Wound Healing: Is My Injury Normal or Concerning?

The wound resembles a volcanic crater?

Hello Doctor: I have a wound on my foot caused by a car accident.
At first, it was black, and the doctor said it was necrotic tissue.
I was prescribed a burn ointment (silver sulfadiazine).
After applying it, the black necrotic tissue gradually turned yellow and solid.
The doctor advised me to continue using the burn ointment, stating that the yellow necrotic tissue would slowly dissolve.
During my last follow-up, the doctor trimmed the scab next to the wound, and the next day, there was a red ring around the wound.
As the necrotic tissue shrank, the surrounding red area became larger and more raised.
It doesn't hurt much when pressed, and it resembles a volcano crater, but there is no pus.
I would like to know if this is a normal part of the healing process.
The wound has not healed after a month and a half, and I am worried it might develop into a keloid.
P.S.
I had surgery for an ankle fracture and external injuries on my foot, and I am being treated by an orthopedic doctor.

Hanhan, 20~29 year old female. Ask Date: 2015/07/27

Dr. Xu Kaixi reply Surgery

Based on your description, your wound is larger, deeper, and more severe, which is why it is healing more slowly; this is not unusual.
It is recommended that you return for regular check-ups and treatment.

Reply Date: 2015/07/27

More Info

Hello! Thank you for sharing your concerns regarding your wound healing process after your car accident. Based on your description, it sounds like you are experiencing a complex healing process, which is not uncommon after significant injuries such as fractures and soft tissue damage.

Initially, the presence of black necrotic tissue (often referred to as "dead tissue") is a sign that the body is responding to the injury. The treatment with silver sulfadiazine (the burn ointment you mentioned) is a common approach to manage burns and wounds with necrotic tissue. This medication helps to prevent infection and promotes healing by keeping the wound moist and facilitating the removal of dead tissue.

As the necrotic tissue begins to slough off and you observe yellow granulation tissue, this indicates that the wound is transitioning into the healing phase. Granulation tissue is a sign of healing and is composed of new connective tissue and blood vessels. However, the surrounding redness you are experiencing could be a normal part of the healing process, especially if it is not accompanied by increased pain, swelling, or discharge. The redness may indicate inflammation, which is a natural response as your body works to heal the area.

It's important to monitor the wound closely. If the redness continues to expand, becomes increasingly painful, or if you notice any signs of infection (such as increased warmth, swelling, or purulent discharge), it would be prudent to consult your healthcare provider immediately. The concern about "golden staph" (Staphylococcus aureus) or any other infection is valid, especially in wounds that are slow to heal.

Regarding your concern about the wound not healing after a month and a half, it is not uncommon for deeper wounds, especially those involving significant soft tissue damage and underlying structures, to take longer to heal. Factors such as blood supply to the area, the extent of the injury, and your overall health can influence healing times. In some cases, if the wound is not healing as expected, further interventions may be necessary, such as debridement (removal of non-viable tissue) or even surgical intervention to promote healing.

In terms of your anxiety about the healing process, it’s understandable to feel concerned, especially when dealing with visible injuries. Here are a few tips to help manage your anxiety:
1. Stay Informed: Understanding the healing process can help alleviate fears. Ask your healthcare provider to explain what you can expect during recovery.

2. Follow-Up Appointments: Regular check-ups with your doctor can provide reassurance and allow for timely interventions if needed.

3. Limit Self-Examination: While it’s natural to want to check your wound frequently, try to limit this to avoid unnecessary anxiety.
4. Focus on Recovery: Engage in activities that promote healing, such as proper nutrition, hydration, and following your doctor's advice regarding wound care.

5. Seek Support: Talking to friends, family, or a mental health professional can help you process your feelings and reduce anxiety.

In summary, while the healing process can be slow and sometimes concerning, it is essential to maintain communication with your healthcare provider and follow their recommendations closely. If you have any doubts or notice changes in your wound, do not hesitate to seek medical advice. Your health and peace of mind are paramount.

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