Skin Necrosis After Finger Wound Suturing: What to Do?

Skin necrosis after finger wound suturing?

Hello doctor, my index finger was cut by a machine while working, and the wound is quite deep.
I received 10 stitches and was given a tetanus shot and antibiotics after the injury.
Ten days later, when the stitches were removed, the doctor mentioned that poor blood circulation had caused some skin and tissue necrosis.
He prescribed a medication called (Winnacot) ointment for me to apply daily until the necrotic tissue falls off.
I have been applying the ointment every day (it's been almost two weeks since the stitches were removed).
Although some of the dead skin has already lifted and can be peeled off, there is still a large area of necrotic skin that is tightly adhered.
The necrotic skin appears white on the outside (which I assume is white on the inside).
Is this pus? Currently, there is no pain or itching, but it does hurt when I press on it.
Should I seek debridement treatment?

Xiao Wei, 20~29 year old female. Ask Date: 2018/01/16

Dr. Li Zhonghuai reply Surgery

Hello! If it's dry, just let it fall off naturally.
If you suspect there is pus inside, it's safer to return for a check-up.
Take care! Changhua Hospital cares about you!

Reply Date: 2018/01/16

More Info

When dealing with skin necrosis following a deep wound, especially after suturing, it is crucial to understand the underlying causes and appropriate management strategies. In your case, the necrosis appears to be a result of poor blood circulation, which can hinder the healing process and lead to tissue death. This is a common complication in deep wounds, particularly when there is significant trauma or when the blood supply is compromised.

Firstly, it is essential to clarify what necrotic tissue looks like. Typically, necrotic tissue may appear black, brown, or white, and it can feel firm or leathery. The white appearance you describe could indicate necrotic tissue or possibly a buildup of exudate, which can occur in wounds that are healing. If the tissue is soft and easily removable, it may just be slough, which is a type of dead tissue that can be removed as healing progresses. However, if the tissue is hard and adherent, it may require further intervention.

You mentioned that you are applying a topical ointment prescribed by your doctor, which is a good step in managing the necrosis. The ointment likely contains ingredients that promote healing and help to debride the necrotic tissue. It is important to continue this treatment as directed by your healthcare provider.

Regarding your question about whether you should undergo debridement, this decision should be made in consultation with your healthcare provider. If the necrotic tissue is extensive, adherent, or showing signs of infection (such as increased redness, warmth, swelling, or discharge), then surgical debridement may be necessary. This procedure involves the removal of dead or infected tissue to promote healing and prevent further complications.

In terms of pain, it is not uncommon to experience discomfort when pressure is applied to the area, especially if there is still necrotic tissue present. However, if the pain worsens or if you notice any signs of infection, such as fever or increased drainage, you should seek medical attention promptly.

Additionally, it is important to monitor the wound for any changes. If the necrotic tissue does not begin to slough off or if you notice any unusual symptoms, such as a foul odor or increased pain, you should return to your healthcare provider for further evaluation. They may perform a physical examination and possibly imaging studies to assess the extent of the necrosis and determine the best course of action.

In summary, while it is essential to continue your current treatment regimen, you should remain vigilant for any signs of complications. Regular follow-up with your healthcare provider is crucial to ensure proper healing and to address any concerns regarding necrotic tissue. If in doubt, do not hesitate to seek a second opinion or further evaluation to ensure that your finger heals properly and that you can return to your normal activities, such as playing the guitar.

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