Managing Non-Healing Wound After Screw Loss in Neurosurgery Patients

After the appearance of serous fluid in the head, the screw fell out. The wound was cleaned with saline and Betadine, but serous fluid still appeared and the wound has not healed?

Twenty years ago, I had a car accident that required one surgery to perform a craniotomy to remove a blood clot and another surgery for cranioplasty.
In the past one to two years, I have noticed a yellow fluid-filled mass on my head.
I was unaware of any issues with my head; I only felt discomfort, so I would touch the yellow fluid-filled mass.
Recently, when I touched the mass, a small screw fell out.
I consulted a neurosurgeon, who informed me that an X-ray showed eight screws in place and that losing one screw would not pose a danger.
However, the doctor did not examine the site where the screw fell out, and I did not inform him that there had been a fluid accumulation at that site for one to two years.
The nurse also did not examine the site of the fallen screw; she only advised me to clean it with saline solution, then apply povidone-iodine, wait a minute, and clean it again with saline solution.
I followed these instructions, but the wound where the screw fell out has not healed, and it continues to produce a fluid-filled mass.
Could you please advise what medication I should apply to the wound to promote healing?

Miss Lin, 40~49 year old female. Ask Date: 2023/12/05

Dr. Zhang Junwei reply Neurosurgery

It doesn't matter what medication is applied; it's important to have a physician identify the underlying cause of the non-healing wound.

Reply Date: 2023/12/05

More Info

Managing a non-healing wound, especially after neurosurgery, can be quite complex and requires careful consideration of various factors. In your case, the history of a car accident followed by two surgeries—one for hematoma evacuation and another for cranioplasty—indicates that your scalp and underlying tissues may have been significantly affected. The presence of a yellowish fluid and the loss of a screw suggest that there may be an ongoing issue with wound healing or infection.

Firstly, it’s important to understand that the body’s ability to heal can be influenced by several factors, including age, overall health, nutritional status, and the presence of any underlying conditions such as diabetes or vascular diseases. In your case, the fact that you have had a non-healing wound for one to two years raises concerns about potential complications such as infection, foreign body reaction, or inadequate blood supply to the area.

When a screw or any foreign object is lost from the surgical site, it can lead to a chronic inflammatory response, which may manifest as the yellowish fluid you are experiencing. This fluid could be serous fluid, which is a normal part of the healing process, or it could indicate an infection or other complications. The fact that the wound has not healed despite regular cleaning with saline and iodine suggests that further intervention may be necessary.

Here are some steps you can take to manage the situation:
1. Consult a Specialist: It is crucial to follow up with a neurosurgeon or a wound care specialist who can assess the wound properly. They may need to perform imaging studies, such as an MRI or CT scan, to evaluate the underlying structures and determine if there are any remaining foreign bodies or complications.

2. Wound Care: While saline and iodine are common cleaning agents, they may not be sufficient for a chronic wound. A healthcare provider might recommend a more specialized wound care regimen, which could include:
- Debridement: This is the process of removing dead or infected tissue to promote healing.

- Topical Treatments: Depending on the assessment, your doctor may prescribe topical antibiotics if there is an infection or suggest advanced wound care products like hydrocolloid dressings, alginates, or even growth factor therapies to promote healing.

- Moisture Balance: Keeping the wound moist can facilitate healing, so consider discussing with your healthcare provider about appropriate dressings that maintain a moist environment.

3. Nutritional Support: Ensure you are consuming a balanced diet rich in proteins, vitamins (especially Vitamin C and Vitamin A), and minerals (like zinc) that are essential for wound healing. If necessary, consult a nutritionist for tailored advice.

4. Monitoring for Infection: Watch for signs of infection, such as increased redness, swelling, warmth, or discharge from the wound. If you notice any of these symptoms, seek medical attention promptly.

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

In conclusion, while the loss of a screw may not pose an immediate danger, the non-healing wound requires a thorough evaluation and possibly more aggressive treatment. It is essential to communicate openly with your healthcare team about your symptoms and concerns to ensure you receive the appropriate care for your condition.

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