Why Is My Surgical Wound Not Healing Properly After Closure?

The wound has opened up and cannot be closed?

Hello: I had a lump in my breast and recently underwent a biopsy.
A week after returning home, the wound became infected, and I had to be hospitalized for a week.
During that time, I received daily antibiotic injections, had dressings changed, and had blood and fluid drained from the wound.
Eventually, the wound healed enough for me to be discharged.
The doctor prescribed Bacitracin Neomycin Ointment for daily dressing changes.
Upon my follow-up visit, the wound had completely healed, and the doctor said it was okay to get the area wet and to return to work.
However, on the first day back at work, I noticed the wound had reopened after I got home, even though it had previously closed.
I applied the Bacitracin Neomycin Ointment and used a hydrocolloid dressing, but the wound has not improved.
Now, a small piece of tissue is protruding from the wound (which is about 5-6 cm), and it won't close.
Occasionally, there is a small amount of white pus.
What should I do?

Xiao Yu, 20~29 year old female. Ask Date: 2007/06/26

Dr. Lin Kecheng reply Surgery

Dear Ms.
Hsiao-Yu,
Breast tissue is soft and highly elastic, with a rich blood supply.
Therefore, one of the most common complications after a breast biopsy is the formation of a hematoma at the incision site.
In such cases, the only solution is to reopen the wound, clean out the hematoma, and place a drainage gauze to allow the blood and fluid to drain out, which will facilitate healing.

If you are experiencing the current situation where a small piece of tissue is protruding from the wound and it cannot close properly, it may require local anesthesia to smooth out the poorly healing tissue, followed by a few stitches.
Applying a local antibiotic ointment and possibly artificial skin should resolve the issue.
Please do not worry too much.
Wishing you a speedy recovery.
Sincerely,
Dr.
Lin Ke-Cheng
Qishan Hospital

Reply Date: 2007/06/26

More Info

The issue of a surgical wound not healing properly can be quite concerning and is often multifactorial. In your case, it seems that you initially experienced inflammation and complications following a biopsy procedure, which required hospitalization and treatment with antibiotics. Despite the initial healing, the wound reopened after returning to work, leading to further complications.

There are several reasons why a surgical wound may not heal properly after closure:
1. Infection: One of the most common reasons for delayed wound healing is infection. Even if the wound appeared to be healing initially, the presence of white pus and the reopening of the wound suggest that there may still be an underlying infection. Bacteria can proliferate in the wound, leading to inflammation and preventing proper healing.

2. Tension on the Wound: If the wound is subjected to excessive tension or movement, it may reopen. This can happen if the wound is located in an area that experiences a lot of movement or if the patient resumes normal activities too soon after surgery.

3. Poor Blood Supply: Adequate blood flow is essential for wound healing. If the area has compromised blood supply due to various factors (such as previous surgeries, vascular issues, or even smoking), healing can be significantly delayed.

4. Underlying Health Conditions: Conditions such as diabetes, obesity, or autoimmune disorders can impair the body’s ability to heal wounds. These conditions can affect circulation, immune response, and overall healing processes.

5. Foreign Bodies: Sometimes, small fragments of tissue or foreign materials can remain in the wound, leading to chronic inflammation and preventing healing.

6. Wound Care: Proper wound care is crucial. While Bacitracin Neomycin Ointment is a common topical antibiotic, it may not be sufficient if there is an active infection. Additionally, the use of artificial skin or dressings should be done carefully to ensure they do not trap moisture and bacteria.

Given your situation, here are some recommendations:
1. Consult Your Surgeon: It is essential to return to your surgeon or a healthcare provider for a thorough evaluation of the wound. They may need to assess for signs of infection, foreign bodies, or other complications.

2. Wound Care: Follow the wound care instructions provided by your healthcare provider. If you notice any signs of infection (increased redness, swelling, warmth, or discharge), inform your doctor immediately.

3. Avoid Strain: Try to minimize movement and strain on the affected area. If your job involves physical activity, consider discussing with your employer about temporary modifications to your duties.

4. Antibiotics: If an infection is suspected, your doctor may prescribe a different antibiotic or additional treatments to address the infection effectively.

5. Nutrition and Health: Ensure you are eating a balanced diet rich in vitamins and minerals that support healing, such as vitamin C and zinc. Staying hydrated is also important.

6. Follow-Up Appointments: Keep all follow-up appointments with your healthcare provider to monitor the healing process and make necessary adjustments to your treatment plan.

In summary, wound healing can be complex, and it is crucial to address any complications promptly. Your healthcare provider will be the best resource to guide you through this process and ensure that your wound heals properly.

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