When to Switch from Dressings to Artificial Skin After Stitches?

When can the wound stop changing dressings and switch to artificial skin or silicone gel after suture removal?

Hello, I fell on June 25 and sustained a puncture wound to the anterior tibial muscle (mid-section) from the sharp edge of a brick.
I have one large and one small sutured wound, with the smaller requiring 3 stitches and the larger requiring 8 stitches, and the larger wound being deep enough to expose bone, necessitating two layers of sutures.
On July 7, both wounds had their stitches removed.
After the removal, there are three indentations on my calf.
The doctor mentioned that the wounds have closed but will still expel necrotic tissue (yellow discharge) and prescribed Fusidic Acid for home use.
It has been over a week since the stitches were removed, and I continue to change the dressing daily; there is still yellow discharge (which is not foul-smelling) when I lift the gauze.

1.
How long will it take for the yellow discharge from the indentations to completely resolve?
2.
When can I stop using the ointment, or should I continue applying it until it is finished?
3.
After the ointment is finished, can I stop changing the dressing and switch to using artificial skin or directly use a silicone adhesive strip?
4.
How long should I keep the silicone adhesive strip on?
5.
The doctor mentioned that my calf will definitely scar, but will the indentations smooth out over time?

Youyou, 20~29 year old female. Ask Date: 2020/07/16

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the wound has not fully healed; otherwise, there wouldn't be any discharge.
1.
Sometimes, deeper wounds can exhibit fat necrosis, and if the discharge consists of necrotic adipose tissue, it may persist for more than a month.
If it is just serous fluid from tissue edema, it usually improves within a week.
2.
The ointment should be applied until there is no discharge, at which point it can be discontinued.
3.
If there is no discharge from the wound, both treatments can be used.
4.
Six months.
5.
Depressed scars are generally difficult to flatten because they result from a loss of soft tissue beneath the epidermis.

Reply Date: 2020/07/16

More Info

After undergoing a surgical procedure, particularly one involving stitches, proper wound care is crucial for optimal healing and minimizing scarring. Based on your situation, where you have sustained a significant injury to your lower leg with stitches and are experiencing ongoing drainage from the wound, here are some insights and recommendations regarding your questions.

1. Duration of Yellow Discharge: The yellow discharge you are observing is likely a combination of serous fluid and necrotic tissue, which is common in the healing process, especially after deeper wounds. This discharge can persist for several days to weeks, depending on the extent of the injury and the body's healing response. Typically, as the wound heals, the amount of discharge should gradually decrease. If the discharge continues beyond two weeks or if it increases in volume or changes in odor, it is advisable to consult your healthcare provider to rule out any infection.

2. When to Stop Using Ointment: The use of topical antibiotics, such as Fusidic Acid, is generally recommended until the wound shows signs of complete healing, which includes the absence of drainage and the formation of new tissue. If your wound is still producing discharge, it may be beneficial to continue using the ointment until the discharge has ceased and the wound appears clean. Once the wound is fully closed and dry, you can discontinue the ointment.

3. Transitioning to Artificial Skin or Beauty Tape: Once the wound has healed sufficiently and there is no longer any drainage, you can consider transitioning to artificial skin or beauty tape. Artificial skin can provide a protective barrier and promote a moist healing environment, which is beneficial for scar management. If you choose to use beauty tape, ensure that the wound is completely dry and closed. It is advisable to consult your physician for personalized guidance on when to make this switch based on the specific condition of your wound.

4. Duration for Beauty Tape Application: The recommendation for using beauty tape can vary, but it is generally advised to apply it for at least 3 to 6 months post-injury to help minimize scarring. The tape should be changed regularly, and it is essential to monitor the skin for any signs of irritation or allergic reactions.

5. Scarring and Skin Texture: Scarring is a natural part of the healing process, especially with deeper wounds. While the appearance of scars can improve over time, the underlying tissue may not completely return to its original state. The use of silicone gel sheets, massage therapy, and other scar management techniques can help in softening and flattening scars. However, the degree to which the scar can be minimized will depend on various factors, including the depth of the injury, your skin type, and your body's healing response.

In summary, continue to monitor your wound closely, maintain proper hygiene, and follow your physician's recommendations regarding the use of topical treatments. If you have any concerns about the healing process or the appearance of your scar, do not hesitate to reach out to your healthcare provider for further evaluation and tailored advice. Remember, patience is key in the healing process, and with proper care, you can achieve the best possible outcome.

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