Managing Non-Healing Surgical Wounds: A Case Study

How to manage an unhealed surgical wound?

On March 7, I underwent surgery for facial lipomas, resulting in five incisions.
The sutures were removed on March 15.
The following day, during a dressing change, I noticed that one of the incisions, approximately 2 cm in size, had a portion measuring about 0.5 cm in length and 0.2 cm in width that had not healed.
It was not opened, and after reporting this to the clinic, the physician decided to excise the granulation tissue and re-suture the area, instructing me to return for suture removal in 14 days.
During this period, there were no signs of inflammation, and I was on oral antibiotics.
Daily dressing changes resulted in slight bleeding for about 7 days.
Upon suture removal after 14 days, the same area still had not healed, and the incision felt noticeably harder compared to the other wounds.
I am currently continuing with dressing changes.
Since there has been no bleeding or drainage, I have only changed the dressing once after suture removal, during which I cleaned away dried blood that had been trapped in the wound.
I am unsure whether I should go to the hospital to investigate the reasons for the poor wound healing.

Yan Liu, 40~49 year old female. Ask Date: 2022/04/04

Dr. Chen Ronghong reply Surgery

Hello, Yan Liu.
Among the five wounds, only one has poor healing, which is more likely due to a localized infection causing inflammation.
The contents of the cyst could potentially lead to a bacterial infection.
Please continue using the antibiotic ointment, avoid pulling on the skin around the wound, and monitor for any signs of redness, swelling, heat, or pain.
If the condition worsens, seek medical attention.
Other common causes of poor wound healing include diabetes or smoking, which are more likely to result in multiple wounds healing poorly, and are less consistent with the situation you described.

Reply Date: 2022/04/04

More Info

Managing non-healing surgical wounds can be a complex issue, often requiring a thorough understanding of the underlying causes and appropriate treatment strategies. In your case, after undergoing surgery for sebaceous cysts on March 7, you experienced delayed healing in one of the surgical sites, which has raised concerns about the effectiveness of the healing process.

Firstly, it is essential to understand that wound healing is a multifaceted biological process influenced by various factors, including the patient's overall health, the nature of the surgical procedure, and the care provided post-operatively. Factors that can contribute to non-healing wounds include infection, inadequate blood supply, underlying medical conditions (such as diabetes or vascular disease), and the presence of foreign bodies or necrotic tissue.

In your situation, the fact that the wound was not inflamed and you were on antibiotics suggests that infection may not be the primary concern. However, the presence of new tissue that did not heal properly could indicate several possibilities:
1. Granulation Tissue Formation: Sometimes, the body produces granulation tissue, which is a normal part of the healing process. However, if this tissue is excessive or improperly formed, it may not allow for proper closure of the wound.

2. Wound Tension: If the wound edges are under tension, this can impede healing. This is particularly relevant in areas of the body that experience movement or stretching, such as the face.

3. Underlying Conditions: Conditions such as diabetes, nutritional deficiencies, or circulatory issues can significantly affect wound healing. It would be prudent to assess whether any of these factors are present in your case.

4. Foreign Body Reaction: If there are remnants of the cyst or any foreign material left in the wound, this could provoke a chronic inflammatory response, preventing healing.

Given that you have already undergone a re-excision and the wound remains unhealed after 14 days, it is advisable to seek further evaluation from a healthcare professional. A thorough examination can help identify any underlying issues that may be contributing to the delayed healing. This may include imaging studies to rule out any foreign bodies or additional surgical intervention to ensure that the wound is clean and free of any necrotic tissue.

In terms of management, here are some strategies that may be considered:
- Wound Care: Continue regular dressing changes, ensuring that the wound is kept clean and moist. This can promote healing and prevent crusting, which can impede the healing process.

- Debridement: If there is any necrotic tissue or excessive granulation tissue, debridement may be necessary to promote healing.

- Advanced Therapies: Depending on the assessment, therapies such as negative pressure wound therapy (NPWT) or the use of growth factors may be considered to enhance healing.

- Nutritional Support: Ensuring adequate nutrition, particularly protein intake, can significantly impact wound healing. A diet rich in vitamins and minerals, especially vitamin C and zinc, is beneficial.

- Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor the healing process and make adjustments to the treatment plan as necessary.

In conclusion, while it is not uncommon for surgical wounds to experience delayed healing, persistent non-healing wounds warrant further investigation. Consulting with your healthcare provider will help determine the best course of action to promote healing and address any underlying issues.

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