a synthetic skin graft, as I had learned how to do this in the hospital.
During the dressing change, I used saline to clean the area, followed by iodine, and then rinsed it with saline again before applying a new synthetic skin graft.
We also made sure to show it to the doctor as soon as possible.
The doctor advised us not to remove the synthetic skin to check the wound, stating that elderly patients heal slowly and that my dressing change method was acceptable.
He instructed us to continue with the same approach unless there were any unusual signs.
Gradually, the wound seemed to be healing well, but recently, we noticed that there was sudden bleeding at a specific point near the sutures.
Since it is a subcutaneous bleed, we only see a deep red area, and it is difficult to determine the condition of the tissue beneath the skin.
Although it seems to be stopping, I am concerned because the bleeding appears to be spreading towards the sutures.

I would like to ask for your advice on what steps I should take next or if there is any additional information you need from me.
I have taken photos for documentation, but I am unable to attach them here.
Thank you very much, and I look forward to your response.
Thank you!

Miss Yang, 30~39 year old female. Ask Date: 2017/09/25

Dr. Li Zhonghuai reply Surgery

Hello! If the wound is deep, do not use artificial skin.
Moreover, since your father has multiple chronic diseases, it is advisable to see a general surgeon or a plastic surgeon as soon as possible to address the wound issue.
Take care! Changhua Hospital cares about you!

Reply Date: 2017/09/25

More Info

Post-surgery complications, particularly in the context of heart surgery, can be a significant concern, especially for elderly patients with multiple chronic conditions. Your father's situation, following his heart valve replacement surgery, raises several important points regarding wound healing and management.

Firstly, it is essential to understand that the healing process after heart surgery can be influenced by various factors, including age, underlying health conditions (such as diabetes and hypertension), and the body's overall ability to heal. In older patients, the healing process may be slower, and complications such as wound dehiscence (the reopening of a surgical wound) can occur. The fact that your father had a large scab that fell off and subsequently revealed a deeper wound suggests that there may have been some underlying issues with the healing process.

The appearance of a pink, tender area after the scab fell off is not uncommon, as this indicates new tissue formation. However, the sudden opening of the wound and subsequent bleeding is concerning. The presence of subcutaneous bleeding, which you described as a deep red area under the skin, suggests that there may be a hematoma (a localized collection of blood outside of blood vessels) or that the wound has not healed properly.

In managing this situation, it is crucial to monitor the wound closely. Here are some steps you can take:
1. Keep the Wound Clean and Dry: Continue to clean the wound as you have been doing, using saline and antiseptic solutions as recommended by your healthcare provider. Ensure that the area is kept dry to prevent infection.

2. Observe for Signs of Infection: Watch for any signs of infection, such as increased redness, swelling, warmth, or discharge from the wound. If any of these symptoms occur, it is essential to contact your healthcare provider immediately.

3. Control Bleeding: If the wound continues to bleed, apply gentle pressure with a clean cloth or bandage. If bleeding does not stop or worsens, seek medical attention promptly.

4. Follow-Up with Healthcare Providers: Since your father has multiple chronic conditions, it is vital to maintain regular follow-ups with his healthcare team. They may want to assess the wound more closely, possibly through imaging or a physical examination, to determine the extent of the issue.

5. Consider Nutritional Support: Proper nutrition plays a crucial role in wound healing. Ensure that your father is consuming a balanced diet rich in proteins, vitamins (especially Vitamin C and Vitamin A), and minerals (like zinc) that support healing.

6. Limit Physical Activity: Encourage your father to avoid strenuous activities that could strain the surgical site. Rest is crucial for healing.

7. Document Changes: Keep a record of any changes in the wound's appearance, size, or any symptoms your father experiences. This information can be valuable for healthcare providers during follow-up visits.

8. Seek Specialist Advice: If the situation does not improve or worsens, consider seeking a referral to a wound care specialist or a surgeon who can provide more targeted interventions.

In conclusion, while some degree of wound healing complications can occur after heart surgery, especially in older patients with chronic conditions, it is essential to remain vigilant and proactive in managing the situation. Regular communication with healthcare providers and adherence to wound care protocols will be key in ensuring your father's recovery progresses positively. If you have any further questions or concerns, do not hesitate to reach out to his medical team for guidance.

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