Post-Car Accident: Managing Tibial Fracture and Slow Healing Wound

After the car accident, there is a tibial fracture, swelling in the right foot, and slow wound healing?

Dear Dr.
Lee,
On December 11, 2023, I was involved in a car accident where my right foot was crushed under the front wheel of an SUV for approximately three minutes.
This resulted in a fracture of the right tibia and contusions on the sole of my foot.
As of January 3, 2024, three weeks have passed, and while some of the swelling has subsided, there is still residual edema that is difficult to resolve.
The adjacent skin wound that has not healed is also slow to form a scab.
I have already consulted a dermatologist and have been taking the antibiotic Bactrim for a week, but the wound still struggles to heal and there is exudate present.
The surrounding skin also appears darker in color.
I would like to ask Dr.
Lee the following questions:
1.
Would you recommend seeing a plastic surgeon for the management of the swelling and the wound, or are there other further interventions that should be considered?
2.
The non-healing wound is located on the bottom of my heel, which comes into contact with my protective brace.
Could this friction be contributing to the difficulty in healing? Is it advisable to temporarily remove the brace while sleeping to prevent continuous friction and aid in the healing process?
Thank you very much for taking the time to address my concerns.

Mr. Wu, 30~39 year old female. Ask Date: 2024/01/04

Dr. Li Zhonghuai reply Surgery

Hello! Would you recommend seeing a plastic surgeon for the management of edema and wound care? Or should I consider other further treatments? Yes, first it is important to confirm whether the wound is infected and if there are any foreign bodies retained in the soft tissue.
Secondly, a non-healing wound located at the bottom of the heel may be in contact with the protective device, which could contribute to the difficulty in healing.
Is it possible to temporarily remove the protective device while sleeping to prevent continuous friction on the wound and aid in its healing? It is fine to remove the protective device while sleeping since the foot remains still.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2024/01/04

More Info

After a car accident, managing a tibial fracture and slow-healing wounds can be challenging and requires a comprehensive approach. Based on your description, it seems you are experiencing persistent swelling and delayed wound healing, which can be concerning. Here’s a detailed response to your questions, along with some additional insights into the healing process.

1. Should I consult a plastic surgeon for the swelling and wound healing issues?
Yes, consulting a plastic surgeon or a specialist in wound care could be beneficial. Plastic surgeons are trained to handle complex wounds and can provide advanced treatment options for non-healing wounds. They may assess the wound for any underlying issues such as infection, inadequate blood supply, or tissue necrosis that could be hindering the healing process. They might also suggest treatments like debridement (removal of dead tissue), skin grafting, or advanced wound care techniques that can promote healing.

2. Is the friction from the protective gear contributing to the wound's difficulty in healing?
Yes, friction from the protective gear can indeed impede the healing of your wound, especially if the wound is located on the heel where pressure and movement are common. Continuous contact with the protective gear can lead to irritation, which may exacerbate inflammation and delay healing.

Recommendations for Managing Swelling and Promoting Wound Healing:
- Elevation: Continue to elevate your leg as much as possible, especially when resting or sleeping. This helps reduce swelling by promoting venous return and minimizing fluid accumulation in the affected area.

- Compression: If recommended by your healthcare provider, using a compression bandage can help manage swelling. However, ensure that it is applied correctly to avoid restricting blood flow.

- Wound Care: Keep the wound clean and dry. Follow your healthcare provider's instructions regarding dressing changes. If the wound is oozing or showing signs of infection (increased redness, warmth, or pus), it’s crucial to seek medical attention promptly.

- Avoid Friction: If you find that the protective gear is causing friction, it may be advisable to remove it during sleep or at times when you can monitor the wound closely. However, ensure that you follow your doctor's advice regarding the use of protective gear to avoid compromising the fracture's stability.

- Nutrition: Adequate nutrition plays a vital role in wound healing. Ensure you are consuming a balanced diet rich in proteins, vitamins (especially Vitamin C and Vitamin A), and minerals (like zinc) that support tissue repair.

- Hydration: Staying well-hydrated can also aid in the healing process and help reduce swelling.

- Follow-Up Care: Regular follow-ups with your healthcare provider are essential. They can monitor your healing progress and make necessary adjustments to your treatment plan.

Conclusion
Healing from a tibial fracture and associated wounds can take time, and it’s not uncommon to experience complications such as swelling and delayed healing. By consulting with a plastic surgeon, managing friction from protective gear, and adhering to proper wound care practices, you can enhance your recovery process. Always communicate openly with your healthcare providers about any concerns or changes in your condition, as they can provide tailored advice and interventions based on your specific situation.

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