Delayed Wound Healing After Surgery: When to Seek Further Medical Attention?

The wound has not healed two weeks after surgery?

Two weeks ago, I was involved in a car accident and sustained a tibial fracture, with some comminution of the adjacent small bone, and there was a puncture wound through the skin.
Surgery was performed on the day of the accident, where a plate and screws were placed.
Now, two weeks later, the sutures have been removed and the incision has healed, but the larger puncture wound still shows no signs of healing; it has only healed partially.
Currently, I am applying the antibiotic ointment prescribed at discharge and covering it with gauze.
After removing the gauze, I notice some yellowish exudate, and the gauze tends to stick to the wound, causing some scabs to come off with it.
I am very concerned that this might indicate an infection.
Should I wait until my next follow-up appointment to discuss this with my doctor, or should I schedule an appointment with a surgeon? The wound does not feel hot, but occasionally I experience slight stinging, and there is some bruising and swelling near the affected area.
I am worried about the possibility of an infection.
Should I bring this up with the orthopedic doctor at my next appointment, or should I see a surgeon before that?

A Bao, 20~29 year old female. Ask Date: 2020/10/11

Dr. Chen Bochen reply Orthopedics

1.
Comminuted fractures and open fractures typically have a slower healing process due to the nature of the wounds.

2.
If there are concerns about wound infection, it is advisable to change the dressings two to three times a day.

3.
If you feel that the wound is worsening, consult your original physician for an earlier follow-up appointment (you are not limited to the originally scheduled time).
Wishing you a speedy recovery!

Reply Date: 2020/10/11

More Info

Delayed wound healing after surgery can be a concerning issue, especially following a traumatic event like a car accident. In your case, it sounds like you have experienced a significant injury with a tibial fracture and a large puncture wound that has not fully healed even after two weeks post-surgery. Here’s a comprehensive overview of what you should consider regarding your situation.

Firstly, it is important to understand that wound healing is a complex process that can be influenced by various factors, including the type of injury, the extent of tissue damage, the presence of infection, and individual patient factors such as age, nutritional status, and underlying health conditions. In your case, the fact that the surgical site has been closed and the stitches have been removed is a positive sign, but the large puncture wound not healing completely raises some concerns.

The presence of yellowish discharge and some crusting at the wound site can indicate several things. It could be a normal part of the healing process, where the body is clearing out dead tissue and fluid. However, it can also be a sign of infection, especially if accompanied by symptoms such as increased redness, warmth, swelling, or a foul odor. The occasional sharp pain you experience could also be a sign of irritation or inflammation in the area.

Given that you are experiencing some bruising and swelling near the wound, it is crucial to monitor these symptoms closely. While some swelling can be expected after surgery, significant or worsening swelling, especially if it is accompanied by increased pain or changes in the color of the skin, could indicate complications such as hematoma formation or infection.

In terms of your next steps, it is advisable to err on the side of caution. If you have any concerns about the healing process or if you notice any worsening symptoms, it is best to seek medical attention sooner rather than later. You can either wait for your scheduled follow-up appointment or, if you feel anxious about the situation, you can make an appointment with a surgeon or a wound care specialist. They can assess the wound more thoroughly and determine if any additional interventions are needed, such as cleaning the wound, changing the dressing, or prescribing antibiotics if an infection is suspected.

In the meantime, continue to care for your wound as instructed. Keep the area clean and dry, and follow any specific instructions given by your healthcare provider regarding dressing changes and the use of topical medications like the one you mentioned (克菌寧). If you notice any signs of infection, such as fever, increased pain, or spreading redness, seek immediate medical attention.

In summary, while some delayed healing can be normal, it is essential to remain vigilant and proactive about your wound care. If you have any doubts or concerns, do not hesitate to reach out to your healthcare provider for guidance. Your health and recovery are paramount, and timely intervention can make a significant difference in the healing process.

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