Wound Care and Healing Time After Injury: A Guide

Wound issues?

Due to currently working in Vietnam and being unable to return to Taiwan because of the pandemic, I have some questions I would like to ask a physician regarding my injury.
The details of the injury are as follows: From September 14 to September 17, I was struck on the outer side of my right leg, approximately 3 cm above the ankle bone, by a hook strap that was ejected from a machine.
The impact caused my right calf to feel very numb and resulted in a somewhat deep laceration (attached image: https://ppt.cc/fuQkYx).
That day, I cleaned the wound with saline and disinfected it with Betadine.
The following day, the impacted area became swollen, and I sought medical attention locally where X-rays and an ultrasound were performed, confirming that there was no significant bone injury, but there was fluid accumulation subcutaneously (the translation issue did not clarify whether it was blood or tissue fluid).
The wound was disinfected and bandaged with Betadine, and no further treatment was performed.
By the end of that week, the wound appeared to have scabbed over, with a small, inconspicuous hole in the middle, and there was bruising on both the inner and outer sides of the foot.
The injured area was swollen but did not affect my ability to walk (attached image: https://ppt.cc/fptk6x).
Starting on September 27, I began to feel pain in my right ankle while walking (there was no pain when standing still or sitting).
After observing for two days, the pain intensified, and swelling occurred, prompting me to seek medical attention again on September 30 (attached image: https://ppt.cc/fkMmqx).
Blood tests showed a white blood cell count of 12.6 G/L, a MONO value of 0.07%, and an MPV of 9.0 FL.
An ultrasound examination revealed fluid accumulation around the wound (two ultrasound images: https://ppt.cc/fv7WUx).
The physician indicated that the pain was due to pressure from the fluid accumulation and prescribed a five-day course of oral medications (once in the morning and once at night): Clarithromycin 500 mg, Cefixime 200 mg, Acetaminophen 500 mg + Diphenhydramine HCL 25 mg (one capsule each time), and Chymotrypsin 4200 USP (two capsules each time).
After taking the medication, there was some improvement, but the right ankle remained slightly swollen, and the pain while walking persisted.
I sought medical attention again on October 5 (attached image: https://ppt.cc/foUF4x).
The ultrasound technician believed that the subcutaneous fluid needed to be drained, while the physician felt that the condition had improved and that incision and drainage would increase the risk of infection (two ultrasound images: https://ppt.cc/fhR9yx).
Another five-day course of oral medications was prescribed for observation: Levofloxacin 500 mg, Amoxicillin + Clavulanic acid 625 mg, and Chymotrypsin 4200 USP (one capsule each time, once in the morning and once at night).
After completing the medication on October 10, the pain while walking had not alleviated, prompting another visit to the doctor (attached image: https://ppt.cc/f99uYx).
Blood tests showed a white blood cell count of 10.2 G/L, a MONO value of 0.055%, and an MPV of 9.3 FL.
The physician noted that the ultrasound appeared to show a reduction in the size of the wound and that incision and drainage were not necessary (three ultrasound images: https://ppt.cc/fuBrhx).
However, the duration for the injury to heal remains uncertain.
Another five-day course of oral medications was prescribed (once in the morning and once at night): Esomeprazole 40 mg, Meloxicam 7.5 mg, Levofloxacin 250 mg, Acetaminophen 500 mg + Diphenhydramine HCL 25 mg (one capsule each time), and Chymotrypsin 4200 USP (two capsules each time).
I would like to ask Dr.
Li: Given that medical practices in Vietnam differ significantly from those in Taiwan and that consultations require translation, I am concerned about potential misunderstandings regarding the diagnosis.
Generally speaking, how long should it take for this type of injury to heal? Additionally, are there any specific considerations or recommendations regarding treatment methods, wound care, and medication usage? Thank you very much!

Angelina, 30~39 year old female. Ask Date: 2021/10/10

Dr. Li Zhonghuai reply Surgery

Hello! The principles for managing subcutaneous fluid accumulation and hematoma are as follows: if there is no surface wound, conservative treatment can be applied, and at most, a fine needle aspiration can be performed.
However, if there is an infection and necrosis at the wound site, debridement is necessary.
Since your wound is infected, it is recommended to perform debridement along with addressing the fluid accumulation.
Take care! Changhua Hospital cares about you!

Reply Date: 2021/10/10

More Info

Injuries like the one you've described can be quite complex, especially when they involve soft tissue damage and potential complications such as fluid accumulation. Based on your account, it seems you sustained a significant injury to your right leg, specifically around the ankle area, which has led to swelling, pain, and the formation of a wound.

Healing Time
Generally, the healing time for soft tissue injuries can vary significantly based on several factors, including the severity of the injury, the individual's overall health, and how well the wound is cared for. For minor wounds, healing can take anywhere from a few days to a couple of weeks. However, since you've mentioned complications such as swelling and fluid accumulation, it may take longer for complete recovery. In your case, given the presence of subcutaneous fluid (which could be either blood or serous fluid), it is essential to monitor the situation closely.
In many cases, if the fluid is not reabsorbed by the body, it may require drainage, especially if it is causing significant pain or pressure. The fact that your doctors have advised against drainage due to infection risk suggests they are weighing the benefits and risks carefully. If the pain persists or worsens, or if you notice any signs of infection (such as increased redness, warmth, or discharge from the wound), it would be prudent to seek further medical evaluation.

Wound Care
For wound care, here are some general guidelines:
1. Keep the Wound Clean: Continue to clean the wound gently with saline or mild soap and water. Avoid using harsh chemicals that can irritate the skin.

2. Dress the Wound: Use a sterile dressing to cover the wound. Change the dressing regularly, especially if it becomes wet or dirty.

3. Monitor for Infection: Watch for signs of infection, including increased pain, swelling, redness, or discharge. If any of these occur, seek medical attention promptly.

4. Avoid Strain: Limit activities that put strain on the injured area. Rest is crucial for healing.

5. Follow Medical Advice: Adhere to the medication regimen prescribed by your doctor. The antibiotics (Clarithromycin, Cefixime, Levofloxacin, etc.) are important to prevent or treat any potential infection.

Pain Management
Pain management is also a critical aspect of recovery. You mentioned being prescribed medications like Acetaminophen and Meloxicam, which are effective for managing pain and inflammation. Ensure you take these medications as directed. If you find that the pain is not adequately controlled, communicate this to your healthcare provider, as they may need to adjust your treatment plan.

Additional Recommendations
- Physical Therapy: Once the acute phase of your injury has passed, consider engaging in physical therapy. A physical therapist can help you regain strength and mobility in your ankle and leg, which is essential for a full recovery.

- Nutrition: Maintain a balanced diet rich in vitamins and minerals, particularly Vitamin C and Zinc, which are important for wound healing.

- Hydration: Stay well-hydrated, as this can help with overall recovery and fluid balance in your body.

Conclusion
In summary, while the healing time for your injury can vary, it is crucial to monitor your symptoms closely and maintain proper wound care. If you have any concerns about your recovery or if your symptoms worsen, do not hesitate to seek further medical advice. Your health and well-being are paramount, and ensuring you have the right support and treatment will aid in your recovery.

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