Post-Circumcision Complications: Managing Wound Dehiscence and Healing

Post-circumcision wound dehiscence?

About a week after the circumcision surgery, I noticed that one side of the sutures had opened up due to morning erections, resulting in approximately four stitches breaking and a wound opening measuring about 2x0.5 cm.
I returned to the doctor to ask if I needed to be re-stitched, but the doctor only provided more ointment and advised me to avoid pulling on it as much as possible.
However, it has now been two weeks, and while other areas have healed almost completely, the wound remains the same size at 2x0.5 cm with no signs of shrinking.
Sometimes, during morning or afternoon naps, I still inadvertently experience erections that pull on the wound.
I am concerned whether these morning erections and the associated tension will affect healing.
Should I go back and request the doctor to re-stitch it so that it can heal faster and reduce tension? Will not returning for stitches mean that the wound will never heal properly and increase the risk of infection?

C Nan, 30~39 year old female. Ask Date: 2010/04/25

Dr. Lai Ronghao reply Urology

Wounds that are sutured may heal faster; those that are not sutured may take a bit longer to heal.
However, it is unlikely that they will "never heal." If you are truly uncomfortable, please return to your original treating physician for a follow-up appointment.

Reply Date: 2010/04/25

More Info

Post-circumcision complications, particularly wound dehiscence, can be concerning for patients and their caregivers. In your case, it appears that you are experiencing a wound dehiscence where the stitches have come apart, leading to an open area of approximately 2x0.5 cm. This situation can be frustrating, especially when it seems that the wound is not healing as expected.

Firstly, it is important to understand that after a circumcision, the healing process can vary significantly from person to person. Factors such as blood supply to the area, the presence of infection, and mechanical stress (like the tension from erections) can all influence healing. In your case, the morning erections may indeed be contributing to the tension on the wound, which can hinder healing and potentially lead to further complications.

The fact that your doctor provided you with topical ointment and advised you to avoid pulling on the area suggests that they are taking a conservative approach to your treatment. However, if the wound has not shown any signs of improvement after two weeks, it may be prudent to seek further evaluation. Wound healing typically involves a gradual reduction in size and improvement in the appearance of the wound. If the wound remains unchanged, this could indicate that it is not healing properly.

You mentioned concerns about whether the wound will ever heal if it is not re-stitched. While many wounds can heal on their own, larger or more complex wounds may require surgical intervention to close properly. If the wound remains open, there is a risk of infection, which could complicate healing further. Additionally, if the wound is under constant tension due to erections, this could lead to a situation where the wound never fully closes, resulting in chronic issues.

It is advisable to return to your healthcare provider to discuss your concerns in detail. You should express your worries about the lack of healing and the potential impact of morning erections on the wound. Your provider may consider re-evaluating the wound and could recommend re-suturing if they believe it is necessary for proper healing.
In the meantime, here are some general tips for managing your situation:
1. Avoid Irritation: Try to minimize any activities that could irritate the area. This includes avoiding tight clothing that may rub against the wound.

2. Monitor for Infection: Keep an eye on the wound for any signs of infection, such as increased redness, swelling, warmth, or discharge. If you notice any of these symptoms, seek medical attention promptly.

3. Pain Management: If you experience pain, over-the-counter pain relievers may help, but consult your doctor before taking any medication.

4. Follow-Up Care: Regular follow-up with your healthcare provider is crucial. If your current doctor is not addressing your concerns adequately, consider seeking a second opinion from another urologist or surgeon who specializes in post-operative care.

5. Avoiding Erection Triggers: While it may be difficult to control, try to minimize any known triggers for erections, especially during the healing process.

In conclusion, while it is possible for your wound to heal on its own, the lack of improvement after two weeks is concerning. It is essential to communicate openly with your healthcare provider about your symptoms and concerns. They can provide the best guidance on whether further intervention is necessary to promote healing and prevent complications.

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